Reaching at-risk women to save mothers, babies
Reaching at-risk women to save mothers, babies
Programs arm potential mothers with knowledge
Recently, Save the Children, an international relief organization, reported that the U.S. infant mortality rate is nearly five per 1,000 babies. Of 33 industrialized nations, the U.S. ranked near the bottom, tied with Hungary, Malta, Poland, and Slovakia.
According to data gathered by the organization, the leading cause of newborn death in industrialized nations is premature birth and low birth weight.
The best way to address both these problems is to provide good prenatal care for women and that includes education, says Lora Harding Dundek, MPH, manager of birth and family education and support services at the University of Minnesota Medical Center and UM Children's Hospital, Fairview in Minneapolis.
"It is a process of good prenatal care and good pre-pregnancy care and education for good nutrition, exercise, and stress management," says Dundek. While most people know that such habits as cigarette smoking are not good for the health of a baby, additional education and support can help them change their behavior, she says.
The earlier the better
Entering into prenatal care early is important, says Renee Padmore-Baccus, MEd, coordinator of the New York state-funded Prenatal Care Assistance Program at New York-Presbyterian Hospital in New York City.
"When women enter our program early, we are able to give them a lot more education and a lot more background in terms of caring for themselves appropriately so the baby is cared for and has a healthy outcome," explains Padmore-Baccus.
Many institutions throughout the United States have created programs that target women who are at risk of receiving inadequate prenatal care. They have been designed to reach specific populations.
Yet, one challenge for any program targeting the underserved is making contact and getting women enrolled. That's why staff involved in the Community Health Worker Program for Urban Health Plan Inc., a New York state-funded clinic in the Bronx, go out into the community on foot to find clientele.
According to coordinator Colette Sturgis, staff members canvas the streets looking for pregnant women that would benefit from the educational program, which includes home visits. They talk to women about the importance of prenatal care at laundry mats and beauty salons. And they get referrals from clinics, social services, and daycare programs.
The program targets women at high risk, such as those who are receiving little or no prenatal care, might be drinking or using drugs, are HIV-positive, or are teenagers.
To get the word out to its target population, staff for the OhioHealth Wellness on Wheels Mobile Unit network with prenatal health care teams throughout Columbus so everyone is aware of the services they provide, says Sonia Booker, RN, clinical coordinator for the program.
A lot of marketing is done, including participating in community events sponsored by organizations that reach out to pregnant women. A phone base called Pregnancy Care Connection at OhioHealth makes appointments for the mobile unit, as well as other providers, to get women into prenatal care. Three appointment slots for the mobile unit are kept open each week so the program can get women connected.
"Our goal is to at least have first trimester entry to care; however, we will take women up to 35 weeks. If women are late entry to care we try to see them at least three times before their baby is born," says Booker.
Removing obstacles to care
Enrolling women in a program is only beneficial if they show up for the appointment. To make sure this occurs the mobile unit, which contains exam rooms, a lab, a small pharmacy, and two counseling rooms, goes out six times a week to eight locations. All the sites are on the bus line, and cab passes are provided when needed. A 12-passenger van also picks up patients. Booker says there are 13 high schools in the Columbus area and the mobile unit goes to five of them and the van driver picks up pregnant teens from other schools. The mobile unit serves women age 12 to 40. Although once it was used for a variety of programs — hence its name, Wellness on Wheels — it is now used for prenatal care and also goes to high schools to give students free sports physicals.
The Community Health Worker Program makes access simple because staff members go to the women's homes. However, Sturgis says some of the women come to the office for their meetings.
Once women have made it to their appointment, there are opportunities for education. However, it's important to have a system to follow to make sure quality education is delivered. Padmore-Baccus says at one time education for the Prenatal Care Assistance Program was delivered randomly but now there is a plan that is followed. Women in the waiting room watch videos and when they see their provider they are given information appropriate to the visit. Before they leave the nurse reinforces the education that took place in the exam room and adds to it.
