Extending postpartum Medicaid in Missouri removes barriers — and it will save lives | Opinion
As the chair-elect of Missouri’s Pregnancy-Associated Mortality Review Board, I strongly believe in the motto coined by current Board Chair Karen Florio: The state of Missouri has the opportunity to go from “worst to first” as we work tirelessly to review how and why moms lose their lives when trying to give life to another human.
Many know Missouri is currently 44th in the U.S. in maternal mortality. More than half of all maternal deaths are after six weeks postpartum, underscoring the reality that after a child is born, our country’s health care system leaves those who give birth to fend for themselves with minimal bridges to care outside of pregnancy.
Legislation that grants 12 months of postpartum coverage to those who give birth has been proven to remove barriers to health care and will no doubt save lives. Those who have made reducing maternal mortality our life’s work are incredibly excited by this legislation that was passed with bipartisan support from the Missouri General Assembly and the governor.
In Missouri, maternal deaths are largely caused by mental health disorders and cardiovascular diseases. Most pregnancy-related deaths from these conditions were preventable. This is huge. This is sad. We must do better.
When looking at mental health conditions as the cause of death, substance use disorder was the cause 58% of the time in data from 2017 to 2019, while depression and other mood disorders were the cause at least 41% of the time, with 12% related to suicide.
While cardiovascular disease encompasses several conditions, the most common reasons for our system’s failures included financial constraints, incomplete or inappropriate assessments, and continuity of care. Postpartum extension of health coverage directly affects these failures, since most cardiovascular deaths and mental health deaths occur postpartum, especially after 60 days.
Pregnancy can be scary, traumatizing
Extending the length of Medicaid postpartum coverage will allow health optimization in multiple ways. With an adverse pregnancy outcome such as gestational diabetes, clinicians can meet with the patient between pregnancies after their routine postpartum visit to address the complication and investigate and educate on risk factors that can be modified before a subsequent pregnancy. It is often necessary to screen or start treatment before a patient’s first prenatal appointment and sometimes even before a mother knows she is pregnant.
In many cases, pregnancy can be scary and even traumatizing. Extended coverage allows health care providers to address any mental health concerns that may result from a pregnancy complication, preventing negative seeds from taking root and blossoming into mood disorders or even post-traumatic stress disorder related to a birth experience.
We at University Health in the UMKC Health Sciences District have made it our mission to knock out maternal mortality. How have we been successful? One example is that University Health has one of the only maternal health teams in the region where obstetricians and obstetric clinicians work in the same clinics with perinatal psychiatrists and psychologists trained in perinatal mood disorders, trauma-informed care and substance use disorders. We do behavioral health very well. We know that mental health is health. We see it affect all patients and all walks of life: affluent, single, married and cohabitating, those with commercial insurance and those with public health insurance. Mental health is not only substance-use disorders. Post-COVID-19, many more suffer from both diagnosed and undiagnosed mental health disorders. With this new legislation, we will provide even more care to those at highest risk.
As someone who has the honor of being the first to greet new people in the world, I am grateful for this change that will help keep the lives of their mothers healthy in Missouri.