‘Mom-Nibus’ to bring services, protection to NH mothers Health

Her son, Sawyer, was so small that doctors could not intubate him. “I was a little hysterical,” Glynn said.

Her husband, Michael Gebo, recognized what she could not. “He said, ‘Can you make her comfortable and can we hold our son?’

He “held her infant” and watched her take her last breaths,” she said.

Glynn said the loss was difficult for his eldest son to understand and took a toll on his own mental health. “Here I am thinking I must have two boys, and my hands are empty,” she remembers.

Glynn qualified for Medicaid because she was pregnant, and for a time that covered severe health complications after the birth, as well as bereavement counseling. But when that coverage ended, so did counseling and medical care.

Glynn and other women who have lived through traumatic experiences related to pregnancy will raise their voices in Concord when the so-called “mom-nibbs” bill comes up for discussion this legislative session.

Advocates say the bill is a life saver, not a luxury.

Sen. Rebecca Whitley, D-Hopkinton, is the lead sponsor of Senate Bill 175, which would extend Medicaid coverage for pregnant women to one year postpartum. It would also cover aids like doulas, breastfeeding services and donor breast milk for the estimated 3,800 women who receive maternity services under Medicaid here annually.

Whitley said the United States has one of the highest maternal mortality rates in the developed world. “It’s mind-boggling because so many pregnancy-related deaths are preventable,” she said.

Eleven pregnancy-related deaths were reported in New Hampshire in 2020 and 2021, according to the 2022 annual report on maternal mortality from the Health and Human Services oversight committee. (Such deaths are defined as those involving a person during pregnancy or within one year of pregnancy, regardless of cause.)

Two women died while pregnant and nine others died postpartum – six within the first three months after delivery, and three after 6 to 12 months. Five died of medical causes from hemorrhage or hypovolemic shock (from blood loss), four from overdose and two from cardiac events.

“We know that both in New Hampshire and nationwide, we have a maternal health crisis,” Whitley said. With some hospitals closing maternity units and a shortage of OB-GYN providers, she said, “we’ve heard really disturbing stories about our crumbling system of care for mothers.”

Whitley said her Mom-Nibbs bill would help women who currently don’t have access to services that wealthier families can afford. It could make a big difference for moms and babies in New Hampshire, she said.

“Our system of OB-GYN care is already very fragile,” she said. “We don’t have enough providers. So part of it is making sure we have other services to ensure a healthy pregnancy.”

Women who do not meet the income limits for Medicaid may qualify based on the pregnancy. These women receive critical prenatal care and support services for mental health and substance use disorders through Medicaid coverage, said Sen. Suzanne Prentice, D-West Lebanon, co-sponsor of SB 175.

A paramedic, Prentice is the former chief of EMS for the state’s Department of Defense and EMS manager at Concord Hospital.

Under the current rules, she said, “Sixty days out, you’re cut off.”

Whitley said, “Anybody who’s had a baby knows what it’s like after 60 days.” “If we’re going to address the issue of mothers getting the help they need, it’s so important to extend the period that they can access treatment.”

MacKenzie Nicholson, senior director of the New Hampshire chapter of Moms Rising, an advocacy group that focuses on issues facing moms and families, got involved in that work for personal reasons. “I’ve become a mother and I like a lot of mothers,” she said.

Nicholson had her first child when she was 23 and eligible for Medicaid coverage because of the pregnancy. She and her future husband were recent college graduates and worked jobs without health insurance.

“The first few months with a newborn are some of the most stressful and most challenging I think a lot of people have experienced,” she said.

Her mental health worsened, she said, but her Medicaid coverage expired after 60 days. “I definitely had postpartum depression and I didn’t have the convenience of going home,” she said. “Being a young mother was incredibly different.”

Nicholson said MOM-Nibus will make a real difference by providing more services for women on Medicaid and by extending the coverage period.

“We are not serving the people who need us the most,” she said. “These deaths are preventable. We can do something to save the children and save the mothers.”

“We treat low-income women as if they don’t deserve those services, and that’s not fair,” Nicholson said.

Sen. Prentice said a measure to expand Medicaid coverage to 12 months postpartum “made it to the finish line” last year, but died at the last minute in convention committee.

“I was devastated,” she said. “We all were.”

“Frankly, last year women were left out at the negotiating table,” Whitley said.

This time, both senators said they were optimistic the bill would pass.

In addition to Medicaid provisions, SB 175 adds workplace protections for nursing mothers, creates advisory boards and certification procedures for doulas (women trained to provide guidance and support to mothers during and after birth) and lactation service providers , and sets up a commission to study. Universal home visits for newborns and young children.

