After Texas passes the heartbeat bill limiting abortion access, Representative Rose hopes to prove Texans care about women and children after pregnancy ends.

Dallas Representative Toni Rose sponsored House Bill 133. She proposed extending Medicaid benefits to low-income women after they have a baby. Rose told The Austin Statesman, “For the past few years, I’ve heard from families across the state who have lost loved ones due to complications of childbirth. Believe me when I say that this issue knows no political or geographical boundaries.”

Under current guidelines, pregnant people qualify for Medicaid for sixty days after delivery. During the Covid-19 pandemic, Texas extended postpartum Medicaid coverage for one year. Some women qualify for a Healthy Texas Women program that provides contraception access and basic primary care coverage.

House Bill 133 is titled “Relating to the provision of certain benefits under Medicaid and the Healthy Texas Women program, including the transition of case management for children and pregnant women program services and Healthy Texas Women program services to a managed care program.”

The bill would allow pregnant people who qualify for Medicaid to continue their health coverage for twelve months after having a baby. The bill passed the Texas House in bipartisan fashion 121-24. The Texas Senate amended the bill reducing the coverage from twelve to six months. The Texas Medical Association is lobbying to extend health coverage back to one year.

Preexisting medical conditions cause many pregnancy complications. To address preexisting conditions, patients need access to medical providers. Primary care, Obgyn, and specialist care before, during, and after pregnancy reduce the risk of maternal deaths.

Many Americans access the US Health system through the Medicaid program. Medicaid covers almost half of the births in our country. In Texas, 54% of pregnant women qualify for Medicaid. But many states, like Texas, chose not to expand Medicaid under the provisions of the Affordable Care Act.

Federal law dictates states must provide prenatal coverage through the Medicaid program. Pregnant women with family incomes up to 138% of the federal poverty level qualify for mandatory prenatal coverage.

Medicaid coverage does not begin until the pregnant woman completes the pregnancy verification process. For many women, this process is slow and arduous. Federally mandated prenatal coverage also ends sixty days postpartum.

In Texas, we provide Medicaid AFTER patients get pregnant and take it away when they deliver. Women gain temporary access to the US health system once they become pregnant and lose access once they deliver their baby. Health providers lose many opportunities to address health needs and prevent complications.

Pregnant people qualify for free health coverage through Medicaid for Pregnant Women, which makes Medicaid available during pregnancy and for two months after birth if they fall under certain monthly income thresholds based on family size ($2,126 or less for a single woman or $3,624 for a family of three).

But to qualify after the two-month postpartum period, the income threshold is significantly lower: $196 a month for a mother with one child or $230 for a mother with two children ($285 a month for a two-parent household with two children).

The maternal mortality rate in Texas is above the national average. According to 2018 data from the U.S. Centers for Disease Control and Prevention, the estimated maternal mortality rate (women who died while pregnant or within 42 days of delivery) was 17.4 deaths per 100,000 live births. In Texas, the maternal mortality rate was 18.5 deaths — that’s nearly 700 deaths nationally and about 70 in Texas each year.

Black and other women of color are two to three times more likely to die from pregnancy-related causes than white women. This risk increases with age. For women over the age of 30, the risk of dying during or after pregnancy is the risk dying before or after pregnancy is four to five times higher than white women.

The 2010 Affordable Care Act (ACA) increased coverage in our country, but millions of Americans are still without health insurance.

The lack of access to high-quality, affordable healthcare increases poor health outcomes and widens the racial disparities.

Why do pregnant women die?

1. Cardiomyopathy and another cardiac disease
2. Thrombotic pulmonary embolism
3. Preeclampsia and hypertensive disorders of pregnancy
4. Hemorrhage
5. Cerebrovascular accidents (strokes)
6. Infections

Representative Toni Rose proposed House Bill 133 to bridge the gap, ensuring Texas provides care for pregnant people after they give birth. This legislation will save lives.

Representative Toni Rose is serving her fourth term in the Texas House of Representatives. District 10 covers the diverse communities of Oak Cliff, Highland Hills, Pleasant Grove, Balch Springs, and Mesquite.

