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—Cynthia “Mama” Green
by Sally James
A new parent in poverty has more health protection in Washington because of a bill signed on April 16 by Gov. Jay Inslee. Senate Bill 5068 extends coverage to new mothers for an entire year after their child’s birth if they are covered by the state’s Medicaid program, known as Apple Health.
At least one physician, Lillian Wu, M.D., told the Emerald in an email that her patient’s face lit up with relief when she heard about the bill’s passage. The patient has a condition, which will now be covered for longer. Wu is the president of the Washington Academy of Family Physicians and practices in Renton.
Before the bill became law last week, a new mother would lose her health coverage on day 61 after her baby was born. She received no health coverage for any problems that turned up later than the cutoff — for instance, if complications related to surgery developed if she delivered her baby by Cesarean section. She also received no coverage for serious mental issues, including postpartum depression or postpartum anxiety.
That has all changed with passage of the bill, which is designed to save lives by improving a mother’s access to health care of all sorts in that critical first year. Each year, roughly 40,000 pregnant women are covered by Medicaid in Washington state.
Molly Firth, who works as a consultant and advocate on maternal health issues and also teaches at the University of Washington School of Public Health, was one of the biggest advocates for this bill, in part because she almost died in childbirth five years ago. As a result she has a clear understanding of how much need exists for new moms. Firth talked to the Emerald about creating and advocating for the bill, which she began working on more than a year ago.
“I started asking everyone: Why are women dying after childbirth?” she recalled. Part of the reason is lack of insurance. The United States has the highest rate of maternal mortality of the top ten industrialized countries. In addition, perinatal mental health disorders are another factor, sometimes leading to suicide. And while the early days or hours following a difficult delivery are certainly high-risk, it’s not the only time a mother’s life can be in jeopardy. Medical conditions that can also seriously threaten a new mother’s health include gestational diabetes and preeclampsia, a serious complication that involves high blood pressure and damage to internal organs such as the kidneys and liver. Both require follow-up for more than 60 days.
Firth notes that a State study published in Oct. 2019 found the average number of days between a baby’s birth and their mother’s death from behavioral problems was 157 days. “I think it was very surprising to people … I don’t think people understood these behavioral health conditions and how they played a role [in maternal deaths],” Firth said. The new law could prevent those deaths, she said.
Though Firth was not on Medicaid when she had her difficult birth experience five years ago, the experience informed her decision to work to improve care for mothers who do depend on state aid.
Rokea Jones, who is a doula and a mother herself, testified at the legislature in favor of the bill. Jones works with mothers through Open Arms Perinatal Services, a nonprofit that provides low-income families with a variety of services. A majority of those families are People of Color. As a doula, Jones provides education and advice to families about birth and sometimes accompanies them to a hospital or birthing place to provide support during labor and delivery. Jones, who has a five-year-old daughter, is also getting her master’s degree in public administration.
In her testimony, Jones, who is Black, talked about how difficult the first year can be for any mother, and especially for a mother in financial need. She talked to the Emerald about the high risk of maternal death in Washington state for some mothers of color. A recent article in the Emerald told the story of a Black family’s experience of racist treatment during the birth of a child.
Indigenous women are at the highest risk in Washington, according to a 2019 report. These new mothers have six to seven times the risk of dying in the year after giving birth as white women, according to Abigail Echo-Hawk, who also testified in favor of the bill. Echo-Hawk, who works for the Seattle Indian Health Board, said she had suffered from postpartum depression in the past and received treatment. You can watch all the testimony on the bill on this TVW page.
Racism and attitudes about families of color within the system play a role in the quality of postpartum care for families. Jones explained that Women of Color who feel symptoms may be afraid to tell a pediatrician or other medical provider about their feelings because they worry about being judged, or even fear having a baby or child taken away by authorities from Child Protective Services.
“It is totally normal,” Jones says, for a new mother or family to feel overwhelmed at times after bringing a baby home. Poverty and illness can make that worse. But if families are also afraid of being judged by the system, they may not report important symptoms of physical or mental health problems.
One of the benefits of the new Medicaid extension is help with transportation for new mothers. Babies typically receive medical check-ups many times in the first weeks and months following birth, and each time a family has to travel for that appointment. Organizations such as the nonprofit Hopelink can now assist with providing that transportation for an entire year after a birth.
The pandemic is also making some women’s lives worse during pregnancy and after childbirth, according to testimony before the legislature. More women have reported increased stress and mental health problems than pre-pandemic.
Expanding this coverage has the potential to spare families from the grief of losing a parent. It’s a grief that has lifelong echoes and consequences for the children of that parent.
Wu, who works for the nonprofit community health centers HealthPoint and has delivered babies and cared for mothers and children for more than 20 years, told the Emerald: “A mother unable to access care for her physical or mental health issues will have a hard time meeting her child’s needs. … Children of birthing parents with mood and anxiety disorders have a higher risk of behavioral and developmental disorders. So extending medical coverage postpartum will definitely improve the health of new mothers and their families.” Firth pointed out that researchers have tried to calculate the financial “cost” to society of caring for a child who has lost his or her mother, in terms of repercussions on that child’s lifelong ability to prosper.
One study estimated that the “societal cost” of untreated maternal mental health conditions in Washington was $304 million. Firth said that when “looking at that mother-child dyad from birth until five years postpartum, nearly half or 45% of all those costs were child outcomes stemming from the fact that children whose parents have perinatal mood and anxiety disorders have a higher risk of behavioral and developmental disorders themselves.”
Sally James is a science writer in Seattle. You can read more of her work at www.seattlesciencewriter.com. She’s written about biotech, cancer research, and health literacy and volunteered as president of the nonprofit Northwest Science Writers Association.
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