neonatal death
Pregnancy Medical Home Program for Mamas on Bedrest?…
August 17th, 2011Not yet, but they would surely be a welcome addition to high risk pregnancy care.
The Pregnancy Medical Home Program is a program initiated in North Carolina that links payment incentives to prenatal care services-specifically those services and treatments shown to lower the incidence of premature birth and that lower maternal and infant morbidity and mortality. The program currently targets providers who care for women who are eligible for Medicaid.
The maternal mortality rate in the United States is abysmal and is far higher than most European Countries. According to statistics presented in a recent blog by Lee Partridge, Senior Health Policy advisor for the National Partnership for Women and Families,
In 1990 in the United States, 343 women died in childbirth; by 2007 that number had increased to 548. A report released July 6 by the National Institute of Child Health and Human Development documents some progress on reducing the incidence of preterm birth, down from 12.8 percent in 2006 to 12.2 percent in 2009. But that rate is still woefully behind the U.S. Healthy People 2010 target of 7.6 percent of all live births.
To date, little has been done that has had a significant impact on these statistics. With the Pregnancy Medical Home Program North Carolina hopes to reverse these turn statistics and turn the tide on maternal and infant mortality.
As previously stated, the Pregnancy Medical Home Program is an incentive program. Providers who wish to become Pregnancy Medical Home Centers agree to provide specific services and treatment during the perinatal period and in exchange, they will receive additional reimbursement, incentives, from Medicaid. The requirements and incentives are briefly outlined in the brochure put out by Community Care of North Carolina, the network of organizations that developed the program. But the aforementioned blog from the National Partnership for Women and Families gives a very good 4 point summary of the program:
Maternity care providers – obstetricians, family practitioners, nurse midwives, community clinics – can apply to be designated as a Pregnancy Medical Home. They must agree to do four things:
- At the first obstetric visit, administer a standardized pregnancy risk tool that provides not only clinical health history but other information about the woman and her situation that could indicate she is at risk of a poor outcome. The questions include poor nutrition, smoking status, use of alcohol or possible physical violence. If a women looks like a high risk, the provider must contact his or her CCNC network and arrange for care management services for that patient throughout her pregnancy. The provider and patient also develop a plan for managing her care.
- Ensure that none of the providers in the Pregnancy Medical Home perform “elective” deliveries – deliveries for which there is no medical reason to induce labor — prior to 39 weeks of gestation. Early deliveries increase the likelihood of infant death, admission to a Neonatal Intensive Care Unit, or life-long health problems for the child.
- Provide the drug 17 alpha hydroxyprogesterone caproate (commonly called 17P) to patients at risk of preterm delivery.
- Aim for a caesarean-section rate for low-risk, singleton births below 20 percent. C-sections expose both mother and child to surgical risk and possible infection, and can create complications for future pregnancies.
The program offers providers an additional $200/patient over and above the normal maternity fees to participate in the program. They receive the first $50 once they complete the initial pregnancy risk tool. The final $150 is paid after a woman has her final post partum visit which must include screening for depression, reproductive health and family planning and any referrals for ongoing care if necessary.
This is an amazing program! While I can appreciate the strategy of attacking the problem of maternal and infant morbidity and mortality in those who are often most vulnerable, women of low income and limited means/resources, I really wish that there had been at least a small portion of the program allotted to high risk pregnancy. I don’t really think that it would necessarily have to change the reimbursement incentives, but to include some provisions/requirements for care for women who do become high risk and require bed rest would have been nice. How about making sure that they have adequate resources for childcare of their existing children? How about at least asking if they are in danger of losing their jobs and assisting them to find resources to make ends meet? How about stress reduction? Maintaining physical strength and endurance while on bed rest? Okay, I am going a little bit off on a tangent, but once again I feel that high risk pregnancy and mamas on bed rest have been overlooked.
But there is a silver lining to this perceived dark cloud. This is the first program of its kind in this country. Other states are following. (See Washington State’s program here.) As a model, its not bad. Hopefully, as other states adopt and tweek the program for their citizens, they will remember the mamas on bed rest, at home (or in the hospital) silently waiting for help and assistance.
What would you add to the Pregnancy Home Program if you were to adapt it for Mamas on Bedrest? Share your comments below.
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Mamas on Bedrest: Coping with Pregnancy Loss
March 14th, 2011
I got yet another heartbreaking e-mail last week. A grandmother-to-be was writing on behalf of her daughter. Her daughter is pregnant with her first child and at the 20 week office visit some anomalies were noted on ultrasound. Further evaluation showed that the fetus has malformation of blood vessels and some other anomalies consistent with a chromosomal defect. Physicians have recommended terminating the pregnancy. This mother/grandmother to be was calling to see if there are any resources that I could share to help her daughter deal with this devastating blow.
There is no easy way to help a mother who is losing or who has lost a child. I know this first hand because I suffered such loss myself-twice. There are no words to describe the grief of losing a child. You cry. You ache. You keep thinking, hoping, that’s it’s a bad dream and you’ll wake up soon. You hope that the OB missed something, that the baby was turned in some funny way and that’s why the heartbeat couldn’t be detected. Your mind does all these tricks in an attempt to shield you from the pain. But in the end, you have to feel the pain and endure its excruciating sting.
In the meantime, it’s a very powerless feeling to watch someone you love deal with this burden, so I can only imagine this mother/grandmother’s pain. On the one hand, she is grieving the loss of her grandchild. At the same time, she has to watch her daughter, her own baby, endure such unspeakable pain and not be able to take that pain away. I think that this pain is sometimes harder to endure. Ask any mother and they will quickly tell you that they would rather suffer themselves than to see their children suffer in any way.
