Maternal and Child Health: Expanding Access and Quality of Care

The Third Roundtable of the Tammy Murphy Initiative of First Lady of New Jersey on Maternal and Child Health was held in Detroit, Michigan, and was presided over by New Jersey Governor Phil Murphy and Michigan Governor Gretchen Whitmer.

This roundtable will identify barriers for mothers and families seeking care and highlight opportunities for states and health systems to ease challenges and ensure that mothers and babies receive quality care. Did. This discussion will focus on efforts to improve the quality of obstetric care in each state, efforts to further grow and diversify the perinatal workforce to create access to the types of care that families are seeking, and an overall approach that includes: raised questions about the importance of access to relevant obstetric care. Mental health, physical health, and social determinants of health. This will be his third in a series of four roundtables taking place in the first half of 2023.

The roundtable on expanding access and quality of care raised eight key themes.

Quality care includes addressing obstetric racism

Black women are three times more likely than white women to die from pregnancy-related causes. Multiple factors contribute to these disparities, including structural racism and implicit prejudice. Accountability for BIPOC deaths is spurring new approaches. One of the new validated measurement tools developed to combat obstetric racism is called the PREM-OB Scale™. The PREM-OB scale measures patient-identified obstetric racism as defined by blacks, by black mothers and black births, against black mothers and black births, during hospitalization for labor, delivery, and postpartum. We examine six theoretical quality-of-care domains: safety, autonomy, communication, and racism. , empathy, dignity = sacred. Currently, 19 hospitals in 10 states have signed up as partners to implement this innovative approach, which has just been validated in 2022.

Culturally Religious Talent Pipeline and Access to Capital

As states begin to shoulder the costs of doulas and community support workers, reimburse midwives, and license midwifery homes, states will need to consider their maternity workforce pipelines. These policies can help create the potential for a more diverse and stratified workforce, but changes in reimbursement policies alone cannot create a pipeline of workers for these roles. States can help expand midwifery schools, provide scholarships for doula and peer support training programs, mentor and recruit support, and access capital to build certified midwifery homes. Roundtable participants discussed the potential for historically black universities to create programs for such a birth-workforce model. Certified nurse midwives, substance use disabled workforce, and rural health care midwives are all eligible categories for the Federal HRSA Student Loan Repayment Program.

Midwives and independent maternity homes

States have begun reimbursing* for two different types of maternity care for childbirth and allowing the establishment of independent midwifery homes. Self-supporting birth centers are facilities where childbirth is designed to occur away from hospitals and away from human residences, where care is provided in a midwifery and wellness model, and where birth center care is integrated into the health care system. is defined as Over the last 40 years, the number of birthing centers in the United States has grown to over 400 by 2021. The number of births in birthing centers has doubled over the past decade to almost 20,000 in 2019. This is just two cases. 5% of annual births in the United States.

*Certified Nurse Midwives (CNMs) and Certified Midwives (CMs) are trained in both nursing and midwifery. Training is hospital-based, with the majority of CNMs doing apprenticeships in clinics and hospitals. Their training takes place in the medical setting, but the CNM/CM’s scope of practice allows them to provide care in any birth setting. A Certified Midwife (CM), also known as a Direct Entry Midwife, is an individual who has or has had a background in a health-related field other than nursing and has graduated from a master’s-level midwifery education program. They have similar training to her CNM and adhere to the same standards as the CNM, but are not required to have a nursing component.

Reduction in caesarean section rates

Caesarean sections, surgical interventions, are on the rise around the world and now account for more than one in five births. On average in the United States in 2021, 32.1% of births were by caesarean section. Utah has the lowest caesarean section rate among all births at 23.4%, and Alabama is one of the states with the highest at 35.1% of hers. Eliminating overuse of caesarean section and promoting, protecting and supporting vaginal delivery are important goals for maternal mortality and morbidity. Most people are healthy enough during pregnancy that institutional incentives need to be changed to eliminate overuse of caesarean sections and to facilitate, protect and support vaginal deliveries.

Fusion of Traditional Medicine and Western Medicine

According to a report by the National Health Board of India (NIHB), indigenousness is the greatest social determinant of health. Some indigenous communities have created the best hybrids of Western medicine that can be offered alongside traditional medicine, such as allowing traditional healers to practice alongside doctors with hospital permits. . For example, the American Indian Medical Family Services Clinic in Detroit, Michigan employs this type of model.

early postnatal care

Current practice typically creates a six-week gap in care from birth to postpartum obstetric visit. This period is a vulnerable period, and perinatal mood and anxiety disorders can quickly take hold along with physical health complications. Universal home visits performed by antenatal and postnatal doulas fill this critical gap in care. New Jersey is one of her states with a Universal Home Visiting Program.

paid family leave

Countries should support the evidence behind paid family leave policies. The Prenatal-3 Policy Center points out that the state’s paid family leave program can improve the financial security of families and keep parents engaged in the workforce. This program helps new parents spend more time bonding with their baby, develop positive parenting skills, and build a foundation for healthy attachment. Additionally, parents may be better able to receive timely preventive health care for themselves and their children.

Perinatal Mood and Anxiety Disorders

The roundtable highlighted the importance of addressing perinatal mood disorders, anxiety disorders, and perinatal substance abuse. According to 2022 CDC data, the leading underlying causes of pregnancy-related deaths are:

  • Mental health conditions (including suicide deaths and overdose/addiction related to substance use disorders) (23%)
  • Excessive bleeding (bleeding) (14%)
  • Cardiac and coronary artery conditions (related to the heart) (13%)

Perinatal mental health and substance use disorders are the most common complications of pregnancy, affecting 1 in 5 women, with significant long-term consequences. In a Mathematica study published in 2019 and led by Kara Zivin, Ph.D., presented at a roundtable, the total societal cost of untreated PMAD in the United States was 2017 (one year) with maternal and infant follow-up. total births alone are estimated at $14.2 billion. A pair from pregnancy to 5 years postpartum. It is important to mandate screening and establish a continuum of care to treat both perinatal mood, anxiety and substance use disorders. Currently, her 11 states are the only states that require mothers to be tested for depression by Medicaid. Screening is just the beginning to reliably monitor and more fully investigate perinatal behavioral health concerns. Continuing care to support treatment to remission and provide prevention for women with mild to severe symptoms requires additional attention. One of the successes is that many states have launched telepsychiatric consultation programs in this area, giving frontline health care providers real-time access to the state’s most highly trained reproductive psychiatrists. that’s what i’m doing These programs are typically initiated with funding from HRSA and then maintained through a combination of national funding and fee-based structures. Most state original programs and models are called Her McPAP for Moms in Massachusetts.

A note on language: This report uses the term “maternal and child health” to refer to the health of individuals of childbearing potential and their biological infants regardless of gender identity. This report refers to caregivers, partners and spouses, as we do not assume that everyone who gives birth will care for the child.

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