Fall  2017  Newsletter  
 Welcome, Fall! 
The team at the Center for Maternal and Infant Health (CMIH) is pleased to share an update about our work, including some important new tools and resources for your practice and new funding to advance preconception care across the U.S.  CMIH strives to improve the health of North Carolina's women and infants by providing quality collaborative care and translating evidence-based strategies into practice. 

We are thankful for the hard work of our team and support from our many partners.  
In This Issue
Serving Families: Cynthia and Hope's Story

At a 21 week ultrasound Cynthia learned that her baby, Hope, would be born with spina bifida, an open neural tube defect (NTD). When Cynthia was 24 weeks pregnant, she and Hope together underwent fetal/in utero surgery at UNC Hospitals to close the open nerves on the baby's spine. Cynthia was placed on modified bed rest for the rest of her pregnancy. Unfortunately, at almost 27 weeks gestation, her water broke prematurely and Cynthia was admitted to the hospital for close monitoring. She was cared for in the hospital until she went into labor and was delivered via cesarean section at 33 weeks. Baby Hope was admitted to the UNC Newborn Critical Care Center (NCCC) for a three week stay.     
During an interview, Cynthia said that the first few months after learning of Hope's condition were not easy, but she was happy to have received so much help from all of her providers, especially her doctor and her case manager. Cynthia said her doctor and her case manager both responded promptly, answered all her questions, and provided excellent support. Their reassurance providers who are caring, detail oriented and helped to ease a stressful and challenging time. Right now, the best thing about being a mom, for Cynthia, is to simply be there with Hope, hold her, and watch her grow. Despite all odds, Hope is now home with her parents and two older brothers and doing great! Hope does not fuss and is so brave. She is a fighter! 
Learn more about the work of the UNC Fetal Therapy program here or contact Dr. Goodnight at William_Goodnight@med.unc.edu or 919.966.1601. 
The CMIH team is proud to partner with the March of Dimes for a World Prematurity Day Tweet chat on November 16th 12pm ET. Join us and show your support  HERE.
The 4th Trimester Project
The "Mom Squad"

The Center for Maternal and Infant Health is becoming a leading organization for preconception, pregnancy, and postpartum health innovation and resources. CMIH investigators are at the forefront of national initiatives to re-envision and implement more comprehensive and effective care for new families. The CMIH team of clinician-researcher-mothers completed a two-year project funded by the Patient-Centered Outcomes Research Institute (PCORI, EAIN-2603) which allowed them to bring together mothers, healthcare providers, community advocates and other stakeholders to define what women need most to achieve their postpartum health goals. This process elevated significant gaps in resources for women, families, health care providers and communities about postpartum recovery and wellness.  
In the 12 weeks following delivery, a woman must recover from pregnancy and childbirth, adapt to changing hormones, body image and role, learn to feed and care for her newborn and navigate relationships and expectations with her partner, family, friends, co-workers and other children if she has them. Mothers with limited resources must also access services for themselves and their infants within a system that is often complex and not consumer-centered. During this "4th Trimester," many women and their families experience considerable, interrelated biopsychosocial challenges that are insufficiently supported by health care providers, employers and the community. It many ways it seems that "Once the candy is out of the wrapper, the wrapper is cast aside" ( Verbiest, Tully, & Stuebe, 2017).
The study found that continuity of healthcare from pregnancy through the postpartum period is neglected, which reflect
Volunteer Baby Holders!
s a complex interaction of poor reimbursement structure for providers and limited time for focus on patient-priorities within clinical encounters. Mothers and their newborns are usually treated separately instead of receiving integrated dyadic care.Women and their families are under-educated about and therefore unprepared for postpartum health and recovery. Women often receive postpartum information at birthing facility discharge when they are exhausted then may wait 6 weeks for care even when it is needed immediately.