The loss of a pregnancy or child is never easy. Even after time, there can still be considerable pain and sadness – especially surrounding the date of birth or death of the child. One thing is certain, the little life that is too soon over is never forgotten.
There are many wonderful resources and supports available to grieving families and below are just a few. They will also be posted in our Resources Section.
Comeunity – This website provides information and resources to families of premature infants and children and children with special needs. I particularly like the listing of helpful books and resources.
SHARE: Pregnancy and Infant Loss Support – A national organization providing resources and support following the loss of a pregnancy or child. I especially like their page telling family and friends what not to say.
Mommies Enduring Neonatal Death (MEND) – A Christian, non-profit organization that reaches out to families who have suffered the loss of a baby through miscarriage, stillbirth, or early infant death.
Mothers in Sympathy & Support (MISS) - The MISS Foundation is a non-profit, volunteer based organization committed to providing crisis support and long term aid to families after the death of a child from any cause.
Now I Lay Me Down To Sleep (NILMDTS) – This national non-profit organization assists families suffering an early infant loss with the gift of free professional portraiture. I know of a few families who have used this service and while they were initially opposed to photographing their infant are pleased to have this tangible memory of their child.
SHARE: Pregnancy and Infant Loss Support – A national organization providing resources and support following the loss of a pregnancy or child. I especially like their page telling family and friends what not to say.
The March of Dimes – A Comprehensive resource for families experiencing difficult pregnancies, preterm labor and prematurity and pregnancy loss.
The Missing Grace Foundation – A non-profit foundation started by Steve and Candy McVicar following the stillbirth of their baby daughter Grace.
I am concerned for this mother/grandmother. There will be few people who will ask her how she is faring. She may not even take time to grieve the loss being so focused on her daughter. But certainly, this mother/grandmother is as much in need of comfort as her daughter and son in law. Loss is loss. We have been corresponding and I will certainly do all that I can to support her. Hopefully she and her daughter will make use of some of the resources listed.
Pregnancy loss or the loss of a child is devastating. I am so glad that there are so many wonderful organizations and resources available to support families following the loss of a child. Please use these resources and please share this information with families in need.
Mamas on Bedrest: Please Consider Donating Breast Milk-If You Can
February 18th, 2011I had the great pleasure to tour the Mother’s Milk Bank Austin this week and then interview the Executive Director, Ms. Kim UpdeGrove, CNM, MSN, MPH. I learned a tremendous amount about the importance of breast milk in the care and development of the most fragile infants-premature infants and infants born with congenital abnormalities or illnesses or diseases. I also learned that for the infants who need it most, human breast milk is in fretfully short supply. The 10 milk banks across North America desperately need more milk to be able to meet the needs of premature and fragile infants, and more milk can only come from more donors.
The greatest benefits of human breast milk are that it is specifically designed to contain the right nutrients, the right amount of calories and the right immune agents to fight disease specific to human infants. Human breast milk naturally changes and adapts so that at each stage, the infant is receiving the right nutrients for healthy growth and development.
The most common complication to fragile infants is necrotizing enterocolitis. This infection damages infants’ delicate intestines so quickly and often so severely that up to 62% of babies die and the remainder face lifelong complications. Infants who receive breast milk, either from their mothers or from donors, have a dramatically reduced risk of developing this deadly infection.
You can become a breast milk donor in 4 easy steps: (The Mother’s Milk Bank Austin Intake Information. Other milk bank information may vary slightly)
- Complete a 10-15 minute phone screening.
- Complete and return an informational packet.
- Have a blood test done. (In Austin, The Milk Bank pays)
- Approval once all information is in, reviewed and approved.
As previously stated, there are 10 Milk Banks in North America, one in Canada and 9 in the United States.
British Columbia, California, Colorado, Indiana, Iowa, Michigan, North Carolina, Ohio, Texas (Austin),Texas (North). Milk Banks are being established in Ontario Canada, Florida, Mississippi, Missouri New England, Oregon. Hopefully one day there will be a milk bank in every US state, all across Canada and in Mexico. There are Milk Banks in many other countries.
All of the milk banks adhere to the guidelines for human milk storage and safety established by The Human Milk Banking Association of North America.
HMBANA is the only professional membership association for milk banks in Canada, Mexico and the United States and as such sets the standards and guidelines for donor milk banking for those areas. It was founded in 1985 to:
- Develop guidelines for donor human milk banking practices in North America
- Provide a forum for information sharing among experts in the field on issues related to donor milk banking
- Provide information to the medical community regarding use of donor milk
- Encourage research into the unique properties of human milk for therapeutic and nutritional purposes
- Act as a liaison between member banks and governmental agencies
- Facilitate communication among member banks to assure adequate distribution of donor milk
- Facilitate the establishment of new donor milk banks in North America using HMBANA standards.
Donor Human Breast Milk is processed in highly scientific fashion. The milk is measured, analyzed, sterilized and exquisitely mixed so that it is the precise formulation for babies at each age, size and developmental stage. “Follow The Milk” to learn more about the process of preparing donor breast milk.
There is so much that needs to be done. If you can donate breast milk, volunteer or make a financial contribution, any and all support is greatly appreciated. To get more involved, contact a Milk Bank in your area. If there is not a milk bank in your area or if you are unsure of how you can help or where, send e-mail to info@mamasonbedrest.com and we will gladly get you to the right people.
Below left, my daughter at 2 days old, born at 36 wks, 6d. She got some donor breast milk until my milk came in. Below right, my daughter today, age 8.
