Case Study

Promoting Postpartum Behavioral Health Screening

“Opportunities exist to improve care coordination for pregnant and postpartum women. It is necessary to explore models of care that are inclusive of behavioral health services. Improving risk screening is vital for early recognition and management of maternal risk factors that lead to mortality and morbidity.”

Maternal Mortality and Morbidity Task Force and Texas Department of State Health Services (DSHS)
Joint Biennial Report, 2018

Leeza, 23, brings Leo to your clinic for his 2-week Texas Health Steps medical checkup. The first-time mother reports she is sore and exhausted from the delivery and needs help taking care of her son. She says her partner works long hours and has no time, energy, or knowledge to help with infant care. As you examine Leo, you also have the opportunity to assess whether Leeza, overwhelmed and vulnerable, may have risk factors that could affect her health and ability to care for little Leo.

portrait of mother and infant
Leeza and Leo

Several treatable medical, social, and behavioral causes contribute to postpartum mortality in Texas.

In 2012-2015, drug overdose was the leading cause of maternal mortality and morbidity in the first year after delivery:

  • 58 percent: Opioids involved, either alone or in combination with other drugs
  • 66 percent: Combination of drugs involved, including sedatives, cocaine, methamphetamine and other substances.

Homicide and suicide are top causes of maternal mortality in the first year after delivery.

  • Homicide: Associated with intimate partner violence.
  • Suicide: Associated with depression.

Untreated mental health conditions can become more serious, leading to negative short- and long-term health consequences for mothers and babies.

Sources: Maternal Mortality and Morbidity Task Force and DSHS Joint Biennial Report (2018, and the American College of Obstetricians and Gynecologists Committee Opinion No. 518: Intimate Partner Violence (2012).

More than half of deliveries in Texas are covered by Medicaid. Women who receive Medicaid benefits during pregnancy are covered until the last day of the month that includes the 60th day after delivery. Eligible women are automatically enrolled in the Healthy Texas Women program when their Medicaid coverage ends. Primary care providers, including pediatricians, are encouraged to address common behavioral health conditions during this postpartum period.

Screening for postpartum depression (PPD) during routine infant checkups is one recommended strategy. Texas Health Steps provides separate reimbursement for conducting maternal PPD screening using a validated tool during a Texas Health Steps medical checkup birth through the infant’s first birthday. Reimbursement is available to Texas Health Steps providers once per infant. A mother whose screen is positive should be referred for additional evaluation and treatment.

PPD screening by pediatricians is an example of integrated behavioral health care, which addresses factors that contribute to postpartum mortality and morbidity in primary care.

“This care may address mental health and substance [use] conditions, health behaviors (including their contribution to chronic medical illnesses), life stressors and crises, stress-related physical symptoms, and ineffective patterns of health care utilization.”

Integrated Behavioral Health Care Measures Atlas (2013)

Many postpartum deaths are preventable. Routine risk screening in the months after delivery is key to addressing behavioral and social factors a mother may be experiencing so they don’t interfere with her health and ability to care for her baby.

Why It Matters

Prioritizing behavioral health care can reduce maternal mortality and morbidity and promote good health for Texas mothers and babies. Check out the related courses to learn more.

Related Courses

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