Further, 40% of American women do not receive a postpartum visit. Women who do receive care report significant differences in what was provided compared to the issues that mattered to them. Isolation, unrealistic expectations, biased/judgmental clinical encounters, lack of attention to relationships/sexual health and stigma around issues such as mental health, incontinence and infant feeding place many barriers in front of new mothers and their families.
The PCORI-funded 4th Trimester Project dialogue resulted in multiple peer-reviewed publications and media attention. Drs. Verbiest, Stuebe, and Tully have been quoted in various news outlets, including Slate Magazine, Quartz, and Vox. How families navigate postpartum issues isactively discussed among the 5,000+ followers of the 4th Trimester Project Facebook page and twitter account.. The team is currently writing grants and seeking funding for the long list of ideas generated by the PCORI moms and stakeholders. Stay current on 4th Trimester news: 
Improving Care for Patients with Trisomy 13 and Trisomy 18 

Learning that their baby has either Trisomy 13 or 18 is a devastating diagnosis for families. A new team at UNC lead by Dr. Wayne Price, the Trisomy 13/18 work group, is working together to develop strategies to better support families during this difficult time. This interdisciplinary group is addressing a number of topics, including increasing the consistency and accuracy of communication and i ncreasing sensitivity around how terminology is used. The team is looking at how to 
improve caregiver/provider understanding of management options at UNC and advancing the collaboration between family and caregivers, and medical providers. Dr. Price underscores that clinicians must  "support families making the best decision based on their values, not ours". Understanding each family's values and setting appropriate goals based on those values is critical as is improving knowledge of how families make difficult decisions. The team's work will not only benefit families and patients with this diagnosis, but can improve care for all families who receive diagnosis, treatment and support at UNC.  For more information, please contact Dr. Price at Wayne_Price@med.unc.edu or 984-974-7854.

Key Reminders for Providers:
  • Remember to use appropriate language when telling parents of their baby's diagnosis. 
  • Many babies can be discharged home. Recent studies show baby's living for months and even years after the diagnosis. There are variable outcomes for these babies.
  • Families may change their mind over time on whether they want to use comfort care or an intervention. 
  • Families assume shared decision-making and that clinicians have accurate data on outcomes (e.g. research on successful surgeries). 
  • Interventions are becoming more common; carefully selected interventions can prolong life for some babies.
  • Families values are important to keep in mind and hopes matter.
Resources for providers:
Resources for families:

New Preconception Collaborative Improvement and Innovation Network on Infant Mortality (CoIIN) Funding 
We are excited to announce CMIH received funding to reduce infant mortality and improve birth outcomes by advancing the status of women's preconception health, particularly for low-income women and women of color in some of the country's most underserved communities.  This funding is one of four cooperative agreements awarded by the U.S. Department of Health and Human Services' Health Resources and Services Administration Maternal and Child Health Bureau (HRSA MCHB) to a national coalition supported by CMIH, the National Preconception Health and Health Care Initiative (PCHHC ). Funding will be administered through UNC School of Social Work and totals $1.4 million over three years.
Supported by and within HRSA MCHB's CoIIN initiative, the Preconception CoIIN team will develop, implement, and disseminate a woman-centered, clinician-engaged, community-supported approach to the well-woman visit. With this funding, CMIH will work with four state teams (California, Delaware, North Carolina, and Oklahoma) to develop adaptable models that effectively integrate preconception care into the well-woman visit - working with clinics to implement validated screening tools and response strategies; enhancing state-level capacity to support effective implementation; and disseminating the model nationally. 

Learn more at: www.beforeandbeyond.org.
PCHHC's consumer preconception campaign, #ShowYourLoveToday  features community voices across it's website and social media.  Click to see more photos!
Take a look at the website HERE, and follow #ShowYourLoveToday on Twitter, Instagram, and Facebook. 
UNC CMIH is Finally Social! 
Connect with us online. Share your work! Stay updated on the latest from CMIH:
You Quit, Two Quit
We are excited to continue and expand our You Quit, Two Quit (YQ2Q) program, which seeks to reduce tobacco use by pregnant and postpartum women by increasing the number of clinics and clinicians who provide evidence-based, comprehensive screening and cessation counseling.  The YQTQ website has been updated  for a more user-friendly experience with new interactive features. There are patient resources, health professional materials, CME opportunities, and details about tobacco cessation/screening technical assistance and training. 
Did you know? Our YQ2Q team offers FREE technical assistance and trainings to providers around North Carolina. If you are interested, please contact:  Erin McClain, MA, MPH at  erin_mcclain@unc.edu  or  919-808-0989.
Perinatal Health and Incarceration in North Carolina

