Panelists at Side Effects Public Media’s two-part Happier Birth Days conversation answered viewer questions about maternal and infant health disparities in Indiana’s black communities. But there wasn’t time to answer all questions. Indiana State Health Commissioner Dr. Kristina Box answered some of the remaining questions via email on breastfeeding culture, legislative support for pregnant women and postpartum health concerns.
I had many young mothers tell me that breastfeeding is disgusting. As a pediatrician, how can we help change this culture?
The most important thing pediatricians can do is educate patients about the reasons for the changes in their bodies during puberty and normalize the biological functions of breasts. Much of the system for breastfeeding occurs in the onset of puberty, and pediatricians can discuss how those hormonal changes are designed to allow women to be able to breastfeed a baby someday. If we can normalize the use of breasts for their biological function in office visits, educational sessions, middle school and high school classes and marketing, we can empower young women to better understand their bodies’ capabilities and change the culture surrounding breastfeeding.
As patients get older, physicians can emphasize the health and emotional benefits of breastfeeding. Women and infants who breastfeed are healthier, breastmilk is the perfect nutrition for newborns and breastfeeding provides a close bonding experience to newborns and a way for the mother’s body to return to its pre-pregnant weight.
Is anyone on the panel aware of any upcoming bills relevant to maternal-child health that we should be watching for this legislative session?
House Bill 1007 would establish an OB Navigator program to help connect women who receive Medicaid benefits and those in areas of the state with the highest infant mortality rates to care and resources designed to promote a healthy pregnancy and baby. The bill also would require physicians to verbally screen pregnant patients for substance use disorder and offer treatment options to help improve health outcomes for mother and baby.
What do you think are the biggest challenges we need to make in Central Indiana (Indianapolis) to lower infant/maternal mortality?
We need to ensure that we are connecting pregnant women to care early in their pregnancies and are reaching all populations to address the disparities in our infant mortality rates. That means providing care closer to home and ensuring that we have the right supports in place, especially in our black communities, where we see significantly higher infant mortality rates. Governor (Eric) Holcomb’s two priorities for 2019 will help with this by establishing OB navigators in the areas with the highest risks for infant mortality and requiring verbal screening for substance use disorder at the first prenatal visit.
In addition, Indiana must continue its strategies to reduce smoking rates in pregnant women and reduce barriers to care, such as transportation, financial coverage, time available, stigma, education, employment and child care.
As providers and policy makers, what opportunities exist to change systemic issues? For example, patient intake, enhancing standard of care, referrals to community resources, claims processing, etc.?
Indiana has joined the Alliance for Innovation on Maternal Health (AIM), a national alliance to promote consistent and safe maternity care to reduce maternal mortality and morbidity. The purpose of the AIM program is to equip, empower and embolden every state, perinatal quality collaborative, hospital network/system, birth facility and maternity care provider in the U.S to significantly reduce severe maternal morbidity and maternal mortality through proven implementation of consistent maternity care practices that are outlined in maternal safety bundles (action systems).
Opportunities for referrals to community resources exist through the Indiana State Department of Health MOMS Helpline. The MOMS Helpline has dedicated specialists who can provide valuable information and referrals and educate and advocate on behalf of moms and pregnant women. They work toward improving pregnant women’s access to early and regular prenatal care and connecting them with a network of prenatal and child health care services within their local communities, state agencies and other organizations around Indiana. The MOMS Helpline is an important resource for ensuring that every Indiana mom and baby is healthy and happy.
The ISDH Maternal and Child Health Division also is implementing the Help Me Grow system within MOMS Helpline to help leverage existing resources to ensure communities identify vulnerable children, link families to community-based services, and empower families to support their children’s healthy development through the implementation of four Core Components.
What are preventative strategies that mothers and/or their social supports can employ to monitor and identify symptoms and signs of postpartum issues? What is the message to communicate?
Upon hospital admission, women are verbally screened for depression. At delivery, new mothers are showered with information and physical care. After hospital discharge, many mothers experience isolation from their family support system. A newborn’s first week well-baby visit is an opportunity for new mothers to share their concerns with a healthcare provider who can recognize signs of depression and link the mother to existing community services.
ISDH also offers the LIV mobile application, which provides information about available resources, and the MOMS Helpline can connect women to an appropriate resource.
What type of nonprofit/assistance programs do you think could lower the infant/maternal death rate?
State and community-supported programs such as Women, Infants and Children (WIC), Nurse-Family Partnership, Healthy Families Indiana and perinatal navigation programs give pregnant women and families, particularly those considered at-risk, necessary resources and skills to raise children who are physically, socially and emotionally healthy and ready to learn.
The Maternal, Infant and Early Childhood Home Visiting program also provides an opportunity for state and community partnerships. Home visiting services are available to women who are low-income and high risk. The program is responsible for coordinating services that include mental health, substance use, childhood injury prevention, child abuse, neglect or maltreatment. Nearly 95 percent of enrolled women were screened for intimate partner violence.
What are the significant differences between practices in Indiana that affect maternal mortality/infant mortality and those states that have much lower rates of mortality?
The implementation of Indiana’s Maternal Mortality Review Committee (MMRC) is key to moving the mark as far as maternal mortality. Many states with lower mortality rates have well-established MMRC teams. Indiana’s team will enable the state to identify accurate information on maternal deaths, causes, and trends so that future initiatives can be directed toward recognized needs.
This problem extends beyond the healthcare system-you are all from that perspective. If you could invite someone else to this table to talk about how to solve the problem, who would it be?
It could be valuable to include families who have experienced the loss of a loved one due to maternal mortality, or mothers who have experienced the loss of an infant to share their perspectives.
What will it take to dismantle the racism that exists in our systems? Where do we start? Is there something that you consider to be within immediate reach?
The Indiana Perinatal Quality Improvement Collaborative is challenging its task forces to examine their health promotion plans to recognize and to include a review of the effect of social disparities in their strategies. The proposed OB Navigation program will support the state’s highest risk counties and zip codes.
Q&A compiled by Robin Tate Rockel