Staff for Wellness on Wheels follow a critical path for education that adheres to the guidelines set in place by the American College of Obstetricians and Gynecologists.
In addition, women receive a pregnancy guide about 30 pages long and nurses review parts of it with them. "We do a lot of education. Much of our population is the young women having a child and we know they may not have a lot of support, people who can take the time to educate. So we do an enormous amount of education," says Booker.
The outreach workers in the Community Health Worker Program cover many topics in their visits. Sturgis says staff members, who often are residents of the community in which they are working, have educational goals.
Women in the program are taught the importance of prenatal and postpartum care and are connected to support programs that help provide the means to obtain nutritious food for mothers and babies, as well as medical coverage.
Breastfeeding is taught and women are encouraged to breastfeed their babies six months or longer. Also the peer counselors try to make sure the children have a family physician they see regularly for preventive care.
Women are taught about such safety issues as domestic violence and the importance of having a baby sleep on his or her back to prevent sudden infant death syndrome. Women are encouraged to know their status for HIV and AIDS and if addicted to drugs or alcohol they are asked to get help. A social worker provides assistance when clients are willing to enroll in a substance abuse program.
Community health workers act as a bridge between the women and support programs and point them in the right direction, says Sturgis. "We want to make sure they are able to make healthy decisions," she says.
Crossing barriers
The language barrier can be a big problem. That's why a telephone interpreting service is accessed when a non-English-speaking patient calls for an appointment to the mobile care unit. "The interpreter tells us what we need for the first visit and also tells the patient how to get to the site of the mobile unit," says Booker. An interpreter from OhioHealth then comes for the patient's appointment and continues to work with the patient for the full nine months of pregnancy.
Sometimes people from other cultures are noncompliant because they do not agree with what is taught. When cultural or religious beliefs clash with the teaching or practice it is important for both parties to work to understand one another, says Dundek.
For example, Somali women who were in labor at the University of Minnesota Medical Center refused to get into a tub of water to make the labor progress faster. It was a foreign concept to them and their modesty prevented them from willingly participating in the practice.
Therefore, hospital staff met with women from that ethnic population and learned they felt abandoned in birth. People who did not speak their language and did not understand their culture surrounded them.
Speak in terms patients can understand
To remedy the problem a Doula program was introduced. ("Doula" is a Greek word that means servant of women.) When a Somali woman comes in to give birth she has the option of using a Doula, also a Somali woman, who provides support during the labor process.
"It has been a useful program for us and the rate of Caesarean births in Somali women is about half. It impacts clinical outcomes and it helps them be more satisfied," says Dundek.
It is easier to educate the patient if she has an active role in her care, says Padmore-Baccus. To overcome compliance challenges, patients must understand why they are being asked to do something. For example, a Hispanic woman eats a lot of beans and rice, which might make her feet swell. If she understands this she is more likely to agree to eat fewer servings.
(Editor's note: Data and reports compiled by Save the Children can be accessed at www.savethechildren.org.)
Sources
For additional information about preventing infant mortality, contact:
- Sonia Booker, RN, Clinical Coordinator, OhioHealth Wellness on Wheels Mobile Unit, Columbus, OH. Phone: (614) 566-9037. E-mail: [email protected].
- Lora Harding Dundek, MPH, Manager, Birth and Family Education and Support Services, University of Minnesota Medical Center and University of Minnesota Children's Hospital, Fairview, MB449/UNMC, 2450 Riverside Ave., Minneapolis, MN 55454. Phone: (612) 672-4688. E-mail: [email protected].
- Renee Padmore-Baccus, MEd, Coordinator, Prenatal Care Assistance Program, New York-Presbyterian Hospital, Cornell and Columbia campuses, New York, NY. E-mail: [email protected].
- Colette Sturgis, Coordinator, Community health Worker Program, Urban Health Plan Inc., New York, NY. Phone: (718) 542-5555.
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