Incarceration and pregnancy presents a myriad of challenges for women, their infants and care providers. The CMIH team is working closely with a team from the School of Social Work and a growing group of clinicians, activists and public health professionals to improve care and well being for these families. Our first meeting, this past summer, focused on building our understanding of perinatal health and incarceration in North Carolina, gathering partners and discussing how to better address this issue. The next meeting is scheduled for December 6th from 2-4pm at the NC Institute of Medicine. Please join us! If you're interested in finding out more, please contact Erin McClain at erin_mcclain@unc.edu .

CMIH Team News
Luana Austin Retires
Luana  has worked with CMIH as a Social Research Assistant on our
Luana Austin
data Division team for 10 years. She is part of a group that reviews labor and delivery records and makes sure that accurate data is entered into the UNC Perinatal Database. This data supports quality improvement and training.  When asked what she was most proud of in her work she highlighted  "being part of a team that assists in making sure women are receiving accurate treatment."  Next it will be wheels up to China and Thailand! Luana will be spending 3 months in Asia visiting her daughter, son-in-law and adorable grandson. We wish her the best of luck!
New Graduate Intern Begins 
This August we welcomed a new social work intern for the academic school year, Morgan Jeter. Morgan is interested in birth outcomes of African American children, parental leave policy, early childhood development and food insecurity. She is in her final year of the MSW program at the School of Social Work and eager to build skills in maternal and child health, evaluation and grant writing. Welcome!
Search Committee Continues
The CMIH team is still seeking a Health Information Director to replace Marshall Clark. We aspire to filling the position before the December holidays. Many thanks to the persistent and dedicated committee let by Alison Stuebe!
Ordering New Patient Education Materials 

If interested in ordering NEW material for either  17P or  You Quit, Two Quit , please visit the NC Division of Public Health,  Women's Health Branch Order Form.
E-Cigarettes &Vaping: Information for Women & Their Families booklet provides information for pregnant women and mothers on the risks associated with e- cigarettes and self-help guidance for quitting.

A new one page handout, addresses the most common questions and concerns that women have identified regarding 17P. (Available in English and Spanish).


There are also new posters for 17P designed to  provide a general preterm birth message to help women who have had a prior preterm birth to initiate a conversation with their healthcare provider. (Available in English and Spanish).

Just Released NC Infant Mortality Data

With the short session of the NC General Assembly coming up in a few short months, the  Child Fatality Task Force is in high gear to review current data and key policy and program issues that related to preventing child death in North Carolina. The Perinatal Health Committee, co-chaired by Belinda Pettiford at the Division of Public Health and Sarah Verbiest, has held two of their three meetings in preparation. The October meeting included presentations by MomsRising on pregnancy and lactation accommodations in the workplace, NC Child and the NC Breastfeeding Coalition on Medicaid coverage of lactation services and UNC Horizons on how to treat women for substance use disorders through evidence-based care. There was also a brief on perinatal funding and a legislative update. The 2016 infant mortality data was released in October and studied at the November 1st meeting. The State Center for Health Statistics prepared a presentation of the data which can be accessed here. Other issues included tobacco cessation, improving the accuracy of birth certificate data and follow ups for congenital health disease newborn screens. The next meeting will be on Wednesday January 24th from 10am to 1pm at the General Assembly. Attendance is open! Learn more about the work of the Child Fatality Task Force and the Perinatal Health Committee here.
  UNC Center for Maternal and Infant Health
Kate Menard & Wayne Price,  Directors
Sarah Verbiest, Executive Director
Alison Stuebe, Research Director
Erin McClain, Assistant Director
Room 3018 Old Clinic Bldg,  Campus Box 7181,  Chapel Hill, NC 27599-7181  
919-843-7865| sarahv@med.unc.edu | https://www.mombaby.org