Ke l s ey P o r t e r

Nicole Hur st

Julie Dahle nHEALTHY PEOPLE 2020MAT ERNAL, INFANT AND CHILD HEALT H

•  Reduce the rate of all infant deaths (within 1 year)

•  Reduce total preterm bir ths

•  Increase abstinence from cigarette smoking among pregnant women

•  Increase the propor tion of infants who are breastfed

LEADING HEALTH INDICATORS & OBJECTIVES28

•  Baseline: 12.7 percent of live bir ths were

preterm in 2007•  Target: 11 .4 percent

LHI: REDUCE TOTAL PRETERM BIRTHS28

Membranes

•  Puf fing• 

Parentage•  Periodontal

•  Plurals •  Perinatology•  PPROM- Preterm •  Prior Preterm Bir th

Premature Rupt ure of •  Preeclampsia

•  Placental Problems •  Pover ty

•  Pressure •  Pus

Disease

THE 1 2 “P’S” OF PRETERM BIRTHS8

•  Baseline: 6.7 infant deaths per 1 ,000 live bir ths occurre d wit hin fir st ye ar of life in 2 0 0 6

•  Targ et: 6.0 inf ant deat h s per 1 ,000 live bir t h s

LHI: REDUCE THE RATE OF ALL

INFANT DEATHS (WITHIN 1 YEAR)28

•  Two age periods•  Neonatal (birth-27 days)•  Postneonatal (28-364 days)

•  Dif ferent causes of death in each period

•  2007-2011: U.S. IMR declined approximately

3% per year•  6.75 to 6.05 per 1,000 live births

INFANT MORTALIT Y7

•  HRSA Healthy Star t Program•  Community Driven•  Ser vice-focused•  Ef fective

•  2006 U.S. IMR was 6.7 infant deaths per 1 ,000 live bir ths•  Healthy Start Participants the IMR was

5.7 infant deaths per 1,000 live births.•  2007 U.S. rose to 6.8 infant deaths per

1 ,000 live bir ths•  Healthy Start participants IMR dropped to

5.1 infant deaths per 1,000 live births.

NATIONAL PROGRAMS26

•  The Collaborative Improvement of InnovationNetwork ( CoIIN )

•  Strateg y team s focus es :•  Reducing elective deliveries at <39 weeks gestation•  Expanding interconception care in Medicaid•  Reducing SIDS/SUID•  Increasing smoking cessation among pregnant

women•  Expanding the regionalization of perinatal ser vices to pregnant women

NATIONAL PROGRAMS7

•  Centeringpregnancy®•  Pregnant women meet with clinician

•  Take own BP, weight and set per sonal goals

•  Meet within a group of women who are the same

gestational age•  Discuss health care issues of pregnancy

•  Centering Model•  Better care, Better health, Lower cost

WASHINGTON STATE PROGRAMS10

•  DSHS Fir st Steps

•  Promotes healthy birth outcomes, increase access to

early prenatal care, & reduce infant mortality•  Medical ser vices•  Family planning•  Expedited alcohol and drug treatment ser vices

•  Enhanced ser vices•  Maternity Suppor t Ser vices (MSS)•  Infant Case Management (ICM)•  Childbir th Education (CBE)

WASHINGTON STATE PROGRAMS26

•  Sea Mar Community Health23

•  Fir st Ste ps:•  Maternity Suppor t Ser vices34

•  Income eligible pregnant women•  Preventative health ser vices to enhance medical visits•  Maternity cycle•  Infant related•  Linkage, advocacy, and referral services•  Education, brief counseling, and interventions

WHATCOM COUNT Y PROGRAMS

•  Baseline: 89.6 percent of females repor ted cigarette

abs t ine nce for live bir ths in 2007

•  Targ et: 98.6 percent abstaining

OBJECTIVE: ABSTINENCE FROM

CIGARETTES28

•  Conception dif ficulty 5

•  Miscarriage5

•  In utero risks4

•  Incre as e ris k of S IDS4

•  Incre as e prete rm and low bir t h we ig ht babie s4

SMOKING AND PREGNANCY

•  Why is this relevant?•  45% of women who smoke quit

during pregnancy•  52% of women relapse after birth

•  Negative ef fects in babies

SECOND-HAND SMOKE EXPOSURE25

•  Standardized preg nancy -s pecific ces s ation1

• inte r ve nt ion• Lacking integration

• America n College of Obstetricians andGynecologists •  ‘A clinicians Guide to Helping

