Pennsylvania Hospitals Work to Improve Screening for Perinatal Depression
According to a 2018 study published by the National Institute of Health, although perinatal depression is quite common, 80 percent of women who experience symptoms of depression and anxiety during a pregnancy or postpartum do not report these feelings to a healthcare provider. The Pennsylvania Department of Human Services (DHS) is working with 16 hospitals to enhance screening process for perinatal depression using a framework established by Pennsylvania’s Perinatal Quality Collaborative (PQC), a partnership led by DHS and the Jewish Healthcare Foundation, focused on improving identification and care for patients experiencing perinatal depression during or after pregnancy.
DHS recently highlighted its partnership with UPMC Magee-Womens Hospital in Pittsburgh to facilitate its work to improve screenings, follow-up, and use of treatment for perinatal depression as well as expanding use of doulas in pursuit of greater equity in perinatal care.
"Pregnancy and the postpartum period are times of great joy and great change. With this change can come stress, fear, and anxiety that can fuel feelings of depression and isolation and invasive thoughts. Alarmingly, nearly 60 percent of pregnancy-associated deaths happen between 42 days and one year after giving birth. Pennsylvania mothers deserve more, which is why DHS is taking a close look at maternal health practices,” said Meg Snead, acting DHS secretary, in a statement. “Our healthcare systems and providers must be partners and advocates in mothers’ health and well-being. The department is proud to be working closely with hospitals to develop and embed better perinatal depression screening, follow-up, and treatment practices as an important step to make this a foundational part of prenatal and postpartum care, and I am very grateful to UPMC Magee for its partnership and leadership in this space. Moms, babies, and their entire families deserve more, and this is our opportunity to do better.”
Disparities in rates of perinatal depression fall similarly to other health disparities, with lower income women and women of color reporting a higher prevalence of depression during and after pregnancy. Left untreated, perinatal depression can seriously impact daily and long-term health and wellbeing for mothers, can influence child development, and can lead to major depressive disorder and, potentially, death.
From 2018 to 2020, DHS, in partnership with the Jewish Healthcare Foundation, participated in the Center for Law and Social Policy’s multi-state Moving on Maternal Depression (MOMD) initiative. The goal of this work was to bring together policymakers and nonprofits to share experiences and form best practices to identify and increase use of treatment for perinatal depression, understand potential gaps and disparities, and, ultimately, establish a recommended framework to better support parents and children affected by perinatal depression.
Black women in the United States have a higher rate of pregnancy-related complications and death than other women. Through the support of the MOMD project, UPMC Magee has made progress in closing this gap by developing educational initiatives and programming, including:
- Doulas: UPMC Magee is actively growing its robust and diverse doula program. Doula care is vital for patient advocacy and trust building for at-risk women.
- UPMC Equity Now: UPMC Magee launched UPMC Equity Now, which is the voice for UPMC Black and Brown women’s healthcare providers. The dedicated group of UPMC employees is committed to decreasing maternal morbidity and mortality for racially and ethnically diverse patients through thoughtful advocacy campaigns.
- Perinatal depression and mood disorder screenings: UPMC instituted compassionate and comprehensive screening for perinatal depression and mood disorders at its 15 birthing sites and at UPMC pediatric offices. The advanced screening tool will consistency screen for mood disorders throughout pregnancy and the postpartum period.
“UPMC is committed to eliminating racism, bias and inequalities in maternal healthcare,” explained Richard Beigi, M.D., president of UPMC Magee, in a statement. “We are proud to partner with Pennsylvania’s Department of Human Services as we develop and implement our innovative programming, research and clinical work to better understand why these disparities exist and address them head on.”
The administration of Gov. Tom Wolf recently announced that Pennsylvania will opt-in to extended postpartum coverage for birthing parents covered through Medicaid due to their pregnancy. Under the American Rescue Plan Act, states are able to extend the Medicaid postpartum coverage period from just 60 days to one year after giving birth. Data on maternal mortality rates in the United States in 2018 and 2019 show a growing trend of maternal deaths that is particularly concentrated among Black women as compared to Latinx and White women.
Expanding postpartum coverage for mothers covered through Medicaid will provide continuity and access to healthcare through a critical period in the mother’s life and a foundational time for the health and well-being of their children, DHS said. The postpartum expansion will be available to states to take effect in April 2022. Currently, individuals are not being disenrolled from Medicaid due to the federal public health emergency declaration. A formal declaration of intent to expand the postpartum coverage period will be submitted to the federal government once guidance is issued to states from the Centers for Medicare and Medicaid Services.
