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Guest opinion: Maternal mental health — An issue of protecting the health of Utah’s children

By Rachel Levy - Special to the Daily Herald | Mar 24, 2022

It is only my fifth month of being a pediatrics resident when I get called to a delivery as part of the newborn resuscitation team. The labor and delivery nurse presents the mother’s past medical history with the familiar words that seem to be a uniting theme of every resuscitation: “Mom suffers from depression/anxiety/chronic stress reaction.” The nurse gives me this information not because it helps me better understand the mother, but because these mental health conditions vastly affect the baby’s health and help me prepare for the resuscitation. If I have learned anything in my short time spent with laboring moms and newborn babies, it is that we are not talking enough and doing enough about the effect poor maternal mental health has on our children’s health in Utah.

As a health care system, we do not respect mental illness the same way we respect other, more tangible health conditions such as high blood pressure or diabetes. We recognize how diabetes and high blood pressure in pregnancy can adversely affect the baby, but what we don’t appreciate is how devastating mental illness can be to a child’s health. Mental health conditions during pregnancy are directly linked to increased risk of preterm birth, certain congenital anomalies and pregnancy complications. This link of mother and child health does not stop after pregnancy. Maternal mental health problems in the postpartum period increase the likelihood of school-age children experiencing delayed cognitive development. These poor health outcomes disproportionately affect those already historically marginalized by our health care system. Being Black alone has been identified as a significant risk factor associated with higher rates of preterm birth, fetal growth restriction and low birth weight. Moreover, mental health conditions are incredibly common, with 1 in 3 women in Utah experiencing depression and/or anxiety during or after pregnancy. Not only are these statistics horrible but they are adding an unnecessary financial burden to the already strained U.S. health care system. It costs our health care system about $32,000 per mother-infant pair when maternal mental health conditions go untreated.

Letting these maternal mental health conditions go untreated is malpractice on behalf of our medical community and our state’s government. A first step in a solution would be extending Medicaid coverage through 12 months postpartum, allowing for better access to services for prevention and treatment of postpartum depression and sets mothers up for success for future pregnancy outcomes. In the past when the Affordable Care Act expanded Medicaid coverage for longer postpartum periods, it successfully reduced preterm birth and lower birthweight outcomes for infants. There was a bill introduced into our state Legislature, HB 220 “Pregnancy and Postpartum Medicaid Coverage,” that would have accomplished this policy but failed to pass this year. Another area for improvement is simplifying how we deliver care to parents and babies, which both reduces health care costs and removes barriers to care. This may look like co-enrolling parent and baby into the same health care plan or could include clinic visits that include newborn and postpartum care in the same visit. Additionally, we need to be thoughtful in how we expand mental health services to include practitioners that look like and relate to the difficulties these women face. Finally, we need to reflect on the barriers we create as a system to access mental health services. Even at this inexperienced stage of my medical career, my fresh eyes and ears can recognize the lost opportunities to prevent illness at a fraction of the cost required for their treatment. Added to that obvious economic advantage of prevention is the additional benefit of circumventing the pain, suffering and long-term consequences of a neonatal illness.

Rachel Levy, M.D., is a pediatric resident physician in Salt Lake City. She can be reached via email at racheldanalevy@gmail.com.

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