Medicaid expansion and the baby connection
Imagine what it is like for a tiny baby to smile up at its mother and not get a smile back.
In recent years, doctors, nurses and researchers like myself have learned a lot about postpartum depression and how to identify women at risk. We know, for example, that it can affect as many as one in five mothers and that women under stress or who lack social support are particularly at risk.
I am enthusiastic about the progress we’ve made on screening, because postpartum depression can have long term consequences, not just for mothers and their partners, but for their babies. Babies of depressed mothers are at increased risk for developmental delays and behavioral problems if the depression goes untreated. Women with postpartum depression are also less likely to breastfeed, and more likely to wean early, eliminating the many health benefits that breastfeeding provides.
But what good is improved screening if the very women most at risk can’t afford treatment?
Medicaid currently helps low-income pregnant women get prenatal care and covers them through the delivery. However, the benefits end 60 days after birth – sometimes even before symptoms of postpartum depression have surfaced. And while these women may be able to see a health care provider for treatment perhaps once before their benefits end, they have no way to afford follow-up care.
I am currently researching a nursing intervention which may help women know when and how to seek help for postpartum depression. 240 women who delivered at Catholic Medical Center are participating and have answered questions about risk factors while in the hospital. At six weeks, three months and six months after the birth, we contact them again and screen them for depression symptoms.
One mother we assessed did not show signs of depression until we questioned her at the three-month mark. Since the birth of the baby, her partner had left her and she was alone in caring not only for the baby but her other children.
She had answered in the affirmative to statements like: “I’ve been anxious or worried for no reason,” or “Things have been getting to me and I’m struggling to cope.” When we saw these and similar responses on our questionnaire, I urged her to see a doctor and to seek out a diagnosis and treatment.
She told me she had no health insurance and couldn’t afford to go because her Medicaid benefits had ended.
She is not the only one.
As a researcher, I cannot provide women with treatment for depression but need to refer them to professionals who can help. As a maternity nurse involved in caring for women since 1979, it is unacceptable to me that a mother and child will suffer needlessly because they cannot access care.
Fortunately, we do have a solution. The federal government is offering to pay 100 percent of the benefits of providing care to adults and families under 138 percent of the federal poverty level for the next three years and never less than 90 percent in the years after that. That’s potentially life-changing health care for thousands of women and children in this state.
Extending Medicaid in cases like this makes too much sense to let the opportunity pass us by in New Hampshire.
Successful treatment can put mother and child back on the right track, helping them to bond and improving the likelihood the baby will be successfully breastfed.
New Hampshire lawmakers have an opportunity to make a real difference in the lives of women and children by accepting these federal funds – and I hope they will act as quickly as possible.
We can improve – and we are improving – our ability to identify women at risk of postpartum depression and to recommend treatment when needed. But what is that effort worth if they can’t afford to get help?
Help at the right time can make all the difference in the life of a new baby – a baby who smiles and whose mother has the support she needs to be able to smile back.
Deborah McCarter-Spaulding of New Boston is a registered nurse, women’s health nurse practitioner and Associate Professor of Nursing at St. Anselm College.