Representative Rose was born and raised in Dallas. Her passions are mental health, social justice, and criminal justice. Her biography states she works on legislation to help “mental health reform, access to affordable healthcare, improving the quality of life for our aging population and underserved communities.”

Mental health access is a key component of her legislation. One in seven women suffers from postpartum depression. Perinatal mood and anxiety disorders can occur anytime from conception to one year after the delivery of a baby.

Perinatal depression is darker and debilitating. A mom feels unable to function for an extended period. Women need access to mental health care to address their needs when certain symptoms are present.

Postpartum depression symptoms include crying spells, feeling sad, feelings of hopelessness, and feeling guilty. Some may express a lack of happiness or feel the absence of bonding with the baby. Some may have feelings of hurt themselves or their baby. All of these symptoms indicate it is time to seek medical attention.

A study written by Mathematica in collaboration with St. David’s Foundation and Texans Care for Children examined the economic impact on Texas for failing to provide postpartum mental health care. Texas loses 2.2 billion dollars each year by not providing access to care for people after having a baby.

HB 133 is an opportunity for Texas to show we care about pregnant during and after delivery. A bipartisan group of Dallas leaders in the Texas House of representatives is working together on prison reform. Let’s hope more leaders come together to support Representative Rose’s common-sense legislation to save tax-payer money and save the lives of new Texas mothers.

The post Dallas Representative Toni Rose Fighting for Medicaid Extension for Women After Having a Baby appeared first on Medika Life.

AHRQ, a branch of the U.S. Department of Health and Human Services, issued a challenge during the summer of 2020 for hospitals to present evidence-based plans to address the needs of women and families after having a baby. Helena’s St. Peter’s Health and Birmingham, Alabama’s Pack Health were the winners of a $50,000 award for their innovations.

St. Peter’s team implemented universal screening programs to identify at-risk mothers. The hospital screened patients for risk factors such as alcohol, substance use, depression, and anxiety. The health team connected patients and families with community resources.

Birmingham’s Pack Health program leveraged a digital health platform to connect new mothers to coaches and health advisors.

Photo: kieferpix Istock/Getty Images

Postpartum depression is an inaccurate term. Perinatal mood and anxiety disorders can occur anytime after conception up to one year after delivering a baby. One in seven women suffers from a mood disorder related to pregnancy and childbirth.

Risk Factors for Perinatal Mood Disorders include:

• Stressful live events.
• Low social support.
• Previous history of depression.
• Family history of depression.
• Difficulty getting pregnant.
• Being a mom to multiples, like twins, or triplets.
• Being a teen mom.
• Preterm (before 37 weeks) labor and delivery.
• Pregnancy and birth complications.
• Having a baby who has been hospitalized.

Perinatal depression can be dark and debilitating, leaving mothers unable to function or adequately care for themself or their baby. Symptoms vary from person to person but include crying spells, sadness, hopelessness, and guilty. Some may express a lack of happiness or feel the absence of bonding with the baby. Some may have thoughts of self-harm or of hurting the baby.

Shame, guilt, and feelings of inadequacy prevent moms from reaching out for help. Moms fear judgment. They wonder “what is wrong with me” for not feeling blissful over the birth of their child. They fear their family will judge them. Others fear they may lose their baby if they express their true feelings out loud.

Some moms have intrusive thoughts causing fear and anxiety. Negative thoughts do not necessarily equal behavior. Help is available to manage these thoughts.

These symptoms indicate a new mom requires medical attention. The first step in treating perinatal mood disorders is recognizing the problem. Patients are often relunctant to share these feelings. Health providers may not be comfortable in screening for peripartum mood disorders.

Treatment options vary from person to person. Some women may only need to expand their social support network. Others benefit from group or individualized therapy. Pharmaceutical interventions may be needed for others.

The Agency for Healthcare Research and Quality recognized the increased challenges facing postpartum mental health care in the rural setting. Access to care, cost, transportation, and internet access all create barriers to identifying and treating those at risk for perinatal mood disorders.

