Dr. Leizl Sapico: State must put data, plans into action to help new parents

Maternal mortality increased in Washington state in 2021–2022, the most recent data available. And the leading cause of maternal death might surprise you. It isn’t birthing complications or post-partum hemorrhage.

Rather, it is something overwhelmingly preventable and treatable: behavioral health conditions such as substance use disorder.

These include accidental overdose deaths – mostly involving fentanyl – and suicide, according to the Washington State Department of Health’s new Maternal Mortality Review Panel Report, released in December. The report found 82% of pregnancy-related deaths were preventable.

We generally focus on the physical health of these women and their babies. But their unrecognized and unsupported mental health is a significantly overlooked and underappreciated threat to their health and safety. We need to recognize this for what it is: a public health failure and a tragedy for our community.

We should be there for moms so they can be there for their children.

As an OBGYN for 13 years, I have helped hundreds of women bring healthy babies into this world. Let me tell you about one patient who almost became a cautionary tale.

She was overjoyed to become pregnant, until her pregnancy became plagued by serious complications. She suffered from severe preeclampsia. Barely into her third trimester, an urgent threat to her and her baby’s life required her to have an emergency cesarean section. Her tiny baby was placed in NICU.

The new mom was despondent and fell into a deep depression. She urgently needed the help of a therapist and psychiatrist.

For six weeks, my team and I frantically navigated the maze of our behavioral health system and insurance requirements. Six weeks of phone calls, filling out endless forms, and trying to support my patient while trying to get her connected to the professional behavioral health providers she so urgently needed. Each day we worried not just for her baby’s life, but hers too.

At a time when behavioral health issues are increasing, rates of depression, suicide, and addiction are all heading north. We can and must do better for our pregnant neighbors and their families. Our data shows that expectant and new parents’ calls for help often go unanswered.

The Washington State Maternal Mortality Review Panel – of which I am a member, though I am writing this in my personal capacity – has outlined three broad recommendations to improve outcomes for new and expecting parents and their families. These are: improving the quality, availability, and coordination of health care, including behavioral health care; investing in proven and cost-effective community support services such as home visiting and doula care; and ensuring care is culturally responsive and free from bias.

A growing body of evidence has found these provide a high return on investment – in terms of improved health for baby and parent.

One pathway toward achieving these recommendations is outlined by the Washington Thriving Strategic Plan, released last month. Endorsed by Gov. Bob Ferguson, the plan proposes evidence-based systemic reforms aimed at strengthening and integrating our state’s current fractured mental health system for young people. The plan as outlined in HB 2429, which we should call on the Legislature to pass, serves as a starting point we can expand and build on to address the maternal mortality crisis.

The strategic plan aims to break down silos to improve access to behavioral health services, support collaboration across state agencies, and create unified data systems that help officials better respond to community needs.

We have the data. We have the solutions. We have a roadmap forward. We must find our will to act on behalf of the newborns each year who needlessly lose a parent. Every preventable death should shock us into action.

Dr. Leizl F. Sapico is an acting assistant professor in the Department of Obstetrics and Gynecology, University of Washington School of Medicine in Seattle, and a member of the Washington State Maternal Mortality Review Panel. These opinions are her own and not necessarily representative of the University of Washington School of Medicine or reflective of the views of the other members of the Washington State Maternal Mortality Review Panel.