Session

Innovations in Maternity Services Poster Session

APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)

Abstract

Prenatal Care Health Behaviors among Pregnant Women

Na'Tasha Evans, Ph.D., M.Ed1, Kimberly McBride, PhD, MA2, Jiunn-Jye Sheu, PhD, MSPH, MCHES2 and Shipra Singh, MBBS, MPH, PhD2 (1)Kent State University, Kent, OH, (2)University of Toledo, Toledo, OH

APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)

BACKGROUND: Access to prenatal care is an important determinant of successful pregnancy outcomes. A barrier to prenatal care may be poor provider communication. Unfortunately, there is very limited research focusing on patient provider communication and prenatal care. This research study aims to bridge the gap by using qualitative methodology to gain a better understanding of pregnant women’s experiences regarding a range of communication practices and interactions with their prenatal care provider. METHODS: Face-to- face interviews were conducted among pregnant women (18-45 years) in their second or third trimester (n=30) who were receiving prenatal care from various community clinics and health care systems in Lucas County, Ohio. The resulting qualitative data were systematically coded and analyzed to identify themes related to prenatal care and a range of communication practices and interactions. RESULTS: The overarching theme was satisfaction, which was influenced by the overall quality of the encounter and health care system influences. Within the overall quality of the encounter, factors that influence decision-making and communication practices were influential in determining patient’s satisfaction with their prenatal health care provider. In regards to health care system influences, continuity of care, referral for resources, information obtained from another source, and other employee encounters influenced satisfaction with prenatal care. CONCLUSION: Our work identified range of communication practices and interactions that influenced satisfaction among pregnant women. Incorporating findings from this study to improve patient satisfaction during prenatal care visits could provide an increase understanding of many complex variables affecting prenatal care.

Public health or related education

Abstract

Happy women during perinatal periods in Taiwan: A trial to examine effects of the positive emotion intervention

Shin-Yow Chang, Ph.D1, Yi-Ting Chen, MS2, Ya-Zhu Lin3 and Yi-Hua Chen, Ph D3 (1)National Open University, New Taipei City, Taiwan, (2)National Taiwan Normal University, Taipei, Taiwan, (3)Taipei Medical University, Taipei, Taiwan

APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)

Background: Almost none of previous studies has adopted a controlled design to examine the effects of the positive emotion intervention (PEI) among women during the critical perinatal periods. In this controlled trial, we aimed to assess the effectiveness of a group PEI program on depressive symptoms and feelings of happiness for perinatal women. Methods: Participants of the PEI program were selected from the Longitudinal Examination Across Prenatal and Postpartum Health in Taiwan (LEAPP-HIT) project. A total of 30 women in PEI, together with 30 controls matched on maternal age and perinatal stage from 2014 to 2015 in selected hospitals in Taiwan were recruited. Women in PEI attended an 8-hour course within three weeks and were followed four times up to six months after PEI together with controls. The Edinburgh Postnatal Depression Scale and the Chinese Happiness Inventory were used, with repeated-measures analyses being performed. Results: We found significant decreasing trends on depression scores along time for women in the PEI program (from 9.9 before PEI to 6.5 six months after PEI, p<0.001). The feelings of happiness significantly increased from 27.7 before PEI to 29.3 two weeks after PEI, p=0.049). Nevertheless, the effects of PEI might lessen along time. High course satisfaction was reported for women in PEI group. Conclusions: We suggested beneficial short-term effects of PEI in decreasing levels of depression and promoting feelings of happiness for perinatal women. Maternal positive emotions may be an important theme to target on in promoting maternal and consequent child health.

