I’m what the Department of Veteran Affairs call a “100% service-connected OEF/OIF disabled veteran.” As such, I am entitled to a host of benefits, the most comprehensive being that of healthcare. When I first separated from the Air Force in 2006, I was a pregnant single mother caught up in the crash landing that is transitioning into civilian life. I spent the last two trimesters navigating unemployment, acquiring social services, and the waiting game every person who applies for disability compensation through the VA does.
At the time, the VA’s standard policy was to outsource all prenatal care, cover the costs of labor and delivery, and provide insurance coverage for newborns during their first seven days—but only to those women veterans who were in their system and registered as disabled veterans, regardless of their rating. As a newly separated airman who had just filed my claims, I was unable to utilize the VA healthcare system for my prenatal care and had to apply for Medicaid through the state of Maryland.
Since that time, the VA has made significant strides in expanding the range of services it provides for women veterans, placing an emphasis on making these services more comprehensive in the women’s health department. Now they go beyond just covering the cost of prenatal care and delivery. They’ve hired maternal outreach coordinators who act as a liaison between pregnant veterans and the VA, provide breast pumps for nursing moms, cover the costs of nursing bras and lactation consults, and have breastfeeding support groups for new moms at their women’s health clinics.
The one area where there still remains a significant gap in care, however, is in that of the mental health of pregnant and postpartum veterans. My recent experience as a pregnant and postpartum veteran with the VA healthcare system has been complex. During this last year it was less than ideal; full of starts, stops, and dead ends that left me incredibly frustrated and disheartened at times.
However, I do believe wholeheartedly that the VA desires to improve their quality of care for women veterans. I’m grateful for the efforts they’ve made to remedy where they’ve misstepped in my particular case. After navigating this system both during pregnancy and over the last 12 months postpartum, I’d like to offer suggestions as to where and how I believe VA healthcare can remove current barriers to treatment and provide adequate, comprehensive care to pregnant and postpartum veterans; particularly those with mood disorders.
Treat Pregnant Veterans with Existing Mental Health Conditions
When I found out I was pregnant, my primary care doctor at the VA outpatient clinic told me to quit my medications immediately and wait for a call from my psychiatrist. I did, and never received that phone call. I instead received an appointment card in the mail two weeks later with a date and time to see her in her office.
At that appointment, my psychiatrist told me that for someone in my “condition” (having bipolar disorder), getting pregnant was irresponsible. When I told her I’d like to discuss my treatment options and wanted to know what she thought about my staying on at least my mood stabilizer, she laughed and said my only option was to go medication free—anything else would put my baby in danger and cause him irreparable damage. When I raised concerns about my increased risk of relapse due to having bipolar disorder and a prior incidence of PPD, she dismissed them completely. When I told her that my civilian OB (who the VA had outsourced my prenatal care to and who also happened to have extensive experience in treating pregnant women with bipolar disorder) had given me his suggested treatment plan and that it involved me staying on at least two of my medications, she got angry and told me that if I wanted to listen to him, then fine, but she wouldn’t treat me.
Two weeks after that appointment I found out she cancelled my prescriptions when I called for refills. I had to go to my OB and request that he provide me with my medications, which he thankfully did. He also called the VA mental health clinic and advocated for me, insisting that they remain in charge of my mental health care. It went all the way to the Chief Medical Director of the Women’s Health Clinic for Central Texas, who relayed this message to the maternal outreach coordinator who had been trying to help me as well:
“The VA can’t assume responsibility for anything that may happen as a result of her staying on these medications during her pregnancy. Our psychiatrists are not experts in this area whereas a private obstetrician is. If he says these medications are safe for her to take during her pregnancy and he will write her a prescription for them, then she can bring that prescription to the VA pharmacy in Austin and we can fill them that way. If something were to happen, then this private OB is the one responsible, not the VA. Unfortunately this is what we have to do in situations such as this.”
While I understand the desire to avoid liability, I fail to see how flat out refusing to treat a veteran who’s been in your care is striving to provide the best level of care for a population you’re committed to serving.
As a result of serving in Iraq (Operation Iraqi Freedom) and Afghanistan (Operation Enduring Freedom), as well as the alarming prevalence of sexual assault in the military, many women veterans suffer from mental health conditions such as PTSD, bipolar disorder, anxiety, and depression. As such, it places them at particularly higher risks for developing antenatal and postpartum mood disorders should they become pregnant. Refusing to continue to treat these veterans during such a critical time in their lives is negligent and dangerous, as is telling them the best thing to do is quit their medications cold turkey. You cannot leave these women out in the wind to navigate the journey through pregnancy alone.
Eventually, I was assigned to a psychiatrist on staff with a background in pharmacology who agreed to work with my OB’s treatment plan and offer input.
I would love to see the VA do away with such a harmful policy and replace it with one that is collaborative with the civilian providers they outsource care to, as well as guided by current research. My fellow veteran mothers deserve that.