Whitley said the price tag for all this would be between $3 million and $4 million the first year and $4 million to $5 million the second year of the Biennial. She sees it as an investment in the future.

“For me, I think it’s a win-win,” she said, citing the economic benefits of getting more women back into the workforce, and “making sure our kids are healthy, so we have more people on the line.” No more problems.”

She knows it may need some convincing. “I think mothers historically didn’t have a whole lot of political power,” Whitley said. “We’re just looking forward to doing what we need to do and support our kids.”

Maternal mortality review committees of the Centers for Disease Control and Prevention found that 80% of pregnancy-related deaths were preventable. The MMRC found that 22% of those deaths occurred during pregnancy, 25% on the day of delivery or within seven days, and 53% between seven days and one year of pregnancy.

The leading cause was a mental health condition, including suicide or overdose in 23%.

Heather Martin, a patient advocate at Dartmouth Health who is board certified in perinatal mental health care, calls the period after childbirth “the fourth trimester.” She checks mothers for postpartum depression and follows up with them to see how they’re doing.

Martin also has personal experiences that inspire the work he does. Thirteen years ago, she said, “I lost my sister to maternal suicide.”

“She was suffering from what we now believe was postpartum psychosis,” he said.

It was her sister’s first child and everyone was very excited, she recalled. But a week after her baby girl was born, her sister, Jennifer, became withdrawn and depressed.

Jennifer went to the emergency room for help, but checked herself out two days later. “She committed suicide about three weeks after the birth of her daughter,” Martin said.

When Martin started working in pediatrics at Dartmouth Health, she saw mothers who reminded her of her sister. That’s when she started the screening program, which the American Academy of Pediatrics now recommends “is done everywhere.”

Martin plans to start a peer support group for new moms suffering from postpartum depression. Sometimes, she said, “women don’t need a counselor. They just need other moms to talk to.”

Lisa Sirois, bureau chief of population health and community services at the state Department of Health and Human Services, said her agency has resources such as newborn screenings, home visits, nutrition programs and breastfeeding support. But those programs don’t reach everyone, she said.

Outpatient lactation services and doulas are also available in New Hampshire, but only for women with insurance coverage or the means to afford them. Sirois said those supports have proven effective in keeping moms and babies healthy in that critical first year.

“It doesn’t have to be just lucky,” Sirois said.

“By having those extra support services in their lives during that stressful period, we see healthy outcomes for both mother and child,” she said. “Which basically leads to healthier kids and health care savings for all of us in the end.”

Sirois said pregnancy also provides an opportunity for mothers to address their mental health and substance abuse issues.

“They’re just eager to learn and make changes,” she said. “Every mom, no matter what she’s struggling with, wants to be the best mom she can be and have a healthy baby.”

These challenges are not new, said Martin of Dartmouth Health, but in previous generations, mothers were often silent.

“I think women have always fought,” she said. “I hear moms of all ages, even grandmothers, saying, ‘Yeah, I had that and I was afraid to tell someone because they’ll take my baby away from me or they’ll lock me up. Will give. ,

She is dedicated to reducing stigma. “The more we talk about it, the more people will come forward and seek help,” Martin said.

Nicholson from Moms Rising said she is doing well today. She and her husband have a house in Nottingham, a 9-year-old son, a 6-year-old daughter, “a dog and a cat.”

And at 32, Nicholson has turned what started as volunteering with Moms Rising into a career and a passion.

“We want to amplify those voices on policy issues and accelerate grassroots movements to make change happen and hold people accountable for how we treat mothers,” she said.

Nancy Glynn said her loss is never far away. “It’s been six years since then, and it’s still something that I can close my eyes and I can relive that trauma,” she said.

Glynn said she’s glad the Mom-Nibbs bill includes coverage for donor breast milk.

When her baby died, Glynn remembered other families she met when her first son was in the neonatal intensive care unit. She pumped her breast milk and donated it to a milk bank.

It was, she said, “an opportunity to give back and maybe put another mom at ease,” she said.

Still, she said, “Every time I did it, I was reminded that yes, it was going to be another child – but it was going to be mine.”

It was a minister who gave Glynn advice that helped him out of his grief: “When a mother loses a child, she inevitably goes down to the darkest depths of hell. Two things can happen. : She can stay down or she can move around and learn from it.

“Which one are you going to be?” the minister asked.

Glynn chose to walk.

She now works for Moms Rising on state and federal issues — a job that provides health insurance. Her son, Hunter, is an engaged 10 year old and their family is happy and prosperous.

The Glynn mom-Nibbs plans to testify in favor of the bill and hopes to bring other moms with her to tell their stories: “to give them an opportunity to come back from hell.”