AUSTIN, Texas — Kimberly Sennett remembers the early years with her first child in vivid detail — small moments, sounds, phrases and expressions that still feel clear years later.
Much of the year after her second daughter was born is a blur.
“I just remember walking around almost in a fog,” Sennett, 45, said. “I wasn’t emotionally there. I was just going through the motions.”
Sennett was 30 when she had her second child. She cared for her newborn and moved through the routines of daily life but remembers little else from that time. She was not screened for postpartum depression and did not recognize that she was experiencing it, so she never sought treatment.
It was years later, after becoming a certified nurse-midwife, that she understood what had happened.
Today, Sennett is a psychiatric mental health nurse practitioner specializing in perinatal mental health. The experience that once went unrecognized in her own life now shapes the care she provides to pregnant and postpartum patients.
Maternal mental health conditions affect about one in five women during pregnancy or the first year after childbirth and are among the leading causes of maternal mortality.
In Texas, new research suggests those challenges may be worsening.
A study published in June in JAMA Network Open examined maternal mental health following Texas’s 2021 abortion law, known as Senate Bill 8. Researchers found the percentage of Texas mothers reporting fair or poor mental health increased from 4.6% before the law took effect to 9.3% afterward. Among mothers in states without abortion bans, the increase was smaller, from 5.4% to 7.5%.
Researchers analyzed data from more than 4,300 mothers in Texas and about 152,500 mothers in states without abortion bans. The study found an association between living under the abortion ban and worse maternal mental health, but it could not establish that the law caused the change.
The association was particularly pronounced among Texas mothers whose children had public insurance. The researchers did not report results stratified by race or ethnicity; subgroup analyses instead examined maternal age and education and the child’s insurance status.
Researchers also noted that Senate Bill 8 took effect during the COVID-19 pandemic and that the effects of the pandemic and new abortion restrictions could have compounded one another. To account for broader changes during that period, researchers compared Texas mothers with mothers in states without abortion bans.
Alyssa Burnett, a study co-author and data analyst at Harvard Pilgrim Health Care Institute, said the research also raises questions about what challenges there are to accessing care.
“There are a lot of other nuances to consider,” Burnett said. “There may be providers, but can people physically get there? Are they all within one health system? What types of insurance are they accepting?”
Those questions are especially relevant in Central Texas, where the availability of maternal mental healthcare varies by county.
According to an analysis of 2025 data by the Policy Center for Maternal Mental Health:
- Travis County had 52 maternal mental health providers for an estimated 16,212 births in 2025 and needed 29 additional providers to close its estimated shortage.
- Williamson County had 22 providers for an estimated 8,441 births and an estimated shortage of 20 providers.
- In Hays County, 13 maternal mental health providers were available for an estimated 3,382 births, which was four providers short of the estimated need.
- Bastrop County had one maternal mental health provider for an estimated 1,207 births and an estimated shortage of five providers.
- Caldwell County had five maternal mental health providers for an estimated 600 annual births, exceeding the estimated provider need by two providers.
Provider counts, however, tell only part of the story. Insurance coverage, public transportation gaps, cost and appointment availability can further limit a patient’s options even when providers practice nearby — the same distinctions Burnett said are important when assessing whether care is truly accessible.
Maternal mental health conditions extend beyond postpartum depression and include anxiety, obsessive-compulsive disorder, post-traumatic stress disorder and, in rare cases, postpartum psychosis. Left untreated, they can affect mothers, infants and families long after childbirth.
Access to that care can be especially difficult for Texans without health insurance.
Texas had the nation’s highest uninsured rate among women ages 19 to 64 from 2021 to 2024, averaging 21%, according to an analysis by KFF State Health Facts, a national nonprofit policy research organization.
In Central Texas, 18% of all residents were uninsured in 2021, compared with 20% statewide.
Texas Medicaid acts as a safety net, providing eligible women with coverage during pregnancy and for 12 months after the pregnancy ends. The program financed 48% of Texas births in 2023, according to KFF.
But having coverage does not necessarily guarantee access to a clinician who specializes in maternal mental health, accepts that coverage and has appointments available.
Sennett said those barriers are familiar in her work with pregnant and postpartum patients. Finding specialized care can mean calling multiple providers, navigating waitlists and asking patients to travel outside their communities.
Delays in treatment take a toll
Dr. Jana Rundle, a perinatal psychologist who treats patients across Central Texas, said another barrier can emerge before a patient ever begins looking for a provider: recognizing that something is wrong.
By the time some patients seek care, Rundle said, they have spent weeks or months questioning whether what they are experiencing is normal, trying to manage symptoms themselves, or navigating insurance hurdles and waitlists.
“I don’t think most people expect to struggle,” Rundle said. “They expect pregnancy and postpartum to be joyful, so when they’re experiencing anxiety, depression or obsessive thoughts, many assume they’re doing something wrong rather than recognizing they’re experiencing a treatable medical condition.”
That misconception, she said, can delay treatment. Some women believe they should be able to handle the challenges of new motherhood on their own, making it more difficult to ask for help.
Sennett understands that hesitation from both sides of the exam room.
Her own postpartum depression went unrecognized. As a clinician, she now sees how screening, insurance and the availability of trained providers can determine whether other mothers receive care.
Texas has taken some steps to expand access.
In 2017, state lawmakers authorized Medicaid reimbursement for one postpartum depression screening during a child’s well-child visit in the first 12 months after birth.
But the American Academy of Pediatrics recommends screening mothers for depression four times during an infant’s first year.
Bills introduced during the 2025 Texas legislative session and supported by the March of Dimes, a nonprofit focused on maternal and infant health, would have provided Medicaid payments for four maternal mental health screenings during pediatric visits in the first year after birth. The measures did not pass, but the organization promotes universal screening, insurance coverage, referrals to behavioral health providers, public education and stronger data collection as key strategies for improving maternal mental healthcare.
Another state-supported effort, the Perinatal Psychiatry Access Network, or PeriPAN, makes it easier for clinicians to offer referrals, giving obstetricians, pediatricians, family physicians and other licensed healthcare providers free access to a multidisciplinary network of mental health experts, including reproductive psychiatrists.
Those programs address different points where patients can fall through the cracks — identifying symptoms, connecting patients with specialists and helping healthcare providers manage perinatal mental health conditions. Sennett said those connections matter because mothers should not have to navigate the system alone.
Looking back, she said, she wishes someone had recognized what she could not see in herself after the birth of her second child.
“Don’t be afraid to ask for help,” Sennett said. “You are not meant to shoulder everything by yourself. You are meant to raise children in community.”
The National Maternal Mental Health Hotline provides free, confidential support 24 hours a day, seven days a week, for pregnant and postpartum people and their families. For help, call or text 1-833-TLC-MAMA (1-833-852-6262).
This story was funded by St. David’s Foundation through its Strengthening Local Media to Advance Community Health initiative. Public Health Watch retains full authority over editorial content; read our editorial independence policy here.