Conduct evaluation related to programs, research, and other areas of practice Epidemiology Implementation of health education strategies, interventions and programs

Abstract

Improving the Readiness, Recognition, and Response to Hypertension in Pregnancy in Florida

Emily Bronson, MA, MPH, CPH1, Annette Phelps, ARNP, MSN2, Paige Alitz, MPH, CPH3, Judette Louis, MD, MPH4, Linda A. Detman, PhD1 and William M. Sappenfield, MD, MPH1 (1)University of South Florida, College of Public Health, Tampa, FL, (2)University of South Florida, Lawton and Rhea Chiles Center for Healthy Mothers and Babies, Tampa, FL, (3)University of South Florida, Tampa, FL, (4)University of South Florida, Morsani College of Medicine, Tampa, FL

APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)

Background Hypertension is a leading cause of maternal mortality in Florida; these deaths pose significant prevention opportunities. The Florida Perinatal Quality Collaborative (FPQC) led a state-wide quality improvement (QI) project on Hypertension in Pregnancy (HIP) to assist hospitals in implementing nationally recommended best practices from the Alliance on Innovation in Maternity Services (AIM) safety bundle to improve recognition, readiness, response, and reporting on HIP. Methods 32 Florida hospitals enrolled to improve hospital processes, structure, and outcomes. Hospitals received change implementation tools, trainings, education materials, personalized technical assistance, and monthly collaborative learning webinars. Hospitals submitted data on key measures through REDCap and received monthly QI data reports to track their progress and promote on plan, do, study, act cycles. Results After a year of project implementation, hospitals have audited more than 1700 cases of severe new-onset hypertension. Hospitals improved treating women within 1 hour of identified acute elevated blood pressure (baseline median of 24% to 67% in the fourth quarter of 2016) and providing women with discharge education on HIP (20% to 100%). A median of 80% of women had follow-up appointments scheduled in appropriate timing for these patients in Q4. At baseline, 7% of hospitals were debriefing any cases of severe hypertension; 55% of hospitals were debriefing cases in Q4. Recommended hospital structural measures, such as HIP protocols, also significantly increased. Conclusions The Florida HIP initiative showed significant improvement in hospital implementation of the AIM safety bundle. The FPQC model was effective and may inform other hypertension hospital-based QI projects.

Administer health education strategies, interventions and programs Clinical medicine applied in public health Implementation of health education strategies, interventions and programs

Abstract

Peer mentor home visitation model improves outcomes in Hispanic women and their infants: Results from a randomized clinical trial

Melanie Lutenbacher, PhD, MSN, FAAN, Tonya Elkins, MSSW and Mary S. Dietrich, PhD Vanderbilt University, Nashville, TN

APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8) Maternal Infant Health Outreach Worker (MIHOW) is a home visiting program that utilizes peer mentors to improve maternal/child health outcomes in underserved communities. Findings are presented from a single site randomized clinical trial (RCT) testing the efficacy of MIHOW in a sample of Hispanic women in Tennessee assigned to either a minimal intervention (MI) group (receipt of educational materials) or MIHOW group. A total of 188 pregnant, Hispanic women were enrolled and randomly assigned (MI=94; MIHOW=94), and 178 women completed the study (MI=87; MIHOW=91). Bilingual staff conducted individual interviews at: enrollment; 35th week gestation; 2 weeks; and 2 and 6 months postpartum. Standardized measures were used to assess maternal and infant health outcomes. Statistical analyses were conducted using intention-to- treat principles. Average age at enrollment was 29.6 years (SD=6.5). Most women reported Mexican heritage (66.9%), < a high school education (80.6%), never marrying (56.7%), and incomes <$,000 (96.6%). Groups were similar at enrollment. Positive, statistically significant (p<.01) effects of MIHOW were observed on levels of depressive symptoms and parenting stress, breastfeeding self-efficacy and exclusivity, safe sleep practices, and stimulation to the child in the home. Results expand limited empiric evidence and provide support of the effectiveness of MIHOW to reduce stress and depressive symptoms in Hispanic mothers and improve stimulation and safe sleep practices for their infants. MIHOW is a viable option for immigrant and underserved families. Understanding culturally appropriate ways to address maternal depressive symptoms and stress is crucial to optimizing infant health outcomes.

