Did You Know 84% Of Pregnancy Related Deaths Between ‘17-’19 Were Determined To Be Preventable?

One new mom – Candace, 30-years-old – goes to her 6-week postpartum appointment and fills out the generic postpartum depression screening being only partially honest about the extent of her feelings of hopelessness and thoughts of self harm - unsure of the implications being honest might have on her and her baby. Seemingly, to her OB, she looks as though she’s “passed the test” but she goes home and continues to suffer in silence for months as things worsen. At her daughter’s 6-month appointment, Candace is slightly more honest with her answers on the screen. The pediatrician hands her a list of mental health providers in the area but never follows up, and Candace can’t get an appointment for 3 weeks. Her symptoms are unlikely to resolve and she runs the risk of becoming part of the 23% of pregnancy related deaths linked to mental health.

Falling through the cracks of a broken health system during the pre- and postnatal period could have a lasting impact on a woman’s health. Untreated conditions during the pre- and postnatal period can lead to an increased chance of early mortality up to 50 years afte giving birth. A recent study tracking 46k women who gave birth between 1959 and 1966, or those within the 50-year window, found that preterm childbirth due to spontaneous labor was tied to a 7% increase in risk of death. Hypertensive disorders tied to pregnancy increased risk of death by 9% and gestational diabetes or high blood sugar during pregnancy increased risk of death by 14%. These conditions were shown to disproportionally impact black women compared to white women. There’s been effort put into securing Medicaid coverage for women postpartum – especially over the last year – but gaps still exist in funding to elevate how we screen for mental health conditions during the prenatal period and how we follow-up on both mental and physical health conditions created or exacerbated by pregnancy and postpartum.

Policy reform and reimbursement models must prioritize both pre- and postnatal maternal care.

Maternity bundles were the first step in doing this, but our survey of OBs and Medicaid MCOs acknowledge they are narrowly focused and not innovative as payment is tied to delivering “standard” clinical practices like achieving a low rate of cesarean births and high rates of HIV or Group B strep screenings. Most of these bundles do not yet promote innovation or reform how maternity care is being delivered, and many still don’t include the time and investment in depression screening and follow-up for moms and families, and often don’t yet incentivize lowering maternal mortality.