Improving Postpartum Care for Healthy Moms & Babies

The health of postpartum mothers is an important issue for Kentuckians. In 2018, the latest year with available data, the national maternal mortality rate was 17.4 deaths per 100,000 live births; Comparatively, Kentucky’s maternal mortality rate was 40.8 per 100,000. The mortality rate for Black Kentuckians is even higher, at 42.1 maternal deaths, versus 17.2 maternal deaths for White Kentuckians. In an effort to address this issue, HB174** extends the Medicaid benefits for postpartum mothers, whose current coverage ends at sixty days, to twelve months after the birth of their child. Kentucky Voices for Health has vocally advocated for this legislation as a measure that would help to improve the health of postpartum mothers.

13.9% of Kentucky’s postpartum mothers experience Postpartum Depression (PPD). The national rate is 13.4%.

Further, the United Health Foundation reports that 13.9% of Kentucky’s postpartum mothers experience Postpartum Depression (PPD). The national rate is 13.4%. We know that the mental and physical health of mothers has a direct impact on the health of their children, so 

Kentucky Voices for Health has also been supportive of SB95, which would require providers to provide postpartum mothers and their families with additional education, and postpartum assessment tools to screen for depression or other mental health changes. Ideally, to align with clinical policy, being sure the law encompasses “perinatal mood disorders” would be a valuable addition, as opposed to only postpartum depression, but unfortunately SB95 does not include more thorough clarification yet as written.

While the research and data are extremely important, and we believe they should be guiding factors in policy-making, there are other reasons why the passing of HB174 and SB95 is important to us at KVH. As Kentuckians, and as mothers, postpartum health is an issue that is personal to us.

Today, Holly Hudnall is the Storybanking Coordinator at KVH. But in 2012, she was beginning her last year of graduate school as a graduate assistant with a small stipend. She felt extremely fortunate to receive a scholarship that paid for her student health insurance. 

And then, Holly found out she was pregnant.

She was thrilled to be a mom. But Holly’s student health insurance had no maternity benefits, and because her pregnancy was high-risk, the student health clinic would not treat her for any condition while she was pregnant. So, she applied for, and received Medicaid. 

“My beautiful and healthy daughter was born in March of 2013 via C-section. Three weeks later, I took my final exams, and five weeks later, I walked in my graduation line, ending my student health insurance coverage. Three weeks after that, my Medicaid coverage ended as well.” 

“I was a new graduate looking for work, a new mother, and completely uninsured. During my pregnancy, I was treated for severe sleep apnea, gestational diabetes, and hypertension; after birth, I had a lingering complication with my C-section incision, and needed to make sure the gestational diabetes and hypertension resolved. I would have had to pay out-of-pocket to continue to follow up on these conditions.”

So, she didn’t follow up. 

“I was scared to add medical debt to my student loan debt, so I went without any follow up for almost a year, until I was able to get insurance coverage. As it was, It took me a year to pay off the portion of my CPAP supplies that were charged to me after my coverage ended.  Eventually, I did pay physically for foregoing follow-up treatment after my delivery. Four years after my daughter was born, I required surgery to repair the issue related to my C-section incision, and I am now on daily medications related to my blood sugar.”

“I know, from experience, new moms need to follow up beyond sixty days. I know that not doing it can have long-term consequences. And I know that other moms will be in the same situation that I was if this expansion isn’t enacted.

Holly Hudnall, KVH Storybanking Coordinator

Holly says that her story isn’t unique, and that’s what makes it unfortunate. “I advocate for the expansion of postpartum coverage, not just because it’s part of my job to advocate, but because it is personal to me. I know, from experience, new moms need to follow up beyond sixty days. I know that not doing it can have long-term consequences. And I know that other moms will be in the same situation that I was, if this expansion isn’t enacted.”

The issue of continued postpartum care is also important to another of our team members. Christina Libby, Health Outreach Navigator with KVH, has testified before legislators on the importance of passing SB95 and HB174 because she understands the impact of postpartum health on Kentuckians . She shared her experience after the birth of her second child in 2019 in testimony before the legislature. “We couldn’t afford for me to be off work long but I was lucky enough to know a friend who was hiring for an office job which could have more predictable hours, more flexibility and logistics for pumping, and also health insurance. 

Christina continued, “I was so grateful to have health coverage in my postpartum to cover not only my amazing midwife, who saw me through multiple bouts of mastitis, and my PCP as I developed a double ear infection in the first weeks of my new job before the health coverage became effective, but also my mental healthcare as I experienced severe Postpartum Depression.”

“Perinatal Mood Disorders are sneaky. It is not just postpartum. It is not just depression. Mental health issues are not one and done doctors’ appointments.”

Christina Libby, KVH & HHCK Health Outreach Navigator

Christina’s pregnancy-related mental health issues began in her first trimester. She testified for SB95, “Perinatal Mood Disorders are sneaky. It is not just postpartum. It is not just depression.” She was able to receive treatment for the condition early, but as she says, “…Mental health issues are not one and done doctors appointments.” 

She pointed out, “Because Postpartum Depression and all Perinatal Mood Disorders are conditions that are ideally treated through ongoing therapy and, when appropriate, mental health medications, the decision to stop any treatment should be made according to the client’s progress, not their insurance coverage.  

Christina’s testimony speaks to both the importance of providers addressing Postpartum Depression and other Perinatal Mood Disorders in a timely manner, and also the importance of making sure that coverage is extended to new mothers beyond the current 60-day window.  “…The effect on the children raised by healthy, functioning mothers would have a ripple effect throughout the Commonwealth.”

KVH is proud to advocate for the healthcare of all Kentuckians, not only because we have made advocacy our careers, but because we, too, are personally affected by these issues. Sharing stories–ours with you, yours with us–helps folks understand that behind every statistical fact and piece of data is a family who has struggled. Please, contact your legislators and ask them to vote in favor of HB174 and SB95 to support Kentucky moms and their families.

**As of Day 58 of 60 for the 2022 Regular Session, the original 12-month postpartum Medicaid provisions of HB174 have been added as a friendly amendment to SB178, which is poised for hopeful final passage. HB174 has multiple amendments attached to it currently, some of which are far from the original intent of the bill, complicating its path for final passage. Stay tuned!