MaternalOptionsthat 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 2011Anomalies 72 66 59

<Gest/Low Birthwt 36 35 28

Maternal Complic 52 39 49

SIDS 39 32 30

Other External 17 10 13

Other 74 71 68

Total 290 253 247

Causes of Infant Mortality in Kansas

2009 2010 2011Anomalies 72 66 59

<Gest/Low Birthwt 36 35 28

Maternal Complic 52 39 49

SIDS 39 32 30

Other External 17 10 13

Other 74 71 68

Total 290 253 247

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 Area Per Capita $

39.8% 66101 $10,986

28.9% 66103 $18,723

29.9% 66105 $12,614

21.9% Wyandotte $19,214 12.6% Kansas $26,545 14.3% US $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 2011Anomalies 72 66 59

<Gest/Low Birthwt 36 35 28

Maternal Complic 52 39 49

SIDS 39 32 30

Other External 17 10 13

Other 74 71 68

Total 290 253 247

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 SmokingSmoking 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 smoking- Five 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 food-stamps/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

WyandotteCounty

No Prenatal Care

Live Births 1.1%

Infant Deaths 6.5%

(2007-2011)

Interventions- Early access to care Information about health behaviors and

pregnancy placed at targeted community sitesOutreach to schools and pharmacies in lowest

income areas (posters, etc.)Billboards and PSA’s – Mother’s Day

Early diagnosis of pregnancyFree 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 WyCo JoCo PMC ~9 to 3+KUMCOPR    33SMMC    72Other

SNC0

County/Hospital Statistics 2010

2010 Reside WyCo

Reside JoCo

Reside Leavenworth

Total

Total 2010 2,754 7,390 946 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

MOM

KUHP

Midwife Program

KU Family

Medicine

Family Health Care

Income from In-patient provider servicesEducational OpportunitiesProvides Faculty/Residents

No IncomeEducational OpportunitiesProvidesFaculty/Students

Income from Out-patient provider services

Provides facility & supports

Workforce

Outcome:Infant Mortality- Reduced byProven Interventions Health care Social supports Education

Our goal- More first birthdays!