Conduct evaluation related to programs, research, and other areas of practice Diversity and culture

Abstract

Supporting Home Visitation of Mothers and Children in Need: The Essential Role of Family Support Workers

Ndidi Amutah, PhD, MPH, CHES1, Monica Rodriguez, MPH2 and Christine Thorpe, EdD, EdM, CHES (1)Montclair State University, Upper Montclair, NJ, (2)Montclair State University

APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)

Background: Home visitation programs improve the health of children in families at greater risk for adverse outcomes. DRU/Mondawmin Healthy Families Inc. (DRUM) provides families with quality support through parent training, resources and referrals to other programs for the child and parents. DRUM utilizes the Healthy Families America curriculum. Methods: Focus groups were conducted with DRUM program participants and family support workers (FSWs) to understand the impact the services have on families as well as the barriers to care and recommendations. Results: DRUM families described their needs from the program regarding housing and employment assistance. Additional needs include education on child development and parenting/life skills, improved community relations, mental health services and adaptation of the program curriculum. Recommendations mentioned by FSWs to improve service delivery were financial resources, workload reduction, support from local public health officials and demonstrating appreciation for their work. Conclusions: The strengths of the DRUM home visitation services demonstrate the need for continued facilitation of the program. DRUM empowers families by improving access to care. By providing low-income families the resources and training to succeed in life, health equity can be improved. FSWs seek opportunities to modify their program curricula to better engage DRUM families and provide them with quality and competent services.

Administer health education strategies, interventions and programs Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Other professions or practice related to public health Planning of health education strategies, interventions, and programs

Abstract

Innovative Perinatal Program Reduces Postpartum Relape in Women with Opioid Dependence Disorder Amanda Fallin-Bennett, PhD, RN1, Kristin Ashford, PhD, WHNP-BC, FAAN2, Michelle Lofwall, MD3, Agatha Critchfield, MD4, Amanda Wiggins, PhD5, Nancy Jennings, RN5 and Niraj Chavan, MD, MFM6, (1)University of Kentucky, Lexington, KY, (2)University of Kentucky College of Nursing Perinatal Research and Wellness Center, Lexington, KY, (3)University of Kentucky, College of Medicine, Lexington, KY, (4)University of Kentucky College of Medicine, Lexington, (5)University of Kentucky College of Nursing, Lexington, KY, (6)University of Kentukcy College of Medicine, Lexington, KY

APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)

Objective: Opioid use dependence (OUD) is a national epidemic. Pregnant women with OUD are less likely to receive recommended prenatal care, and are more likely to have adverse maternal and infant health outcomes. This study was undertaken to evaluate the impact of a multidisciplinary prenatal medication assisted treatment (MAT) program on postpartum relapse among opioid dependent pregnant women. Design: This was a prospective longitudinal study and key treatment components include MAT, nurse- facilitated prenatal addiction group sessions (weekly-bimonthly), and individual counseling sessions. A validated urine assay was used to confirm illicit drug use at each prenatal appointment, at birth and 2, 4 weeks post-delivery. A positive urine test result (other than buprenorphine) indicated illicit drug use. Results: Nearly all women (93%) were using tobacco at delivery. Among participants, 66%, 69% and 67% had a negative urinary drug screen at delivery, 2- and 4-week follow-ups. Of those who had a negative UDS at delivery, 94% had a negative result at subsequent visits. Controlling for maternal age, parity and final buprenorphine dose, increased attendance at nurse-led group sessions were significantly associated with decreased risk for relapse to illicit drugs at delivery (p=.041) and 2- weeks (p=.007) and marginally associated at 4- weeks (p=.054) after birth. For every one-session increase, women were 13%, 18% and 11% more likely to have sustained recovery at each follow-up period. Conclusion: Women with OUD receiving comprehensive care including MAT and nurse-facilitated prenatal addiction group sessions are less likely to relapse to illicit drugs during and after birth.

