Experiences of Birthing Individuals Receiving Perinatal Behavioral Health Care in the Military Health System and Civilian Care With TRICARE Insurance

OBJECTIVE: To explore birthing individuals' experiences of mental health care in the Military Health System or through TRICARE insurance.

METHODS: We conducted a qualitative study. This was an IRB-approved protocol for individuals who delivered within the previous 5 years at military treatment facilities or with TRICARE insurance at civilian hospitals and were recruited for semi-structured qualitative interviews from February 2023 to June 2023. Interviews focused on participants' experiences of care during pregnancy, delivery, and the postpartum period. Purposive and snowball sampling was used to ensure diverse participation. Interviews were recorded and transcribed with deductive coding, and themes were identified until saturation was reached.

RESULTS: Thirty-one individuals completed interviews, with 12 main themes identified: importance of support from their obstetric clinician and colleagues, importance of mental health check-ins during pregnancy, challenges accessing care, feelings of dismissiveness regarding mental health needs, inadequate assessment of symptoms, curtailing of symptoms and situational stress, lack of postpartum care, waiting extended periods for postpartum visits, privacy concerns leading to the concealment of symptoms to avoid documentation, concern for the adverse effect on careers, and support from doulas and support groups postpartum. A common theme included the need to improve screening for depression and anxiety.

CONCLUSION: These results indicate varied perinatal mental health care experiences. Some individuals had supportive care, whereas others experienced delays and challenges accessing care despite having universal insurance. Opportunities to improve perinatal behavioral health care include timely access and expanding support programs.