1 in 5 maternal deaths are from suicide. Why is it so hard to get help?

There are traces of Andrea Kolbe all over her big sister, Kyra Vocci.

A long chain with Kolbe’s wedding ring — an ornate silver band — hangs close to Vocci’s heart, beside a locket engraved with Kolbe’s photo and fingerprint. Tattooed on Vocci’s forearm is a rainbow and a quote Kolbe liked: “There is a rainbow of hope at the end of every storm.”

“We called each other soul sisters,” said Vocci, her eyes glossy with tears.

In December, one day after Kolbe turned 35 and four months after she gave birth to her first child, she took her own life at her Long Island, New York, home. When Vocci got the call, she dropped to the floor and screamed so loud and for so long that her neighbors called police.

Kyra Vocci has a tattoo on her forearm that reads, "There is a rainbow of hope at the end of every storm; Always, Andrea" with the closing in the handwriting of her late sister Andrea Kolbe, who took her own life in December while fighting postpartum depression. (Karl Merton Ferron/Staff)
Kyra Vocci has a tattoo on her forearm that reads, “There is a rainbow of hope at the end of every storm; Always, Andrea” with the closing in the handwriting of her late sister Andrea Kolbe, who took her own life in December while fighting postpartum depression. (Karl Merton Ferron/Staff) 

Before Kolbe died, she had been struggling with postpartum depression, a mood disorder characterized by persistent feelings of sadness, worthlessness, guilt and shame. The condition can cause new mothers to experience terrifying and unwanted thoughts about accidentally or intentionally harming themselves or their baby.

Postpartum depression is distinct from the “baby blues” — a mild and temporary form of depression experienced by most new moms that typically goes away within two weeks after they give birth. The mood disorder is more serious, and, while it’s less common, studies estimate that up to 15% of people who have a baby will experience it. Black women and those with a history of depression or bipolar disorder are especially at risk.

According to national and local experts, screening and treatment for postpartum depression remains lacking across the country. Until recently, there was no standardized strategy for collecting data on maternal deaths from suicide. Now, research suggests that nearly 1 in 5 maternal deaths in the country are due to suicide, making such deaths more common than those caused by postpartum hemorrhage or hypertensive disorders.

Lately, Vocci, of Towson, and her mother — Lisa Kolbe, who lives in Gaithersburg — have been pouring their grief into advocacy. Earlier this month, they both testified in support of a bill in the General Assembly that would connect at-risk pregnant women and new moms to their local health departments. Both the House and Senate have passed versions of the bill.

Lisa Kolbe doesn’t mince words when asked how she is doing. She is broken. But Andrea — pronounced ahn-DREY-ah — would want her to be happy, so she is trying to move forward. And she doesn’t want to keep how her youngest daughter died private.

“I’m open about it with everyone,” she said. “It can’t be hush-hush anymore. It can’t. We’ve got to protect women. We’ve got to get them proper care.”

Infrequent screenings

Under guidelines from the American College of Obstetricians and Gynecologists released last year, providers should screen women for depression and anxiety multiple times during their pregnancy and after they give birth. However, according to data from public and private insurance companies, that usually doesn’t happen.

For Medicaid patients in 2022, screening rates were 16% during pregnancy and 17% postpartum, according to data compiled by the nonprofit National Committee for Quality Assurance. The rates were even lower for people covered by private insurance — 9% during pregnancy and 11% postpartum.

At Mercy Medical Center and Greater Baltimore Medical Center — the hospitals that deliver the most babies in Baltimore and Baltimore County, respectively — doctors said they regularly screen pregnant women and women after birth for mental health concerns.

Across the country, however, the maternity care infrastructure is threadbare, said Joy Burkhard, executive director for the Policy Center for Maternal Mental Health. More than a third of counties are maternity care deserts, meaning they have no hospitals or birth centers offering obstetric care and no obstetric providers, according to a 2022 report from the March of Dimes.

Providers who deliver babies also don’t learn enough about maternal mental health in medical school, which makes it hard for them to identify and manage the conditions and teach their patients about them, Burkhard said.

“It’s a bit like the Wild West in terms of what kind of care someone might or might not get,” she said.

Kyra Vocci wears a locket paying tribute to her deceased sister Andrea Kolbe. (Karl Merton Ferron/Staff)
Kyra Vocci wears a locket paying tribute to her deceased sister Andrea Kolbe. (Karl Merton Ferron/Staff) 

Last year, the policy center released report cards measuring each state’s success at screening for and treating maternal mental health conditions. Maryland received a C-minus — above the national D grade.

According to the report card, the state is doing some things well. Last year, the Maryland Department of Health announced that people eligible for Medicaid would be able to access benefits for their entire pregnancy and the 12-month postpartum period, regardless of their immigration status or any changes in income or household size.

However, the report card also noted that Maryland doesn’t require providers to screen for maternal mental health disorders or require Medicaid to reimburse for that. A report released in 2016 by a task force created by the General Assembly said the state should start requiring screening. But that recommendation — like most others in the report — has yet to be fulfilled.

Barriers to treatment

Even when a woman is screened for depression, she may not be forthcoming if she’s worried her baby will be taken from her, or her doctor will think she’s a bad mom. Despite being so common and treatable, maternal mental health issues remain draped in societal misunderstandings.

“It’s a terrible stigma,” Vocci said. “Like, if you don’t feel blessed and joyful to have a baby, then something’s wrong with you.”

An outdoor banner proclaims, "Her Fight is My Fight, Postpartum Depression Awareness" outside the home of Kyra Vocci, to spread the message about postpartum depression regarding her sister Andrea Kolbe, who committed suicide last Dec. shortly after giving birth. (Karl Merton Ferron/Staff)
A banner proclaims, “Her Fight is My Fight, Postpartum Depression Awareness” outside the home of Kyra Vocci, to spread the message about postpartum depression. (Karl Merton Ferron/Staff) 

Then, there’s what happens after screening: Research shows that less than a quarter of women who test positive for depression receive mental health treatment. Black women are even less likely to be screened and receive treatment than white women — even though they’re more likely to experience perinatal mood disorders, said Dr. Lindsay Standeven, clinical and education director of the Johns Hopkins Reproductive Mental Health Center.

There’s also a dire shortage of mental health workers, which has only gotten worse since the beginning of the coronavirus pandemic. Some providers are reluctant to screen women for postpartum depression because they know how hard it is to find help.

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