Pregnant Women Stop Smoking’

NATIONAL PROGRAMS

•  5 A’s1

• Ask• Advise• Assess• Assist• Arrange

•  Af fordable Care Act27

• Preventative Services

NATIONAL PROGRAMS

3 Main Health Goals31

•  Reduce Smoking Among Adults•  Prevent Smoking Initiation Among Youth•  Reduce Smoking Among Pregnant Women

•  Reduce Relapse Among Postpartum Women

WASHINGTON STATE PROGRAMS

•  Tobacco Control Strategies31

•  Cessation Programs•  5 A’s•  Telephone counseling•  Training healthcare providers

•  Public Education and Awareness•  Community Based Programs•  School Based Programs

•  Comprehensive

WASHINGTON STATE PROGRAMS

•  Af fordable Care Act•  Uninsured•  Enrolled in WA Apple Health

• Medicaid•  Individual plan- WA Health Benefit Exchange•  Employed Based Insurance Plan•  Medicare

WASHINGTON STATE PROGRAMS32

•  Smo ki n g a n d Pr egn a n c y

•  Pr e v en ti on Pr ogr a ms

•  4 main goals

•  Cessa tion R esou r ces

•  Ac c e s s to I n f o r m a t i o n

WHATCOM COUNT Y PROGRAMS30

•  Baseline: 74.0 percent of infants born in2006 were ever breastfed, as repor ted in2007–09

•  Target: 81 .9 percent

OB JEC T IVE: INC REAS E T H E P ROP ORT ION OF INFANT S W H O ARE B REAS T FED28

• Mothers• Infants• Society

THE BENEFIT S OF BREASTFEEDING35

•  Maternity care •  Suppor t in the practices workplace

•  Professional •  Social marketing education

•  Addressing the•  Access to marketing of

infant professional and formulapeer suppor t

CDC: GUIDE TO STRATEGIES TO SUPPO RT BREAST FEEDIN G M OT

HERS AN D BABIES12

•  Baby -Friendly USA HospitalInit iat ive6

• Breastfeeding Coalition of

Was h ing ton: WA DOH ’s Nutrition and Physical Ac tivity Program20

MATERNIT Y CARE PRACTICES

•  Increase in duration of breastfeeding15

•  Incentives for continuing education credits (CE)12

•  Staf f breastfeeding training and education scores

by Maternity Practices in Infant Nutrition and Care

(mPINC)15:• 31/100 for PeaceHealth St. Joseph ChildbirthCenter

• 43/100 for Washington state

PROFESSIONAL EDUCATION

•  Whatcom County Mate rnit y Care Pract ice sAssessment15

•  88% of patients receivedformula-containing gif t

bag•  WHO ’ s “the Co d e” ha s

gu i d el i n es for ma rketi n g and dis t ribut ion of bre as t fe e ding s ubs t it ute s12

•  WI C d i str i b u tes > ½

infant form ula us e d in t he U.S .14

MARKETING OF INFANT FORMULA

•  La Le c h e League mother-to-mother suppor t35

•  Local meetings and classes

•  2011 USDA/WIC Loving Suppor t Through Peer Counseling: A Journey Together 12

PEER SUPPORT PROGRAMS

Breastfeeding AmongMinorit y Wome n: Moving from Risk Fa ctor s toInte r ve ntions

Study by Donna J.Chapman and Rafael Per ez - E sc a mi l l a

CULTURAL RELEVANCY13

•  Highest gap betweenHP 2020 goal andcurrent breastfeeding rates

•  African AmericanBreastfeedingNetwork (since 2008)

•  African AmericanBreastfeeding Alliance

AFRICAN AMERICANS13

•  Hispanic women meeting HP 2020 goal of 81 .9 %13

•  Puer to Rican Hispanics and non-P

ue r to RicanHispanics 50% gap13

•  Bre as tfe e ding : AMagical Bond of Love(WIC HispanicBreastfeeding andPromotion Project) 18

HISPANICS

•  Af fordable Care Act2

•  Supplies•  Counseling•  Break time

•  Depar tment ofHealth and Human Ser vices: Business Case forBreastfeeding29

SUPPORT FOR BREASTFEEDING IN

THE WORKPLACE

•  AAP suppor ts use of donor m ilk2

•  Eat s on Fe et s15

•  Milk donor banks15

•  11 donor banks inUSA; none inWashington.•  Free screening for transmittable

diseases

DONOR BANKS

THANK YOU QUESTIO

NS?