The federal agency’s mission is “to make health care safer, higher quality, more accessible, equitable, and affordable,” The stated goals are to “keep patients safe, help doctors and nurses improve quality, and to develop data to track changes in the health care system.”

The AHRQ competition brought together digital health and other nontraditional health partners to find unique and innovative solutions to help rural families receive the help they need. Perinatal depression and anxiety universal screening programs for perinatal depression and anxiety along with patient and provider education programs help these women come out of the shadows.

Women need to know they should never feel ashamed to speak up about postpartum depression. These award-winning programs help patients and doctors learn to ask the right questions to get the help they deserve. 

The post Helena Hospital Awarded $50,000 for Helping Women with Postpartum Mental Health appeared first on Medika Life.

Motherhood is not for the weak at heart. And anyone who tells you differently is either lying or delusional. Every stage of motherhood will come with a variety of ailments, concerns, and risks. This is part and parcel of becoming a parent.

Your obstetric and pediatric providers have seen it all and will be your biggest champions in educating you on the normal changes in your body. But there are some physical and mental changes that need more than a little extra TLC from your healthcare provider. Below are a few examples of how motherhood can make you sick.

Mood Disorders

One in three adults will experience a mood disorder in their lifetime, and Covid based research suggests women are predominantly more prone to depression, anxiety, and post-traumatic stress disorder. As many as 1 in 5 women will experience mood disturbances during or after pregnancy. However common mood disorders are, they are surprisingly unreported by women for a variety of reasons.

Common complaints of women suffering from mood disorders:

1.Unable to perform activities of daily living

2. Ongoing sad, empty, hopeless, or helpless feelings

3. Irritability, anxiety, quick to anger, or restlessness

4. Loss of appetite or overeating

5. Insomnia or oversleeping

6. Physical pain that does not respond to treatment

Left untreated, mood disorders can lead to thoughts of self-harm, harming others, or suicide. ALWAYS tell your provider if your behaviors or thoughts have changed since pregnancy. There are several medications and non-pharmacological interventions that can help, but the first step is to seek help. In addition to medication and/or counseling, women can consider exercise, sunlight, building support systems, and decreasing sugar and high-fat foods.

Irregular Periods

Menstrual cycles can take several months to return to normal, or your cycle could be significantly different. It is not uncommon for women to have increased cycle lengths, increased cramps, and irregular bleeding. In addition, women may not ovulate or bleed at all while strictly breastfeeding.

It is important to remember that ANY time you have unprotected sex during the postpartum period, you can become pregnant. Especially if your cycles have not returned to normal and you cannot track them using regular methods. Consider a barrier method in the postpartum period to prevent a surprise pregnancy.

Clots larger than a golf ball, foul vaginal odor, or soaking through more than one pad an hour are never normal in the postpartum period. Talk to your healthcare provider if any of these occur to rule out infection or postpartum hemorrhage.

Hair Loss (Telogen Effluvium)

Listen…postpartum hair loss is no joke. Women often say they feel like they are going bald. Major hair loss occurs after childbirth or a miscarriage. This is due to the hair cycle returning to the pre-pregnancy hair loss phase and is completely normal. But major hair loss can be a symptom of other health conditions and should be discussed with your healthcare provider if accompanied by other symptoms.

Low thyroid levels: Hair loss, unexplained weight gain, brittle/dry skin and nails, constipation, fatigue, depression, sensitivity to cold, and muscle aches or cramps.

Iron-deficiency anemia: Hair loss, extreme fatigue or lethargy, headaches, weakness, difficulty concentrating, shortness of breath with activity, and cold hands or feet.

Less common conditions include nutritional deficiencies, birth control pills or implants, immunodeficiency conditions, hereditary hair loss, and/or over-styling.

If you haven’t already noticed, these symptoms are vague and can occur at any point during or after pregnancy. When the symptoms do not improve or negatively impact your life, you need to report them to your provider.

This list is not all-inclusive, and pre-existing medical conditions and/or medications can alter the “normal” changes associated with the postpartum period. Make sure you discuss anticipated postpartum changes with your healthcare provider so you know what is abnormal for you.

