Transcript Building a Charitable Specialty Health Care Network for

Maternal
Options
that Matter - MOM
MOM- One Goal

To increase the proportion of Wyandotte County
infants who reach their first birthday.
MOM- Our Mission

To promote and deliver the highest quality
medical care services for mothers and their
children in Wyandotte County.

To train Family Medicine Resident Physicians
and Certified Nurse-Midwives in the clinical care
of mothers and young children.
Training Providers

The provision of labor and delivery services by family
physicians is especially important in largely rural states
such as Kansas. 80 of the 105 counties in Kansas do not
have obstetricians, most of those counties rely on family
physicians for prenatal and delivery services.

There is a need for additional trained professionals to
provide access to prenatal and delivery services
throughout the state. MOM is positioned to help increase
the number of trained providers in the community and in
the State of Kansas.
MOM- Our Vision

Healthy mothers,
healthy children
Wyandotte County Infant Mortality

The infant mortality rate in Wyandotte is
higher than the State rate (per 1,000 births)
Causes of Infant Mortality in
Kansas & WyCo
2009 2010 2011
Anomalies
<Gest/Low Birthwt
Maternal Complic
SIDS
Other External
Other
Total
72
36
52
39
17
74
290
66
35
39
32
10
71
253
59
28
49
30
13
68
247
Causes of Infant Mortality in
Kansas
2009 2010 2011
Anomalies
<Gest/Low Birthwt
Maternal Complic
SIDS
Other External
Other
Total
72
36
52
39
17
74
290
66
35
39
32
10
71
253
59
28
49
30
13
68
247
Targeting the need.
2009 report noted Black infant mortality
was highest in five Kansas zip codes of
which three are in Eastern Wyandotte
County: 66101, 66102, and 66104.
 The zip codes with greater than twenty
infant deaths include five located in
Eastern Wyandotte County- 66101,
66102, 66103, 66104, and 66106.

Contribution of Poverty- Difficult
to Assess, Impossible to Ignore
% < FPL
39.8%
Area
66101
Per Capita $
$10,986
28.9%
29.9%
21.9%
12.6%
14.3%
66103
66105
Wyandotte
$18,723
$12,614
$19,214
Kansas
US
$26,545
$27,915
2007-2011 American Community Survey 5-Year Estimates US Census
MOM- Objectives

Assumption- High infant mortality in
Kansas/Wyandotte County has modifiable
causes. (As shown through previous research.)

MOM will improve outcomes through changing
modifiable risks in an immediate and concrete
way through the use of proven or promising
interventions targeting identified causes of
infant mortality.
Causes of Infant Mortality in
Kansas
2009 2010 2011
Anomalies
<Gest/Low Birthwt
Maternal Complic
SIDS
Other External
Other
Total
72
36
52
39
17
74
290
66
35
39
32
10
71
253
59
28
49
30
13
68
247
Contributing to Infant
Mortality-
Low Birth Weight
Causes of Low Birth Weight
Smoking
 Drug abuse
 Maternal malnutrition (anemia)
 Preterm delivery

Causes of Low Birth Weight
Smoking
 Drug abuse
 Maternal malnutrition (anemia)
 Preterm delivery

Low Birth Rate- smoking

Maternal Smoking
 Smoking
during pregnancy was noted in
24.3% of infant deaths compared to 15.2% of
live births in Kansas. (2007-2011)
 Multiple studies show about a 2-2.5 times
increased rate of low-birth weight and growth
retardation in infants of women who smoke
compared to those who do not smoke.
Intervention- Smoking Cessation
Cartoon/Poster detailing smoking
cessation whys and hows in exam rooms.
 Brochure for pregnant women and new
mothers about tobacco cessation.

 (>80%
of women who quit do so “for the
baby.”)

Staff education about smoking effects on
pregnancy and use of “Five A’s” evidence
based intervention.
Reduce maternal smokingFive A’s
Ask about tobacco use.
 Advise to quit.
 Assess willingness to make a quit attempt.
 Assist in quit attempt.
 Arrange follow-up.

Low Birth Rate- malnutrition
Maternal Malnutrition is associated with
LBW- studies show women with adequate
weight for height have about one-half the
rate of low birth weight infants (10.8%) as
those who have low weight for height
ratios (23.6%).
 Anemia is a marker of poor maternal
nutrition.

Intervention- Nutrition
Cartoon/Poster in exam rooms detailing
healthy diets in pregnancy.
 Social Services support for foodstamps/WIC.
 Early start (free) prenatal vitamins.
 Nutrition information/counseling.
 Grocery.

Contributing to Infant
Mortality-
Preterm Delivery
Effect of Preterm Delivery on
Infant Mortality

One reason for the higher infant mortality
in our community is that the rate of
preterm deliveries in Wyandotte County is
higher than the State average (10.2 per
hundred compared to 9.3- 2008 figures.)
The preterm delivery rate is even higher
among black women in our County (13.2
per hundred in 2008.)
Preterm labor is associated with:
Late entry to care
 Infections (genital, dental)
 Street drug and alcohol use
 Smoking
 Close pregnancies
 Domestic violence
 Long work hours and strenuous work
 Maternal health conditions (HTN, DM, etc.)

