MotherBaby Network

advocacy and commentary with a focus on Lane County, Oregon

Category Archives: Medicaid

Stepping Toward A Baby-Friendlier Oregon

Download this entry

The Breastfeeding Coalition of Oregon under the direction of Amelia Psmythe recently hosted its sold-out 5th annual two-day statewide conference – Stepping Toward A Baby-Friendlier Oregon. Supporters who made the conference possible include Oregon WIC, Oregon Public Health Institute, Hygeia, Limerick, and Medical International.

Anyone wanting to know what Oregon’s many infant-feeding stakeholder groups are up to should make a habit of attending. While there is still so much to be done to protect and promote breastfeeding, the following downloadable synopsis of conference presentations will give you a quick bird’s eye view of the excellent and diverse work already underway.

Oregon is fortunate to have an extraordinarily talented cadre of savvy, skilled and committed advocates for quality care. Throughout the state, these advocates promote and protect women’s health, well being and basic human rights spanning the entire arc of their reproductive lives whether at home, in the community, in the health care system, in the economy or as “subjects” of scientific research and inquiry. The BCO annual conference is a good opportunity to check in and rally for the difficult but critical work ahead to achieve breastfeeding’s full-spectrum benefits for the entire population.

Framing the discussion…Presentations and discussion were conceived of and organized to align with the Surgeon General’s Call to Action to Support Breastfeeding (SGCTA). The SGCTA is a federal tool to direct policy, fund activities and align stakeholders around important objectives outlined in Healthy People 2020. Federal, state and local grants and staffing resources are made available and prioritized based on alignment with SGCTA objectives.

The SGCTA to Support Breastfeeding is a ground-breaking document because it is a clear departure  from previous policy and political frameworks that define breastfeeding as an individual responsibility or lifestyle choice beyond the concern, responsibility and reach of government focus. Finally, breastfeeding behaviors and outcomes have been re-defined as the product of cultural norms and structures at all levels of society. Accordingly, public health workers, researchers, employers, health care systems, communities and families are “called to action” to better and more effectively support mothers and babies to breastfeed.

Presentation Synopses. Following is a list of presentations. It gives a wide-angle view of how individuals and institutions are aligning Oregon with the SGCTA. Click here for a version of this post that also includes a synopsis of each presentation.

The Role of Consumer Advocacy in Increasing E-B Infant Feeding Practices
Katharine Gallagher, MPP. Consumer advocate, blogger and independent childbirth educator.
slides
, talk

Let’s Talk! Breastfeeding Education Series Tear Sheet Project
Rachel Martinez, BA, IBCLC, RLC. New Member Training Coordinator at Nursing Mothers Counsel of Oregon, and Legacy Emmanuel Hospital lactation consultant.

The Oregon Black Women’s Birth Survey
Shafia Monroe, Midwife. Founder of the International Center for Traditional Childbearing

Supporting Families the Whole Way: Continuity Care Model
Debbie Alba, RN, IBCLC. Nurse and Lactation Consultant at Good Samaritan Regional Medical Center, currently serving as Western Region Steering Committee Chair

Angie Chisholm, CNM. Certified Nurse Midwife at Samaritan OB/GYN in Corvallis, with a long interest in lactation and evidence-based care.

Oregon WIC Peer Counseling: A Public Health Approach
Kelly Sibley, MPH, RD, IBCLC. Nutrition Consultant and Breastfeeding Coordinator with the Oregon State WIC Program. Coordinates WIC BF peer counselors.

Engaging Community Partners in Breastfeeding Support
Helen Bellanca, MD, MPH. Family physician who has worked with health policy and advocacy for four years, leading insurance collaborative and child care survey.

Lessons Learned on the Way to Baby-Friendly: Providence Newberg
Joanne Ransom, RN, IBCLC. Labor & delivery nurse and lactation consultant at Providence Newberg, former Vice-Chair of Northwest Mothers Milk Bank, new OEBIN co-lead

Redesignation with Baby-Friendly: Strategies for Success
Michelle Stevenson, RN. Perinatal Nurse and former La Leche League Leader, led two CA hospitals to Baby-Friendly designation, and now manages the Women and Newborn Care and Nursery at Kaiser Sunnyside Hospital.

Eliminating Elective Deliveries Prior to 39 Weeks Gestation: OR Challenge
Joanne Rogovoy, Executive Director of the Oregon March of Dimes, and leader of the workgroup that banned early c-sections on Portland area hospitals.

Donor human milk & Northwest Mothers Milk Bank
June Winfield, Board Chair / Director

Breaks for Nursing Mothers are Federally “Reasonable”
Amelia Psmythe, Director of the Breastfeeding Coalition of Oregon and West Region Coalition Representative to the United States Breastfeeding Committee.

