Postpartum depression bills get hearing before House lawmakers

Donna Kreuzer says she never testifies on bills at the Capitol because she doesn’t want her testimony to get lost in her tears.

But Kreuzer, 65, slowly rose from her seat on Tuesday during a House Public Health Committee to tearfully tell legislators about her daughter, Kristi, who was diagnosed with postpartum depression three days after giving birth. Kristi didn't tell her family for two months after the diagnosis, and despite their efforts to help, she died in 2010.

“I don’t want that to happen to anyone else if I can help it,” Kreuzer said. “Each of you, please realize postpartum depression is real. It’s not just because you have children and things are different and you’re tired and not getting sleep.” 

House Public Health Committee members heard testimony on three measures — House Bill 2466, House Bill 2604 and House Bill 2135 — that would aim to increase access to postpartum depression screenings and treatment for mothers.

About 17 percent of Texas mothers experience postpartum depression before or after giving birth, according to a 2016 report from the Texas Health and Human Services Commission and the Texas Department of State Health Services. Symptoms can include anxiety, panic attacks, shame, loss of appetite, sleeplessness and feelings of guilt.

"Depression risks not only a mother's well-being but also a child's safety, well-being and development," said Lisa Hollier, chairwoman of the state’s Maternal Mortality and Morbidity Task Force, as she testified in support of HB 2466.  

The hearing comes as legislators grapple with how to curb the alarming rise of Texas mothers dying less than a year after giving birth. Hollier's task force reported in July that 189 Texas mothers died between 2011 and 2012, and a month later the medical journal Obstetrics and Gynecology published a study that found Texas’ maternal mortality rates had nearly doubled between 2010 and 2014.  The state task force report found mental health disorders and substance abuse were key factors, particularly depression and overdoses from prescription opioids.

The task force's recommendations included increasing mental and behavioral health screenings, improving access to health services for women in the first year after their pregnancy and more education for women at higher risk of death from childbirth.

Rep. Jessica Farrar, D-Houston, chairwoman of the Texas House Women’s Health Caucus and author of HB 2604, said it's important for the state to reduce stigma surrounding postpartum depression. Her bill would require the Texas Health and Human Services Commission to create a five-year strategic plan for screenings, referral treatment and support services for women with postpartum depression.

“The solutions in this strategic plan will increase the number of women successfully treated for postpartum depression and help to decrease the maternal mortality rate in Texas,” Farrar said.

HB 2466 by Rep. Sarah Davis, R-Houston, was less well-received by testifiers. Her bill would allow mothers in Medicaid to receive postpartum depression screenings during their child’s wellness visit and get referred to a mental health provider for counseling.

Monica Ayres, policy director for the Citizens Commission on Human Rights Texas, a non-profit  mental health advocacy group, said mothers getting asked about postpartum depression could easily answer yes to feeling sad, stressed, or exhausted after giving birth. She said it would be better to help women by having doctors give guidance on making sure they’re getting enough sleep and have adequate help with the baby.

“A questionnaire is not going to help much with the real problems that she’s facing,” Ayres said.

Davis later said postpartum depression is “a very serious issue” and “not just about being overwhelmed or having a little anxiety.”

“This is something that, if enacted and as soon as it becomes effective, will start saving women’s lives,” she said.

Committee members also heard testimony on Houston Rep. Garnet Coleman’s HB 2135. Coleman’s bill would allow pregnant women who don’t have insurance and don’t qualify for Medicaid to receive postpartum depression screening and treatment through their baby’s Children’s Health Insurance Program plan.

Lee Spiller, executive director for the Citizens Commission on Human Rights, testified against Coleman’s bill, saying there is not enough in the legislation about educating patients about risks of taking drugs for postpartum depression.

“Whether or not they choose the treatment is their business, and nobody should condemn them for that,” Spiller said. “But please, let’s educate people not just on what the purported benefits are but also the risks. That is so important because we all try to make the best choices we can.”

All three bills were left pending in committee.

Read more of the Tribune's related coverage:

• Texas’ maternal deaths have been sparingly mentioned during the legislative session, overshadowed by issues such as child welfare, the “bathroom bill” and sanctuary cities. 

• Two recent studies have highlighted the increasing rate of maternal deaths in Texas, but researchers say they can't explain why it's happening. 

• More than a decade ago, Andrea Yates drowned her five children. The publicity around the case brought attention to the mental struggles of some mothers. Now, advocates are hoping lawmakers will approve mandatory screening.