This article was contributed by MacArthur Medical Center’s Certified Nurse Midwife Jen Rockhold.

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US maternal morbidity and mortality are now a hot topic. Physicians and nurse leaders across the country are focused. Few are talking about the disparity in care and attention to maternal mental health. I saw an opportunity to make a difference.

A nurse on a mission

When I started this journey to address the mental health of the moms in our community, a well-respected physician with deep roots in community service told me I was asking the right questions but did not have the answers. He said, “you can’t fix a problem until you understand it.” He was right!

The disconnect between obstetric care and behavioral health specialists was rampant. The availability of resources to the uninsured and those on Medicaid was limited and poorly organized. One in seven women suffers from postpartum depression. Almost half go undiagnosed and untreated. We could no longer offer excuses for ignoring this issue.

With a team of nurses and physician supporters, we set out to build a program to identify women at risk for mood and anxiety disorders in the perinatal period. While still a work in progress, we have an excellent basis for families to get the help they need.

We want women to know that they are not alone.

Help is available to get them through the dark.

Postpartum depression can occur anytime

Postpartum depression is a misnomer. Perinatal mood and anxiety disorders can occur anytime from conception to one year after the delivery of a baby. These disorders are quite distinct from the baby blues.

The Baby blues are a common issue occurring in 50–80% of women and peaks between postpartum days 2–14. The baby blues are related to fluctuating hormones and lack of sleep. Although new moms are concerned when they openly sob at a TV commercial, baby blues will resolve without treatment.

Perinatal depression is much darker and debilitating. A mom feels unable to function for an extended period. Women need to know that when certain symptoms are present, it is time to talk to someone.

These include: crying spells, feeling sad, feelings of hopelessness, and feeling guilty. Some may express a lack of happiness or feel the absence of bonding with the baby. Some may have feelings of hurt yourself or your baby. All of these symptoms indicate it is time to seek medical attention.

Help is here. You are not alone.

Moms negative thoughts prevent the help she needs

Shame, guilt, and feelings of inadequacy prevent moms from reaching out for help. Moms fear judgment. They wonder “what is wrong with me” for not feeling blissful over the birth of their child. They fear their family will judge them. Others fear they may lose their baby if they express their true feelings out loud.

Some moms have intrusive thoughts. She becomes afraid of them. She needs to know that negative thoughts do not necessarily equal behavior. Help is available to manage these thoughts.

We want moms to know we want to take care of her. We want to see her with a happy, healthy family. Our goal is to help her succeed. We do not want women to be afraid to speak out and ask for help. We should be as comfortable talking about depression and anxiety disorders as we are about other pregnancy complications such as gestational diabetes or pre-eclampsia.

Moms life is at stake

Suicide is the leading cause of death of new mothers in the first year postpartum. Infants of mothers suffering from perinatal depression are at increased risk for impaired development, poor communication skills, and future mental health problems. Perinatal depression is not a woman’s problem. It is a family problem. Everyone suffers. We must help women feel safe to come forward and get the help they deserve. Every life matters.

Depression is just the tip of the iceberg

Perinatal anxiety is another important aspect of mental health for new moms. Anxiety is something we have historically written off as “normal” for a parent. Most moms worry over their children, their husbands, and their homes.

However, for those with an anxiety disorder, worry becomes consuming and all-encompassing. Panic attacks may be frequent, leaving mom to feel she has no control.

Panic attacks can be terrifying because of the physical symptoms that occur, racing heart, sweating, chills, and chest pain. These symptoms lead to a constant sense of doom or failure.

Post Traumatic Stress Disorder can occur after delivery

A woman can experience Post Traumatic Stress Disorder after having a baby. This concept surprises some.

After all, no one’s been to war or been attacked by a stranger. PTSD is real for these mothers and their families. Childbirth does not always go according to plan. The birth may not live up to the expected birth plan she had imagined. The beautiful delivery experience may have turned tragic or life-threatening?

Emotional and mental turmoil is real for a mom who almost died from postpartum hemorrhage or the dad who almost lost his wife.