Nursing Mothers Counsel Workplace Lactation Support Program
Marion Rice, Ed.D. 25 year educator, currently leads the Nursing Mothers Counsel of Oregon Worksite Lactation Support Program

What Do Women Really Want? A 21st Century Mother’s Movement
Andrea Paluso, MSW, MPH. Co-founder of Family Forward Oregon, The Mother PAC, and recent graduate of the Emerge Oregon legislative mentoring program.

Breastfeeding Outcomes in Women with a Prior History of Cesarean Section
Cathy Emeis, PhD, CNM. A nurse-midwife and researcher at OHSU, Cathy’s current research examines the impact of birth interventions and c-section on breastfeeding.

Breastfeeding Coalition of Oregon: Northwest Edge of the Wave of Change
Amelia Psmythe, Director of the Breastfeeding Coalition of Oregon and West Region Coalition Representative to the United States Breastfeeding Committee

US Breastfeeding Committee Annual Report
Robin Stanton, MA, RD, LD. USBC Past-Chair and Nutrition Consultant with OR Department of Human Services, Public Health Division

Collaboration for Collective Impact
Amelia Psmythe and Robin Stanton, MA, RD, LD

Share

Oregon Health Plan applications should be expedited for pregnant women

Low-income pregnant women in Oregon experience too many delays in completing the Oregon Health Plan application process. These delays run counter to Department of Human Services policy requiring applications by pregnant women be expedited and processed within two business days. DHS branches must have or develop a specific process for expediting applications made by pregnant women.

Inadequate prenatal care is linked to increased risk for low birth weight, prematurity and infant and maternal mortality. Lane County fetal-infant mortality data for the period of July 2007 to June 2010 shows than 34% of affected families accessed prenatal care after the first trimester.

In an effort to minimize delays stemming from policy non-compliance, DHS has sent a policy transmittal to case workers and eligibility workers who process OHP applications. The transmittal reiterates and clarifies existing policy that until now has had variable degrees of implementation. Women can verify pregnancy with an informal note from a medical clinic or crisis center. Neither a note from a doctor, nor an ultrasound are required – though an ultrasound may be used for verification purposes.

“Emergent medical needs, and those who are pregnant, have priority when processing applications for medical. They do not need to disclose the basis of their emergent need. The application should be pended, approved or denied by the eligibility worker within one business day whenever possible.” – DHS transmittal

Pregnant women can print and bring this transmittal with them when applying for OHP. Regardless of a woman’s plans for her pregnancy, she is entitled to have her application expedited. If a woman planning to terminate her pregnancy encounters delays, this should be reported to the Network for Reproductive Options (NRO).

Special thanks to Representative Mitch Greenlick for providing legislative intern Jessica Matthews, MPH, the opportunity to work on this issue. Matthews worked with the Oregon Health Authority to clarify and communicate the correct policy. Thanks, too, to Bayla Ostrach for sharing the data from her master’s thesis that found low-income pregnant women in Oregon experience notable delays in the OHP application process.

Wider awareness of this policy can help to further eliminate bureaucratic barriers to pregnant women seeking access to care – spread the word. If you have a website or blog, post the DHS transmittal.

Lane Co’s extends prenatal to women ineligible for OHP due to immigration status

Following six other counties, Lane County is implementing Oregon’s Prenatal Expansion Program to provide Oregon Health Plan (OHP) Plus Prenatal services to pregnant women who have “Citizen / Alien Waived Emergency Medical” (CAWEM) coverage.

Expansion of CAWEM coverage to include prenatal care is made possible through the federal Children’s Health Insurance Program (CHIP) that allows States to serve the unborn children of women who would be Medicaid-eligible except for immigration status. Oregonians access Medicaid through OHP.

The CAWEM Plus prenatal benefits are the same as OHP Plus with four exceptions: sterilizations, therapeutic abortions, hospice care services and death with dignity services. Maternity coverage ends at delivery, unless postpartum services are provided through a bundled (packaged) rate. The newborn will be enrolled in OHP Plus for one year of automatic eligibility.

Providers accepting OHP can now serve CAWEM Plus clients. For more information, see the Provider Alert Sheet (includes Spanish-language description) and Quick Facts. Clients can enroll at any Department of Human Services site.

Share

Project Aims to Improve OR Hospital-Based Breastfeeding Services

With funding support from Oregon WIC and Multnomah County Health Department, the Breastfeeding Coalition of Oregon (BCO) recently launched a new statewide project – Oregon Hospitals Partnering for Evidence-Based Infant Nutrition. This project supports hospitals in developing the evidence-based systems associated with increased rates of breastfeeding.  The project aims to promote evidence-based hospital maternity practices related to breastfeeding by offering technical assistance, convening a spring 2011 hospital summit, and supporting the formation of a hospital collaborative learning community.

