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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!