This commentary is written by Sandra Wood of Richmond, a nurse practitioner specializing in nurse midwifery and mental health psychiatric nursing. She has been working at the UVM Medical Center since 1994.
When the Vermont legislature returns this week, I will ask it to consider why 60 days of postpartum medical coverage under Medicaid is not enough to keep women healthy, reduce deaths and cut costs.
For the past 28 years, I have worked with our Vermont communities as a Certified Nurse Midwife and most recently as a Psychiatric Nurse Practitioner specializing in pregnancy and postpartum mental health. In various roles, I have walked the path with thousands of our pregnant and postpartum clients as they and their families go through pregnancy and the transition to parenthood.
Pregnancy and parenthood can be a wonder and a blessing, but it is a very powerful stressor and can lead to significant complications. Not having insurance soon after baby arrives shouldn’t make this stress worse.
Medicaid plays an important role in improving maternal and perinatal outcomes. Timely and adequate antenatal care is undoubtedly essential for the well-being of the deliverer and the child.
This may be the first time that a pregnant person has been fully engaged in the medical system. This can be a time when underlying conditions are diagnosed or new challenges arise. One of the most common complications of pregnancy is mood disorders and anxiety. Up to one in five people may suffer from mood or anxiety disorders during pregnancy and / or the first year postpartum.
Psychiatric disorders affect the well-being of our children and families and are risk factors for maternal drug addiction and suicide.
The current 60-day coverage, which coincides with the classic postpartum visit, is just sufficient to ensure physical recovery after childbirth and family planning. However, this time frame is insufficient to address follow-up medical or behavioral health problems that are discovered, exacerbated, or that are a consequence of pregnancy.
Additionally, new parents are often so busy navigating the transition to parenthood in the first 60 days that they may postpone their own care during this time. Access to medical follow-up during the first postpartum year would allow treatment of chronic and pregnancy-related health problems, such as diabetes and hypertension; mental health condition, including depression and anxiety; and substance use disorders.
Pregnant women in Vermont need comprehensive health services before, during, and after pregnancy to make sure they are healthy and ready for parental responsibility.
Reducing maternal mortality is a public health priority. Continuous postpartum coverage for 12 months is essential to help meet this priority. The Centers for Disease Control and Prevention reports that one-third of pregnancy-related deaths occur a week to a year after pregnancy ends.
In Illinois, 56% of pregnancy-related deaths occurred between 43 and 364 days. Recently, the American College of Obstetricians and Gynecologists reported that more than half of pregnancy-related deaths occur during the postpartum period; 12 percent after the six week postpartum visit up to a year. In Colorado, 30 percent of pregnancy-related deaths were the result of self-harm, suicide, or overdose. In California, after obstetric problems as the leading cause, drug-related deaths and suicide accounted for 18% of deaths.
About three in five pregnancy-related deaths are preventable, including suicide and drug-related deaths. Extending this coverage for a full year gives our families the support they need to be successful, giving postpartum people the time they need to deal with health issues such as depression and anxiety, substance use and pregnancy-related health issues, and is an important health equity tool to positively impact communities of color.
Maternal mortality has been a growing health crisis in the United States for decades. Black women are particularly at risk. They are three to four times more likely to die from a pregnancy-related complication than non-Hispanic white women.
For every person who dies from pregnancy-related causes, another 70 suffer from a serious physical illness or disability, including behavioral health issues, at a rate twice as common for black people who give birth.
The American Rescue Plan Act gives states a new option to extend Medicaid postpartum coverage to 12 months. Act as follows:
- Reduce maternal complications from chronic diseases such as heart disease, hypertension and diabetes.
- Improve treatment of maternal drug addiction and maternal mental health complications.
- Decrease maternal mortality rates, including suicide and overdose deaths.
- Enable new postpartum people to acquire health care for themselves that will give them a better opportunity to provide the best care to their infants as well.
Uniform coverage improves the well-being of a new parent. Studies show that one in three birth attendants experiences an interruption in coverage before, during or after pregnancy.
When coverage expires or they lose and regain coverage over short periods of time, the disruption results in adverse consequences such as delays in early identification or resolution of health problems, discontinuation of medications and treatments, even death. We can and must prevent this.