Lane County’s Desiree Nelson joins the project’s four-member team:  BCO Director Amelia Psmythe, Helen Bellanca, MD, MPH, Rachel Burdon, RN, MPH, and Mary Lou Hennrich, RN and Executive Director of Oregon Public Health Institute (OPHI).  Oregon WIC allocated federal funds for increasing breastfeeding rates through outreach to hospitals. Locally, Nelson is well known for co-founding Baby Connection, a phenomenally successful live demonstration of Baby Friendly step 10:

Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

Arriving early and leaving well after closing time, families and babies consistently demonstrate the very real but unmet demand for weekly, drop-in evidence-based lactation support in the weeks and months following birth.

Key Backers

The BCO’s parent organization, the Oregon Public Health Institute recently formed an innovative working group for health insurers – the Oregon Health Insurers Partnering for Prevention (OHIPP). The first of its kind in the nation, OHIPP is a collaborative obesity prevention effort between health plans and public health policy advocates.

Currently, six health insurers participate in OHIPP – representing 65% of private insurance and 45% of Medicaid. Insurers contribute money to fund selected interventions. Because breastfeeding is increasingly associated with reduced risk of childhood obesity, OHIPP has selected increasing breastfeeding rates as its first collaborative public health intervention.

OHIPP’s direction could have a huge impact on breastfeeding practices in Oregon. Imagine, for example, the impact of a reimbursement system in which rates for births were higher for hospitals certified as evidence based by the Baby Friendly Hospital Initiative. This type of innovative intervention conveys the importance of becoming evidence based and signals growing understanding that evidence-based care is preventive and effective in the long run.  In this scenario, hospitals would be incentivized to seek support and resources like those the BCO is offering through this project.

Additional critical support for evidence-based breastfeeding services comes from the Oregon Association of Hospitals and Health Systems (OAHHS). A recent OAHHS membership survey indicates 85% of nurse managers are aware of the gold standard for evidence-based breastfeeding support systems – the Baby Friendly Hospital Initiative. 39% want technical assistance and support on Baby-Friendly 10 Steps. Plans are underway for OAHHS to partner with the BCO to co-brand educational opportunities and communicate the importance of evidence-based breastfeeding support to its membership.

Hospital Outreach

The Oregon Hospitals Partnering for Evidence-Based Infant Nutrition project is in the initial outreach phase to hospitals and health system leaders. Interested hospitals are encouraged to begin forming multi-disciplinary teams for the purpose of assessing current internal practice. Representatives from these teams will be invited to participate in a Spring 2011 summit for a day of education, group facilitation and collaboration. Participants will be encouraged to form an ongoing network of communication between their facilities, to support the path toward institutional change.  Interested hospitals should contact Amelia@breastfeedingOR.org or Desiree@breastfeedingOR.org for more information.

Lane County’s PeaceHealth Nurse Midwifery Birth Center is one of four Baby Friendly Hosptial Initiative-designated facilities in Oregon. Community and consumer support for moving the birth center from downtown Eugene to the new Sacred Heart Medical Center campus in Springfield were centrally linked to the unwavering demand for ongoing access to evidence-based breastfeeding services. Judging by the outcomes and immense demand for these services, making them available at the county’s two leading hospitals, Sacred Heart Medical Center (SHMC) and McKenzie-Willamette Medical Center would be a tremendous boon for families and communities.

Next week, Lane County Friends of the Birth Center will release results from a recent survey taken by more than 100 local women and families describing their experiences evidence-based breastfeeding services at the PeaceHealth Nurse Midwifery Birth Center. Demonstrating the connection between evidence-based services and consumer satisfaction, LaneCoFBC intends the survey to encourage all Lane County hospitals to achieve the Baby Friendly designation. For a copy of the survey, email lanecofbc@gmail.com. (Click here to access the survey.)

Progress already

Locally, there is positive discussion of SHMC RiverBend Labor and Delivery staff’s recent innovative and successful introduction of uninterrupted skin-to-skin contact immediately following birth. Providing skin-to-skin as standard care is a very positive development because it is bedrock practice for developing evidence-based breastfeeding services. Babies placed skin-to-skin with their mother are more likely to be breastfed and to breastfeed for longer.

Having SHMC Labor and Delivery staff describe how front-line practices and internal systems have been altered to bring more evidence-based care to the floor is an example of useful information that could be shared at the upcoming Spring 2011 summit hosted by the Oregon Hospitals Partnering for Evidence-Based Infant Nutrition project. Attending health professionals would return to their respective hospitals with a concrete, doable action for improving mother-baby breastfeeding outcomes.

Writing on the wall

Discussion of evidence-based breastfeeding care is a roundabout way of saying hospitals should identify ways to understand and implement Baby-Friendly practices. Savvy hospitals understand consumers, legislators, government agencies, the business community and accreditation bodies have connected hospital-based breastfeeding practices with the success mothers and babies have in the months following discharge.