There is hope for those suffering

Moms and their families need to know that they will get better with help. The type of help needed may be different for everyone. Many benefit from a no-judgment zone support group where a group of moms can get together and talk. Others may benefit from medications to help control symptoms.

Whatever help looks like, the first step is reaching out and communicating your feelings. Available resources include mom groups on social media and in-person counselors, psychiatrists, and community resources for help with job searches, food, and clothing.

You are a priority for us

We are raising the bar and setting high expectations for moms. We hope other hospitals and medical groups will also follow this path.

Implement universal screening programs for perinatal depression and anxiety. Provide education programs to nurses and community physicians.

Provide education during routine prenatal care. Build community support groups through social media. Remove the fear. Help these women come out of the shadows.

Let women suffering from perinatal mood disorders know it is safe to seek the help they deserve.

The post Never Feel Ashamed or Afraid to Speak up About Postpartum Depression appeared first on Medika Life.

She was a nurse. I worked with her daily. She was my friend and also my patient. Happily married. Perfect pregnancy. Easy delivery.

How did I not recognize she was suffering from postpartum depression?

She could not get out of bed. Although madly in love with her baby, dark and dangerous thoughts filled her head. Each day she forced herself out of bed. She cried daily. The stress of hiding her depression from her husband was tearing her marriage apart.

One year later, she confessed. During her annual exam, she revealed all that she had been through. Struggling in silence. Sharing with no one. She was miserable.

I am the doctor she trusted. Once I knew of her illness, she got better. Why did I not catch it sooner?

I didn’t ask. She didn’t say.

I’m sorry.

A teen mother

She was a 17 years old child. She and her newborn lived with her mother and mom’s four other children. She grew up without a father. The father of the baby was long gone. Her house was full of family, but she was living all alone.

Four years later, she is pregnant again. She shares with me her fear of having postpartum depression again. She cried as she explained the terrifying thoughts of hurting her baby that flooded her mind after her delivery. She loved her baby. She asked what was wrong with her for thinking this way.

All the risk factors for postpartum depression were right there in front of me four years ago. How did I miss it?

I didn’t ask. She didn’t say.

I’m sorry.

A high-level executive

She was a senior vice president of a large tech company. After years of infertility treatment, she and her husband got pregnant. Always the overachiever, she was not pregnant with one baby. She had twins. During her six-week postpartum visit, she told me she was getting divorced. I was surprised. On the surface, they seemed like the perfect couple. Was postpartum depression a factor?

I didn’t ask. She didn’t say.

I’m sorry.

Depression has many faces

One patient’s husband had an affair. Another struggled with her teenager’s rebellion. One lost her job for not showing up for work. Another couldn’t pay her bills. Another repeatedly came to the office for various vague abdominal pains.

I didn’t ask. They didn’t say.

I’m sorry.

Postpartum depression is real

One in seven women suffers from postpartum depression. I had been treating it throughout my career. I caught the easy cases. I helped them, and they got better.

The world of women’s health has started paying more attention to the 4th trimester. I realized I was missing the harder to spot cases. I had overlooked the subtle clues that were there along. I had underestimated the efforts patients would take to hide their mood disorder. Shame, fear of being judged, and embarrassment forced those suffering from postpartum depression to hide alone in the dark.

We implemented universal screening

We added universal screening for postpartum depression to our office protocol. The Edinburgh Postnatal Depression Scale (EPDS).

Ten questions. Five min.

This simple tool made it safe to step into the light. Each patient fills out a simple questionnaire. The score is not diagnostic, but the questions open a window and an opportunity for dialogue. The tool triggers me to ask the right questions. Five min can change someone’s life.

My eyes are now open to the prevalence of postpartum depression and the subtle ways people hide it. It also revealed to me that these cases were there all along.

They wanted to talk, and I wanted to listen.

I just didn’t ask, and they didn’t say.

A new approach

Universal screening opened a window and shed light on postpartum depression. I have changed my approach. I am asking the right questions. Now we are talking. Patients are speaking up.

I asked. You answered.

I’m so thankful.

You are not alone.

Never be afraid to talk about postpartum depression.

The post Better Care is Needed for Postpartum Depression appeared first on Medika Life.