TOPEKA — The birth of a child brings joy to families, but danger lurks in the shadows if mothers fall into postpartum depression that puts new infants at risk.
Prompt treatment can help the one in seven mothers experiencing symptoms such as excessive crying, difficulty bonding with the baby, withdrawal from family and friends, insomnia, severe anxiety, panic attacks, thoughts of harming a baby or recurrent thoughts of death or suicide. Consequences for mothers without access to counseling include hypertension, overdose, suicide and even cardiovascular disease.
The Kansas Legislature and Gov. Laura Kelly took a step toward alleviating this suffering with passage into law of Senate Bill 267 extending the state’s Medicaid postpartum coverage from the current 60 days following birth to 12 months. More than 30% of Kansas births are covered by Medicaid, or KanCare. Provisions of the law are expected to improve postpartum services of an estimated 9,000 Kansas mothers.
The reform was an option for states created by Congress under the federal American Rescue Plan Act. Illinois, New Jersey, Virginia and Louisiana are among states also adopting the extension that became available April 1 and would be on the books for five years. In Kansas, several legislative committees recommended adoption of the postpartum policy. The shift also was endorsed by 29 organizations in the state.
Salym Soderholm, a new mother who endured postpartum depression following birth of her second child, said the new state law would address the two-month ticking clock that cut mothers in Medicaid off from mental health services.
“My personal need for help with my postpartum depression wasn’t diagnosed until my first post-pregnancy checkup at six weeks, which would have left me with only two weeks of coverage under the existing traditional Medicaid rules,” she said.
Soderholm said she fell into survival mode rather than a place where she could engage in a healthy relationship with her new child. She was in denial about extent of her challenges. She opened up during her six-week appointment with health providers.
“I wasn’t gonna say anything at first. Then of course, I just, you know, started crying,” said Soderholm, who was promptly scheduled to meet with a therapist. “That alone, I felt so much relief, like just leaving the doctor’s office.”
In addition to broadening therapy for mothers, the extension of services could result in a higher rate of women seeking well-child visits and immunizations for their children.
Racial disparities
Sapphire Garcia-Lies, founder and president of Wichita Birth Justice Society, said the organization was created two years ago to address racial disparities of fatalities among mothers and infants. Infant mortality among Black babies in some areas of the state is three times higher than mortality of white children, she said.
“In the zip code where Wichita Birth Justice Society’s offices located 67214 in 2013, the Black infant mortality rate here in this neighborhood was among the highest in the nation. It has not changed much since then,” she said.
Garcia-Lies said she endured the tragedy of losing a child to an unnecessary death tied to medical negligence. She is convinced timely intervention with postpartum therapy would help mothers deal with mental health issues contributing to substance use disorders and other behaviors putting mother and child at risk.
She said incidence of postpartum depression was “extremely common” and often undiagnosed because mothers tend to internalize problems about not feeling well.
“There is a lack of resources in these neighborhoods that are hit worst. But I think it spans beyond poverty. In in our country as a whole, a Black woman with a PhD is actually more likely to die of childbirth than a white woman who doesn’t even have a GED. I think that that really speaks volumes. And, some of those deaths are by suicide. They’re a direct result of untreated postpartum depression,” Garcia-Lies said.
Heart disease, stroke
Kari Rinker, Kansas government relations director for the American Heart Association, said heart disease and stroke were the leading causes of death of pregnant women and of mothers during the first year following pregnancy.
“We all want babies to have the best possible start in life. Ensuring the expectant parent has access to care during pregnancy and for the first year after giving birth is essential for providing a healthy and successful start,” she said.
Kelly, the Democratic governor running for re-election, recommended in January the Legislature earmark $4.3 million in the state budget for the postpartum expansion under Medicaid. A bipartisan chorus of legislators supported the budget bill containing authorization and funding.
“It’s a huge victory for Kansas families,” she said. “We definitely will take this extension as a win. It was supported, regardless of party.”
She said the next step would be for the Legislature to expand general eligibility for Medicaid to an estimated 150,000 lower income Kansas under the Affordable Care Act. The governor has worked to convince the Legislature to embrace this piece of the ACA, but Republican leaders have blocked approval.
“We’ll just keep working towards that ultimate goal of KanCare expansion,” Rinker said.