Perusal of the following links demonstrates a trend toward adoption of Baby Friendly language for discussions of evidence-based care. They also demonstrate large-scale convergence around breastfeeding as a top-ranking major objective in health care.

  • The Joint Commission’s new perinatal care core measure set includes exclusive breast milk feeding

The question hospitals must answer about breastfeeding services is no long whether or not to become evidence based but (1) how to do it and (2) how to demonstrate that it is being done. Because Baby-Friendly is the established and universal standard for effective breastfeeding care, pursuing and maintaining this designation answers both questions in the most expedient manner. The project’s greatest potential value to hospitals lies in the efficiencies it can generate through developing models of collaboration for identifying and removing barriers to reform. The potential for idea sharing and cost sharing for staff training and education increases significantly with each hospital’s commitment to participate.

To learn more, contact Amelia@breastfeedingOR.org or Desiree@breastfeedingOR.org for more information.

Tags, categories, share button


Share

Maternity Act – doing right by pregnant women and babies, everyone benefits

Despite mounting evidence to the contrary, bipartisan efforts aren’t dead in Washington, D.C. Just before Thanksgiving, Congressman Elliot Engel (D-NY) and Congresswoman Sue Myrick (R-NC) filed the Partnering to Improve Maternity Care Quality Act of 2010 (MCQA). This act begins the necessary work to remove the multiple, interlocking barriers separating women and babies from effective care.

MCQA is a prudent and overdue response to several years’ worth of reports and media coverage of the appalling disparities in access and outcomes for mothers and babies across and within communities in this country. Amnesty International’s Deadly Delivery: The Maternal Health Care Crisis in the USA is the latest report. Inside these reports are the details of our embarrassingly high national maternal mortality and infant maternal mortality rates. The most tragic of outcomes, these mortalities are a “canary in the mind shaft.”

62 Lane County babies lost before first birthday

Lagging behind 40 to 50 nations, including all other industrialized nations, the country’s infant mortality rates are evidence of far too many tragic and suboptimal outcomes for a country of our resources and standing. This is especially true given that US per-capita spending far exceeds that of any other country on the planet. Locally, Lane County’s fetal-infant mortality rate leads the state – 62 babies were lost before their first birthday from July 1, 2007 to June 30, 2009.

We’re talking serious money and not enough to show for it

The federal government has a big interest in seeing better outcomes for mothers and babies. Annually, 4.2 million babies are born in the US. Medicaid pays for more than 40% of all maternal hospital stays. Put another way, over half of hospital discharge bills going to Medicaid are for childbearing women and newborns. This adds up to a $39 billion dollar business. It’s reasonable to expect a better than below 40 ranking for this kind of investment.

MCQA does three things:

1. Develop a maternity care quality measurement program

Specifically, a complete set of national, evidence-based, quality consensus measures to assess processes, outcomes, and the value of maternity care provided to Medicaid and CHIP (Child Health Plus) beneficiaries will be developed.

2. Identify payment mechanism improvements

A national demonstration project to identify and evaluate emerging payment reform mechanisms that actually support high-quality, high-value care will be created. An example would be bundled payment for a complete care provided to women and newborns.

3. Identify essential evidence-based maternity care services

The Institute of Medicine will be authorized to identify a package of essential evidence-based maternity care services for childbearing women and newborns.

Creating and bringing each of these components to bear on our under-performing maternity care system would go a long way toward providing early prenatal care, effective breastfeeding support, stemming the tide of induction-driven preterm births and the cesarean epidemic and so much more.

More than a chit for motherbaby advocates

MCQA is much more than a boon or chit for motherbaby advocates. Rather, it fits part and parcel with all other efforts to move national and local economies beyond recession. Healthier women and babies mean stronger families, workforces and communities. Women now make up a majority of the paid workforce. Never have employers and government had a more obvious reason to support maternity care reform.

Don’t you think DeFazio should co-sponsor?

Let’s encourage Congressman DeFazio to co-sponsor MCQA. Send him a message using his email form. Be sure to refer to MCQA by its bill number: H.R. 6437. Feel free to copy and paste a link to this blog in your message.

Some media coverage please…..

As a final thought and in addition to legislative action, serious and ongoing local Lane County coverage of these bedrock issues affecting the well being of women and babies would be helpful. Despite high fetal-infant mortality rates in Lane County, community-level coverage has been scant at best.

The Sacramento Bee’s recent coverage of its local fetal-infant mortality rate is a positive and productive example of the kind of coverage needed in Lane County. The Bee article gets beyond the numbers to put a human face on the complicated but addressable issues contributing to the unnecessary suffering and loss of life.  Here’s hoping we see better (any?) coverage from, among others, The Register Guard, The Eugene Weekly and KLCC in 2011.