FROM THE NACHC LENS

Taking Action to Reduce Maternal Mortality and Improve Postpartum Health

Health centers are the primary and prenatal care providers for many people who are disproportionately affected by maternal health complications.

To improve health outcomes, NACHC, Maternal Mortality Review Committees (MMRCs), and Perinatal Quality Collaboratives (PQCs) around the country are learning how health centers are strengthening prenatal and postpartum care and coordination across the maternal health continuum. To reduce disparities in care and advance MMRC recommendations, health centers are also taking a deep dive into maternal health data from different sources for creative programming and partnerships that are improving the lives of pregnant persons and reducing preventable deaths. 

Five Rivers Health Centers’ Data-Driven CALM Program Drives Up Baby Birth Weights

“We are the second largest FQHC obstetrics practice in the state and are very focused on delivering high quality care and positive outcomes for our patients and their new babies," says Gina McFarlane-El, CEO, Five Rivers Health Centers, Dayton, OH. “But year over year, proportionally we had the worst low-birth weight rates among all 59 Ohio FQHCs. We knew we had to do something about it, so we became super data-focused to create some much needed actions.”  

In February and March 2023, McFarlane-El pulled together a Brain Trust of certified nurse midwives (CNMs), care managers, nurses, quality managers, educators, and center managers to dive into the data. They found that people who delivered low-birth weight babies had one or more of the following risk factors: hypertension, tobacco use, marijuana use, depression or anxiety, and/or a sexually transmitted infection. They also found another trend. Babies with low birth weights that were not under the care of one of their CNMs tended to have a smaller abdominal circumference at their 20-week ultrasound. 

“We knew that we could not do everything for everyone, and most of our patients were likely going to have one of the modifiable risk factors,” explains Toni Tipton, a Five Rivers Health Centers' CNM. “So, we focused on prenatal patients with at least one of these risk factors whose babies’ abdominal circumference was at least 40% below average at the 20-week ultrasound.” Clients who fall into this very high-risk group are placed under the care of a CNM and enrolled into Compassionate and Loving Maternal Care (CALM), a new intensive wrap-around services program. In other words, keep calm and call the midwife. 

The goal of CALM is to keep the patient calm. “We focus on their health and pregnancy, the health of their growing baby, and work to alleviate the stressors that can impact their health that includes, but also goes beyond, social determinants of health challenges,” says Tipton.  

The combination of CALM and midwifery care is working. In 2023, the health center's UDS data reported that an average of 10.8% of newborns had a low birth weight vs. 14.9% in 2015 or 12.8% in 2021. By February 2024, 11 new CALM babies were delivered, and none had a low birth weight.

Compassionate And Loving Maternal Care (CALM)

Program Components

• Clinical pharmacy consult
• Community health worker
• Dietician consult
• Marijuana Cessation Program for Pregnant Women (The Herb Cessation Program)
• Monthly massage therapy
• Social Drivers of Health (SDOH) interventions (e.g. transportation, food insecurity, intimate partner violence, social isolation)

ACCESS Westside Healthy Start: Closing the Postpartum Care Gap

“We often hear moms of newborns say their focus needs to be on the new baby. We are here as a reminder to say, ‘no we need you to focus on you,’ and we are helping moms do just that,” says Timika Anderson Reeves, PhD, LSW, Director, Maternal Child Health & Women’s Health and Community Integration, Access Community Health Network (ACCESS), Chicago, IL. Within ACCESS' Obstetrics and Midwifery practice, Dr. Reeves oversees the ACCESS Westside Healthy Start program. 

Healthy Start is a national initiative started in 1991 to improve health outcomes before, during, and after pregnancy with postpartum care offered up to 18 months for community's high-risk maternal health clients. Currently, Healthy Start supports 101 projects across the country including nine FQHC. Local projects provide: 

• Prenatal and post-partum care, screenings, and referrals to services for depression and interpersonal violence
• Outreach and case management to link parents with social services and educational programming, such as parent skill building
• Public health services, such as immunizations and health education
• Continuing education and training on best practices for health center staff and community partners  
• 
  

For over 25 years, ​​​​the ACCESS Westside Healthy Start program has served thousands of birthing people from some of Chicago’s most medically and socially high-risk communities. ​​​​The network’s Healthy Start project serves on average 600 women (300 in prenatal and 300 in postpartum care) every year. Between 2022 and 2023​,​ its obstetrics team ​completed​ 7,700 prenatal visits and 3,500 postpartum visits. ​​​​ 

To provide enhanced support to clients including those in the ACCESS Westside Healthy Start program, ACCESS created several strategies to create stronger connections and continuity with birthing patients across the maternal health continuum. “The human connection made during the prenatal phase helps to strengthen our bond and engagement during the postpartum periods,” says Dr. Reeves. These maternal health focused strategies include:  

• Postpartum care management services – Community Health Specialists work with patients during the postpartum period to address SDOH challenges and other stressors common among higher at-risk moms. 

• Establishing multiple postpartum patient touch points – Along with every well child visit, postpartum patients enrolled in the Healthy Start program also meet with a care team member. These touch points allow care members to conduct maternal depression screenings, establish a reproductive health plan, and reconnect patients back to their primary care provider. 

• Preparing prenatal patients early for labor, delivery, and postpartum care – ​​A nurse care coordinator begins working with high-risk prenatal patients (e.g. those with hypertension or gestational diabetes) during their second and third trimester to prepare them for labor and delivery. They also partner with them to transition care back to their primary care provider.

• Designing postpartum care plans – Whether patients are returning to school or work or staying-at-home, Community Health Specialists help postpartum patients navigate their needed services, and establish care plans, which helps them transition out of the Healthy Start program. 

• Accessing patient benefits – ACCESS Patient Benefit Specialists and additional care team members support patients to leverage available maternal health resources.

• Hospital partnerships – By securing labor and delivery privileges at many Chicago area hospitals and utilizing the Care Everywhere Link to exchange hospital delivery data, patient information remains consistent through electronic health records.

“One thing we have learned is to leverage our partnership and resources. No one program can do everything, but as a strong care team we can do a lot,” says Dr. Reeves. For example, in 2023, the infant mortality rate among their Healthy Start patients was 4.5 per 1000 births. The community area’s death rates of newborns is 8.03 deaths per 1000 births. 

With the support of a dedicated care team, the ACCESS Westside Health Start program is able to improve the health outcomes of both the mother and baby. They partner with community members to reduce infant mortality rates on the West side and empower families to create stronger, healthier communities. 

HEALTH CENTER SPOTLIGHT

Gina McFarlane-El

Founder and Chief Executive Officer

Five Rivers Health Centers

RESOURCES

NACHC is working with partners including MMRCs, PQCs and health centers to follow MMRC recommendations to address gaps in data, postpartum care, and linkages for improved maternal health programming and coordination.  

NACHC is also working with HCCNs and health centers to create new and ideally interoperable electronic health record systems and workflows to track key measures for postpartum health, such as mental health and gestational diabetes.

Learn more about these projects here. 

Watch Empower Health Center Staff to Raise Awareness about Urgent Maternal Warning Signs: Tap Into the CDC Hear Her® Campaign.