Interventions to reduce preterm
deliveries caused by:
Late entry to care
 Infections (genital, dental)
 Street drug and alcohol use
 Smoking
 Close pregnancies
 Domestic violence
 Long work hours and strenuous work
 Maternal health conditions (HTN, DM, etc.)

State and County
% Inadequate PN (began >16 wks)
Prenatal Care
Wyandotte
County
Live Births
Infant Deaths
(2007-2011)
No Prenatal
Care
1.1%
6.5%
Interventions- Early access to
care

Information about health behaviors and
pregnancy placed at targeted community
sites
 Outreach
to schools and pharmacies in lowest
income areas (posters, etc.)
 Billboards and PSA’s – Mother’s Day

Early diagnosis of pregnancy
 Free
pregnancy testing at clinical sites.
Early Prenatal Care
Interventions to reduce preterm
deliveries caused by:
Late entry to care
 Infections (genital, dental)
 Street drug and alcohol use
 Smoking
 Close pregnancies
 Domestic violence
 Long work hours and strenuous work
 Maternal health conditions (HTN, DM, etc.)

Screening and treatment for
genital and dental infections

Screening and treatment for dental disease.
(Studies have linked peridontal disease to
preterm delivery and fetal demise.)
Interventions to reduce preterm
deliveries caused by:
Late entry to care
 Infections (genital, dental)
 Street drug and alcohol use
 Smoking
 Close pregnancies
 Domestic violence
 Long work hours and strenuous work
 Maternal health conditions (HTN, DM, etc.)

MOM- Support Services


Resources Screen
 Reponses: Referrals - Food, housing, etc.
Domestic Violence Screen
 Response: Mental Health Therapy
 Response: Legal Services (Orders of Protection)
 Response: Referral – Shelter
(MOM utilizes the social, mental health
and legal services of Family Health Care
to address positive screening.)
Prenatal Care in WyCo
L&D Site
PMC
KUMC
OPR
SMMC
Other
SNC
JoCo
WyCo
~9 to 3+
33
72
0
County/Hospital Statistics 2010
2010 Reside
WyCo
Total 2010
2,754
Reside
JoCo
7,390
Reside
Leavenworth
946
Total
11,090
Deliver WyCo
1,434
671
185
2,290
Deliver JoCo
1,197
6,231
446
7,874
Deliver KUMC
1,529
Deliver PMC
1,114
WyCo Hosp
2,643
Contributing to Infant
Mortality-
Sudden Infant Death
Education to reduce SIDS
Cartoon/Poster detailing infant sleeping
recommendations in exam rooms and at
weighing table.
 Brochure for pregnant women and new
mothers about infant sleeping
recommendations.
 Staff education about infant sleeping
recommendations. Ask at each visit.

Infant Mortality-
No more negative
headlines!
“Kansas Worst for Black
Infant Deaths”
Headline
 The National Center for Vital Statistics
ranks Kansas the worst state in mortality
rate of black infants.
Rank #50- Kansas recorded 19.6 deaths per 1,000 births
among blacks; the national average is 13.2 deaths.
Rank #40- Kansas ranks in the bottom 10 for overall infant
mortality.
Sunday, May 1, 2011 Wichita Eagle
http://www.kansas.com/2011/05/01/1830329/kansas-worst-for-black-infant.html#storylink=cpy
MOM utilizes promising and
proven interventions

Preconception education
 Well woman examinations
 Increased maternal folic acid use (PN vits)
 Optimal birth spacing encouragement
 Improved care and education between births
 Social services assessments and support
MOM



Optimal Prenatal Care (Family-centered, peer-supported)
 Early (1st trimester) start of prenatal care
 Reduce maternal alcohol, tobacco, or illegal drug use
 Appropriate prenatal weight gain and nutrition
 Dental evaluations and treatment
 Exercise and nutrition information/classes
 Direct care for appropriate risk level pregnant women
 Assessment and referrals for high risk pregnant women
Delivery of patients at KU Hospital & Medical Center L&D
Well child examinations
MOM utilizes promising and
proven interventions

Postpartum Care and Education
 Safe sleep position and safe sleep environments for
infant
 Adequately immunized mothers and infants
 Increased breastfeeding
 Social supports to improve mental health
 Parenting instruction and support
Gearing Up- Together
KU
Family
Medicine
Workforce
No Income
Educational Opportunities
ProvidesFaculty/Students
Income from In-patient
provider services
Educational Opportunities
Provides Faculty/Residents
KUHP
Midwife
Program
Income from Out-patient
provider services
MOM
Provides facility & supports
Family
Health
Care
Outcome:
Infant Mortality- Reduced by
Proven Interventions
Health care
 Social supports
 Education

Our goal- More first birthdays!