Tanzina Vega: Last week, Illinois became the first state in the nation to expand postpartum Medicaid coverage. The move will allow people who've just given birth to be covered for a full year postpartum, instead of just for the first 60 days. According to the CDC, about one-third of pregnancy-related deaths happen within the first year after giving birth.

This move and others like it could be one step toward addressing the glaring disparities in maternal mortality rates for mothers of different races. According to CDC data from 2019, Black and Indigenous women are two to three times as likely to die from pregnancy-related deaths compared to white women. I'm now joined by Dr. Joia Crear-Perry, founder and president of the National Birth Equity Collaborative. Dr. Crear-Perry, thanks for joining us.

Dr. Joia Crear-Perry: Thank you so much for having me.

Tanzina Vega: I had a baby at the very, very beginning of the pandemic. My experience with postpartum care is very lacking. What's it supposed to be typically?

Dr. Joia Crear-Perry: I wish I could say that your experience was somehow drastically different, but, sadly, we don't really focus on postpartum in the United States of America. Typically, a patient has a baby in a hospital, most babies in the United States are born in hospitals, and then we give them a follow-up appointment for six weeks later, and we send them off on their way. If you had a follow-up visit six weeks later, you had the typical experience of postpartum, pandemic or not.

Tanzina Vega: Tell me about the experience of what Medicaid offers right now for postpartum? We understand it's 60 days, but what are they offering now in Illinois? An entire year, what would that entail?

Dr. Joia Crear-Perry: Yes. Going back to even your experience, that we wish that even without a pandemic that people would be able to come in for at least one other visit prior to the six weeks, though that six weeks was made up so long ago. We haven't looked at our prenatal care visit schedule as OB-GYN since 1930. We've been doing the same exact procedures, and other countries, the people have a home visit after they have the baby. The midwife comes to see them, to check on them, and then they have a visit two days later and a week later.

What this Illinois law allows you to do is think through how would we reimagine what happens when you go home? Right now, patients have that one visit covered, and then that's it. What if you have complications, we've mentioned in your beginning that people are dying, at least third of the time up to a year later. If you have chest pain, or if you're having feelings of depression or anxiety, we don't have an opportunity to share that with a provider if you only have one visit available to you. This allows for more than that for prolonged.

We know Erica Garner, who died six months after having her baby in New York City, she was reliving her father's murder on the streets of New York City and so that her heart stopped six months later. In a state like Illinois, she would now be able to still continue having health coverage for that six months to be able to come in and be seen which does not exist right now if you only have six weeks.

Tanzina Vega: Let's talk about that because I don't know if we even-- I can tell you, I had no idea of what could potentially happen to someone after they've given birth. There's so much emphasis on the birthing process and complications that could happen in that process, but the postpartum experience feels like it's lacking. I don't know if a lot of women or people who were giving birth even know what to look for after they've given birth. You come home, you have this little tiny human, you're charged with caring for that person. What should people who have given birth be thinking about in terms of watching for their own health in that very important time?

Dr. Joia Crear-Perry: There's association called A-1 created-- what's called post-birth warning signs. That's the association for the nurses who care for you in the hospital after you have your baby on postpartum. If you look up post-birth warning signs, you'll see things like if you see excessive bleeding, if you have swelling, if you have chest pain, if you have thoughts of hurting yourself or hurting someone else, if you have a fever, those are things to look for.

Unfortunately, we shouldn't just tell you that in the hospital because, as you've mentioned, you have a new baby. Even at moment of birth, all the attention goes to the baby and mom is kind of left there. I frequently say we have the candy, we throw away the wrapper, and everybody runs towards the candy. The mom is just there and ignored. We don't talk to her about all the things that could happen and making sure that she's supported, even about normal things like how to breastfeed, how to ensuring that people have the social safety that they need in order to be able to do that safely.

I just think we have a lot to work on when it comes to the United States in how we even teach patients what to look for when they are going home and that shouldn't just happen in the hospital. That should be something that happens during prenatal care, and something that happens in the community, so other community members can look as well.

Tanzina Vega: Dr. Crear-Perry, one of the things that stands out to me often is the things that you just described, learning how to breastfeed, having a home visit, that's often outsourced for women and people who have had children who can afford to hire lactation consultants and a postpartum doulas and things like that. For those who can't, are they pretty much left to figure it out on their own?

Dr. Joia Crear-Perry: Unfortunately, they are. We have programs like A Healthy Start, we have programs like Home Visiting through MIECHV. These are fancy public health things that I do as a public health person. If that infrastructure is not in your city, or if it's not invested in by your state, and because for four years, many of these programs weren't invested in by the federal government as well, we don't see the robustness that could exist for other countries like I keep mentioning that have as much wealth as we do.

Every human being that has a baby gets at least one home visit, not to police you but to take your baby away, or the way that we think of social services in this country is becoming much more of a policing than a support and making sure that people have well-being and figure out who is at risk and go into their homes to check on them. It's very different from saying every human being who births the baby needs support. We need to check in on them and see how they're doing to make sure that they have all the mental and physical things that they need for support, not to police.

Tanzina Vega: Finally, we've got less than a minute to go, but are you hopeful that the expansion of postpartum Medicaid coverage will go beyond the state of Illinois?

Dr. Joia Crear-Perry: Yes, we're hoping that it'll-- Places like Texas and Florida where they have not expanded Medicaid at all. We'll see this an opportunity to at least do it for moms and babies because we should at least value those folks.

Tanzina Vega: Dr. Joia Crear-Perry is the founder and president of the National Birth Equity Collaborative. Dr. Crear-Perry, thanks so much for joining me.

Dr. Joia Crear-Perry: Thank you for having me.

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