When Madavia Johnson gave birth to Donald Ray Dowless III last year, she was hit by a case of severe postpartum anxiety.
She was scared to carry her son downstairs or drive him in a car. She couldn’t manage to continue law school―and could hardly leave the house―because she didn’t trust anyone to watch him. Her weight dropped from 140 to 115 pounds.
“It was very stressful for me mentally,” said Johnson, now 29, who lives in Clayton, North Carolina. And she found it hard to secure medical assistance because her Medicaid coverage ran out just two months after her son’s birth. Public health advocates are pushing to change that.
The difficulties Johnson faced contribute to the United States’ dismal record on maternal and child health. The U.S. is one of only three countries where maternal deaths are on the rise, joining Sudan and Afghanistan, according to the Alliance for Innovation on Maternal Health, a program of the Council on Patient Safety in Women’s Health. And data from the Centers for Disease Control and Prevention indicates that about 700 women die in the U.S. every year from pregnancy complications. Sixty percent of those deaths are deemed preventable.
Democratic presidential candidates such as Senator Cory Booker of New Jersey and Senator Kamala Harris of California have talked about those problems on the campaign trail, offering sweeping proposals to address disparities that lead to poor health for many new mothers.
Though maternal and child health experts appreciate the attention to the issue, they also point to what they say is a fairly minor policy option that could make a major difference: increasing access to Medicaid for postpartum women.
“Given that we know that this crisis disproportionately falls on low-income people … Medicaid is a very smart starting place to make sure these people are getting access to needed care,” said Valarie Blake, an associate professor of law at West Virginia University who focuses on health care law.
Take Johnson, for instance. At the time of her pregnancy, she was eligible for Medicaid based on a rule that provides women who otherwise might not qualify under strict income restrictions with coverage during pregnancy and for 60 days after. She gave birth August 14, 2018.
But North Carolina has tight eligibility requirements. It is also one of the 14 states that have not chosen to expand Medicaid under the Affordable Care Act. So, by mid-October, Johnson was no longer “Medicaid eligible.” Because her physician was backed up on appointments, she lost her coverage before she had a “six-week” checkup.
Eventually, she reapplied for Medicaid and was able to qualify because her status changed since she had a child. But Donald was 8 months old before she was able to see a doctor.
Experts point to the 60-day timeline as a sort of clock ticking on some severe postpartum medical issues: bleeding, infections, breastfeeding issues, and mental health screening, among others.
“If you’re on postpartum Medicaid, you need to get those issues solved right away,” Blake said.
And that 60-day countdown? It is arbitrary, said Alison Stuebe, a professor of obstetrics and gynecology at the University of North Carolina School of Medicine. It has roots in a general idea across cultures that women need special care after giving birth, but the 60-day mark isn’t based on medicine.
“It comes from the same place as the six-week postpartum visit,” Stuebe said. “We don’t know where it comes from either.”
Stuebe chaired a task force for the American College of Obstetricians and Gynecologists that recommended a different approach. Providers should check women two weeks after giving birth, and then continue holistic care for 12 weeks, eventually transitioning the patient to primary care.
That prolonged contact is essential, she said. ”Postpartum depression, if untreated, can begin to spiral,” Stuebe said. “Even if you’re in treatment, after 60 days, you’re not better.”
Johnson, though, was left to wrestle with severe postpartum anxiety on her own.
She sought support from other new moms on Facebook who were coping with anxiety. Since her son had Medicaid for the first year of his life, his pediatrician was a source of help. She also got care through her local health department’s free clinics.
At the federal level, the idea of extending postpartum Medicaid is getting more attention. At a September House hearing, representatives from the American Medical Association, the Icahn School of Medicine, and the Kaiser Family Foundation called for expanding postpartum Medicaid to 12 months as a possible solution to the maternal mortality crisis. The American College of Obstetricians and Gynecologists has also recommended it. Booker’s bill would extend Medicaid coverage from 60 days to 12 months alongside other far-reaching proposals. (Kaiser Health News is an editorially independent program of the foundation.)
Beyond protecting women during the medically vulnerable time after they deliver, experts think increasing Medicaid could go a long way toward addressing the racial disparities that exist in maternal mortality rates. Black women are two to three times more likely to die from pregnancy-related causes than white women.
“It’s not a silver bullet,” said Jamila Taylor, the director of health care reform at The Century Foundation, a nonpartisan think tank. “There’s racism in the health care system. Coverage is a piece of that, but we need to transform the system.”
Kaiser Health News (KHN) is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
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Stressed Students, Bridesmaids Drama, And More: An Advice Column From A Total Amateur
Hi! A while ago I asked the BuzzFeed Community to tell me a problem they’re having, so that I — a person with absolutely zero professional qualifications to help anyone — could give them advice. So, here are the results! NBC 1. “Dear Andy,I have NO idea where I should go to school… I’m applying…
Hi! A while ago I asked the BuzzFeed Community to tell me a problem they’re having, so that I — a person with absolutely zero professional qualifications to help anyone — could give them advice. So, here are the results!
I have NO idea where I should go to school… I’m applying to 12 schools, 10 on the west coast and two in BC. I’m a high achieving student (I’m in five AP classes, president of two clubs, volunteering and a job, etc.) and I don’t want to go somewhere that’s all about the pressure, but I still want a high quality education. I’m so lost, help!”
—The Overwhelmed Student
You posted this just to dunk on all of us academically, didn’t you?
