Why Do We Care More About New Babies Than New Moms?

It’s an important question, and before you yell “Because adorable innocent baby, DUH,” I’m not talking about why we take more pictures of babies or why we all want to touch babies or why we turn into singing, cooing weirdos around babies.

I’m talking about healthcare.

These are the well-check appointments a new baby receives (at no out-of-pocket cost, with insurance):

• 2 weeks
• 2 months
• 4 months
• 6 months
• 9 months
• 12 months
• 15 months
• 18 months
• 2 years.

Few could argue that this many well-checks is not appropriate. Everything changes so quickly in those first months of baby’s life. My daughter’s pediatrician will spend 10-15 minutes asking me everything about her–what her interests are, her sleep habits, her eating habits. And I understand why–the baby can’t speak for herself. These well checks are critical times for early health practices and prevention.

In stark contrast, these are the well-checks a new mom receives:

• 6 weeks postpartum

And that’s if she’s lucky, and they can even manage to get her in. In my case, my ob/gyn was so booked solid, they couldn’t book me until 12 weeks postpartum, and they had to categorize my appointment as “annual physical/pap smear” so they could get me in then. I didn’t get to see any of the doctors or midwives who’d actually participated in the birth. In fact, the nurse practitioner had no clue I’d even given birth at all. She asked if I was currently sexually active, and I ran from the room screaming (figuratively).

This I don’t understand. A woman’s body changes at least as rapidly as her baby’s following birth, yet no one thought that checking in on that process every few weeks would be beneficial in preventing serious health issues? I realize we mothers can speak for ourselves, and we can make doctors appointments if we need them. We can clearly communicate our problems to a healthcare practitioner.

Or can we?

I consulted a group of 23 moms with toddlers from all over the country. I asked them whether they’d had the time, energy, and capacity of mind to schedule and attend all the doctor’s appointments they thought they needed for themselves in the months following birth. The response: 43% said they got some help but not as much as they needed, and 30% said they didn’t have the time or energy to make any appointments for themselves.

Even if they had been able to schedule appointments, there’s no guarantee anyone would have known how to proceed in caring for a patient who’s recently given birth. There is no specialty that specifically addresses postpartum healthcare–no medical field that recognizes issues that are most likely to occur post-birth. The fact that I had recently given birth became a horrible, frustrating curse that every doctor used as a fallback excuse when they couldn’t figure out what was wrong with me.

Our healthcare system is failing new mothers.

Of course, babies need all the concern we can muster, but a mother’s health is critical to her baby’s. Why would we not be equally, if not more concerned for the health of mothers after birth?

And I’m not only talking about the immediate six weeks following birth, though those are a beast, for sure. I’m talking about a whole two years following birth. Or hell, how about a lifetime following birth? The much-touted 6-8 week recovery is a joke–a woman’s body is never the same once she’s given birth. Pregnancy changes our bodies in ways scientists are only just beginning to grasp. There are hormonal changes during and after pregnancy that can cause long-term affects to the immune system, resulting in diseases with postpartum onset, that are often dismissed as “normal” or something that “will get better with time.”

These hormonal changes are mind-boggling. Postpartum depression, a serious condition that wouldn’t be hard to diagnose with a proper screening, is something that affects up to 1 in 5 women, yet only 15% of women who experience symptoms seek treatment. How could that be?

There are no postpartum well-checks.

And because there are no well-checks, there simply isn’t a clear path for how to seek help. My ob/gyn told me to seek help with my family doctor. My family doctor told me to seek help with a psychologist. The next available appointment to see a psychologist that participated in my insurance was six months later. That may as well be six years in new baby time. Symptoms of depression are exacerbated by sleepless nights, a crying baby, and the unbelievable amount of stress brought on by new responsibilities and changing hormones. Hearing that no one can help for six months is enough to make anyone spiral downward into dangerous territory.

Only 10 states in the US have centers for intensive perinatal psych treatment. In May 2016, the Centers for Medicare and Medicaid Services issued an informational bulletin emphasizing how important it was to screen early for maternal depression. They allowed state agencies to cover maternal depression screening as part of a well-child visit. After all, maternal depression absolutely affects the child’s health, right? Apparently not, because as of the publication date, only 13 state Medicaid programs were providing coverage for one of these screenings.

What can we do?

Bless my birth center, they tried. They sent me home with a folder 2 inches thick full of resources that I could use post-birth. I had the energy to read exactly none of it. I had no presence of mind to research, and no brain power to figure out what was wrong with me. I needed someone else to be proactive when I couldn’t be.

Here are some actions we can take now to help mothers receive better postpartum care:

• Tell your child’s pediatrician that, as of Jan 1, 2017, there is a Current Procedural Terminology (CPT) code of 69161 for the administration of a caregiver-focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument. In plain english, this means a standardized maternal health assessment can be performed at a baby’s well check and be billed under the child’s name.
• Tell your ob/gyn to advise pregnant mothers to establish with a psychologist during pregnancy, so they have someone to call if they need immediate postpartum care
• Reach out to your state’s policy-makers to advocate for postpartum well care and health screening coverage and payment.
• Reach out to your state’s Medicaid program about a plan that advises physicians on maternal screening tools, billing help, and options for referrals.
• Join a state medical or specialty society or a parent or family advocacy group in your state to support increased access to maternal health screenings.
• Be aware of existing community resources for maternal health before giving birth.

If you have thoughts of harming yourself and/or your baby, call the National Suicide Hotline at 1-800-273-TALK (1-800-273-8255), 911, or other emergency services right away.

Sources

American Academy of Pediatrics: Maternal Depression Screening: Medicaid and EPSDT Coverage

AAP News: CPT Code Changes for Health Risk Assessments Take Effect Jan 1

Naturopathic Currents: The Postpartum Period – Incidence and Risk Factors of Autoimmune Diseases

Postpartum Progress: The Statistics

Postpartum Support International: Intensive Perinatal Psych Treatment in the US