California bill would require new moms to get screenings
SAN FRANCISCO — Lawmakers in California will begin debate next month on a bill that would require doctors to screen new moms for mental health problems — once while they’re pregnant and again after they give birth.
But many obstetricians and pediatricians bristle at the idea, saying they are afraid to screen new moms for depression and anxiety.
“What are you going to do with those people who screen positive?” said Dr. Laura Sirott, an OB-GYN who practices in Pasadena. “Some providers have nowhere to send them.”
Nationally, depression affects up to 1 in 7 women during or after pregnancy, according to the American Psychological Association.
And of women who screen positive for the condition, 78 percent don’t get mental health treatment, according to a 2015 research review published in the journal Obstetrics & Gynecology.
Sirott said her patients give a range of reasons why they don’t take her up on a referral to a psychologist: “’Oh, they don’t take my insurance.’ Or ‘my insurance pays for three visits.’ ‘I can’t take time off work to go to those visits.’ ‘It’s a three-month wait to get in to that person.’”
She said it’s also hard to find a psychiatrist who is trained in the complexities of prescribing medications to pregnant or breastfeeding women, and who is willing to treat them, especially in rural areas.
“So it’s very frustrating,” Sirott said, “to ask patients about a problem and then not have any way to solve that problem.”
Moms are frustrated, too. After the baby comes, no one asks about the baby’s mother anymore.
Wendy Root Askew struggled for years to get pregnant, and when she finally did, her anxiety got worse. She couldn’t stop worrying that something would go wrong.
“And then, after I had my son, I would have these dreams where someone would come to the door and they would say, ‘Well, you know, we’re just going to wait two weeks to see if you get to keep your baby or not,’” Root Askew said. “And it really impacted my ability to bond with him.”
She likes California’s bill, AB 2193, because it goes beyond mandated screening. It would require health insurance companies to set up case management programs to help moms find a therapist, and connect obstetricians or pediatricians to a psychiatric specialist.
“Just like we have case management programs for patients who have diabetes or sleep issues or back pain, a case management program requires the insurance company to take some ownership of making sure their patients are getting the treatment they need to be healthy,” said Root Askew, who is now advocating for the bill on behalf of the group 2020 Mom.
Health insurance companies haven’t taken a position on the legislation. It’s unclear how much it would cost them to comply, because some already have infrastructure in place for case management programs, and some do not. But there is consensus among insurers and health advocates that such programs save money in the long run.
“The sooner that you can get good treatment for a mom, the less expensive that condition will be to manage over the course of the woman’s life and over the course of that child’s life,” Root Askew said.