Administer health education strategies, interventions and programs Implementation of health education strategies, interventions and programs Public health or related nursing

Abstract

Mother-Infant Contact in the First Hours of Life to Support Breastfeeding — United States, 2009 - 2015

Ellen Boundy, RN, CNM, ScD1, Ruowei Li, MD, PhD1 and Heather Hamner, PhD2 (1)Centers for Disease Control and Prevention, Atlanta, GA, (2)Centers for Disease Control and Prevention, Chamblee, GA

APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)

Background: Helping mothers initiate breastfeeding within an hour of birth is one of the Ten Steps to Successful Breastfeeding supported by the World Health Organization and UNICEF. Mother-infant contact after birth increases the likelihood of breastfeeding initiation and duration. This study examines trends in maternity practices related to early postnatal contact between mother and infant. Methods: Data were from the Maternity Practices in Infant Nutrition and Care (mPINC) surveys (2009 – 2015), a biennial assessment of all US maternity facilities. Facilities reported how often patients experience mother-infant skin-to-skin (STS) contact for ≥30 minutes within one hour of uncomplicated vaginal birth and two hours of uncomplicated Cesarean birth, how often routine infant procedures are performed while STS, and whether healthy breastfed infants and mothers are routinely separated for transition to postpartum care. Results: The percentage of facilities reporting that ‘Most (≥90%)’ women experienced early STS increased from 2009 to 2015 following both vaginal (43.3% to 83.0%) and Cesarean (32.4% to 69.9%) births. The percentage of facilities reporting routine infant procedures were performed ‘Almost always (≥90%)’ while mother and infant were STS increased from 20.1% to 49.5% (vaginal births) and from 2.2% to 10.7% (Cesarean births). The prevalence of mother-infant separation during transition decreased from 43.0% to 20.5% (vaginal births) and from 76.7% to 46.5% (Cesarean births). Conclusions: Significant progress has been made in increasing the number of women and infants experiencing early postnatal contact between 2009 and 2015. Continued efforts to support maternity practices related to breastfeeding initiation are needed. Epidemiology Provision of health care to the public Public health or related research

Abstract

SisterFriends-Detroit: I am my Sister’s Sister

Leseliey Welch, MPH, MBA1, Yolanda Hill-Ashford, MSW1, Bianca Lawrence, MPH1 and Stephanie Young, BA2 (1)Detroit Health Department, Detroit, MI, (2)City of Detroit Mayor's Office, Detroit, MI

APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)

Black babies in Detroit are two times more likely to die before their first birthday than other babies in Michigan. Although there are more than 100 infant mortality reduction programs in Detroit, the Black-¬White infant mortality disparity persists. In winter 2017, the Detroit Health Department launched SisterFriends- Detroit, a volunteer effort to encourage better birth outcomes by providing practical support to women and their families during pregnancy and one year after the birth of their children. Volunteer mentors, called SisterFriends, support and care for pregnant moms (“Little Sisters”), helping moms overcome obstacles to accessing existing perinatal care services. The first project created to serve an entire city; SisterFriends Detroit aims to reach 6500 women over three years by employing three strategies: community partner sites, kitchen table projects, and creation of a virtual community. At each step in development, expansion, and scaling, ownership of the initiative shifts further from the Detroit Health Department and closer to the community. The model leverages the community as its best asset, Detroit’s robust network of maternal child health providers, collaboration with the Mayor’s Office, and dedicated financial resources to support healthier mothers, infants, and families. It is anticipated that with robust evaluation and demonstrated impact, SisterFriends- Detroit and the Birthing Project Model of “SisterFriending” can be adapted and scaled through local health departments in other cities. SisterFriends Detroit is a part of the Birthing Project USA network.

Administration, management, leadership Planning of health education strategies, interventions, and programs Systems thinking models (conceptual and theoretical models), applications related to public health