Kidding. In all seriousness, you can get a very good education at a bunch of different schools. And when you’re done, you’ll have a degree that probably nobody will ever verify! In my completely amateur opinion, the only reason people think the “Ivy League” schools are better is because a lot of wealthy, well-connected people go there (and have gone there), and therefore when you graduate from one, you’re more likely to get in at some fancy law firm or whatever because of your connections. So if you aren’t planning on being like, IDK, the CFO of Waystar Royco or something, just pick the school that you really want to go to. Where are you going to be happy living? Is one of the schools in a city you already want to move to and/or the city that has jobs in your future profession? Is it important for you to be close to home? How many Wendy’s are there on campus, and do they carry Spicy Nuggets? These are the questions you should be asking.
Oh, wait, actually…forget all that. Go to the school that will cost the least when you factor in tuition, room & board, and any scholarships you might get. Student loans are a curse and you want as little of them as possible. In the end, you might not even end up doing the thing you studied in college. Wanna know what degree I have? A BFA in Theater Performance. An acting degree. And now here I am, writing for a website. You’ll be fine.
I got married this summer, and I decided to choose only family to be my bridesmaids. For me this included three female cousins and my (now) sister-in-law. My husband, on the other hand, decided to do a mix of family as well as friends from high school for his groomsmen. I had no problem with this at all.
I had a few friends who I knew would expect to be bridesmaids, so I made it clear to them from the very beginning that I would be choosing family only as to not have a huge wedding party, but I told them they were not any less important to me and that I still wanted them to be involved in the wedding as much as they felt comfortable with. Most of the friends I had this conversation with were very understanding, however one straight up told me that she was disappointed (this was two years before the wedding).
Now it’s been a few months since I got married and this friend (a friend from childhood) started talking about the wedding. She told me she felt left out of the wedding since she wasn’t part of the wedding party. It particularly bothered her that my husband included friends and I didn’t. She then proceeded to tell me that it was difficult for her to be there the day of my wedding because of these feelings. AT MY WEDDING. She also included the fact that she didn’t want to upset me and that it doesn’t change our friendship. But if that is the case then why say anything in the first place? I’ve already said one too many times the reason for my bridesmaid choices and how important she is to me regardless. And she says she understands. I just wish she would let it go. Ever since this conversation I feel like I’ve been seeing her in a whole new light.
I do care about her feelings, but I stick by my decision and I don’t regret anything. I feel like I’ve done everything I can to make her feel better.”
—The Besieged Bride
[TL;DR: Bride had only family as bridesmaids, groom had some friends in the mix, bride’s childhood friend felt left out and complained about it a few months after the wedding.]
Question one: How drunk was your friend when she brought this up to you? If she was like, a 6 or more out of 10, I say let’s give it a pass and hope she got it out of her system.
Question two: Has your friend had a wedding of her own yet? If yes, then she should’ve understood the situation, because wedding planning is a special kind of hell and inevitably you have to make difficult decisions like this one that might hurt people’s feelings. So if you’ve planned your own wedding, you know the deal and you’re able to say to yourself, “It’s their wedding, I’m just going to be supportive and have fun.” If she hasn’t gotten married yet, she’ll realize later that it was totally inappropriate to complain about this to you. Hopefully.
I have been taking so many of the relationship quizzes on BuzzFeed but they all say I’m single. The major problem is I have an S.O. Is she just faking or am I?? Help me!! Is my girlfriend not actually mine or are we real?”
—The Quizzical Quiz-Taker
You’re not real. This is all a simulation.
—Andy (or am I?)
I’m not sure where to live. I live in Milwaukee, WI, right now. Moved here three years ago for school, but that fell through because Milwaukee is friggin expensive. My family wants me to move back to the other side of the state, towards Minneapolis/St. Paul. What should I do?”
—Meandering the Midwest
Get the fuck out of there, it’s so cold! Listen, I used to live in Michigan, and it was depressing because it was grey and miserable nine months out of the year. Now I live in Southern California, it’s sunny and beautiful and my vitamin D levels are through the roof. Migrate south, seriously.
But if you HAVE to stay, I will say that everybody who lives in Minneapolis seems to LOVE Minneapolis for some reason.
My problem is that I struggle with feeling attractive. I started taking birth control when my boyfriend and I started dating (six years ago). I started gaining the weight right after. I’m now a size 12 and my boyfriend is a slender guy. I haven’t felt attractive in the last year. I gained so much weight at one point I was a size 16. I’m back to a 12 and trying to lose weight again. I don’t feel sexy or beautiful in any way. I prefer to keep my shirt on during sex now. I don’t know why my boyfriend still finds me attractive. I have a tummy, I have rolls when I sit down, I just don’t know what he sees anymore. Any advice you could give me would be much appreciated.”
—Struggling With Size
First off, don’t worry about your boyfriend. Clearly he finds you attractive, and when you actually care about someone, the size tags on their clothes don’t matter to you at all. Appreciate that fact and find some security there.
Now, consider the possibility that if your boyfriend finds you attractive at any size, you can too! It’s not easy. It requires shedding every bit of toxic influence that the media and our society overall has thrown at you for your entire life. That takes time and work.
But if you are worried about your physical health at all, consult a doctor. There are many different types of birth control and like 40 different pills, and everyone reacts to each one differently. It can take time to find the right one, and not every doctor is going to be helpful about it. Advocate for yourself if you’re unhappy with your medication. You may have done all of this already and I’m just sitting here mansplaining BC to you, but if so at least you can cross that off your Mansplaining Bingo Card.
That’s it for this week. But if you’re having a problem that you need advice about, let me know! It could be anything: petty arguments that you need a judge to decide who was right and who was wrong, help making life decisions, relationship issues — I’m your completely unqualified man. Email email@example.com (for total anonymity) or leave a comment here!