MotherBaby Network

advocacy and commentary with a focus on Lane County, Oregon

Category Archives: Uncategorized

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.

Midwifery legislation passes OR House

HB 2380 passed in the Oregon House today. See earlier post on 2380 here.

HB 2380 creates a majority of licensed direct-entry midwives on the Oregon Board of Direct Entry Midwives. This is accomplished by reducing the total number of board members from eight to seven. The bill also establishes protected peer review for licensed direct entry midwives. Additionally, the bill requires the Board to collect and report birth data. Outcomes between licensed and unlicensed direct entry midwives will be distinguished in Board reporting.

The bill now goes to the Senate Health Care Committee.  The Oregon Midwifery Council intends to meet with each member of this committee in the next two weeks. Supporters are encouraged to send each of the following committee members letters of support. Letters from constituents are particularly desired.

Frank Morse (Corvallis, Albany, Lebanon, Philomath, Adair Village)
District: 008
900 Court Street NE
Suite S-311
Salem, OR 97301-4068
Phone: (503) 986-1708
Fax: (503) 986-1058
WebSite: http://www.leg.state.or.us/morse/
E-Mail: sen.frankmorse@state.or.us

Chip Shields (parts of North and Northeast Portland)
District: 022
900 Court Street NE
Suite S-421
Salem, OR 97301
Phone: (503) 986-1722
Fax: (503) 986-1080
WebSite: http://www.leg.state.or.us/shieldsc/
sen.chipshields@state.or.us

Laurie Monnes-Anderson (Gresham, Wood Village)
District: 025
900 Court Street NE
Suite S-413
Salem, OR 97301
Phone: (503) 986-1725
Fax: (503) 986-1080
WebSite: http://www.leg.state.or.us/monnesanderson/
E-Mail: sen.lauriemonnesanderson@state.or.us

Alan Bates (Medford, Ashland, Central Point)
District: 003
900 Court Street NE
Suite S-205
Salem, OR 97301
Phone: (503) 986-1703
Fax: (503) 986-1080
WebSite: http://www.leg.state.or.us/bates
E-Mail: sen.alanbates@state.or.us

Jeff Kruse (Roseburg, Gold Beach)
District: 001
900 Court Street NE
Suite S-315
Salem, OR 97301
Phone: (503) 986-1701
Fax: (503) 986-1086
WebSite: http://www.leg.state.or.us/kruse/
E-Mail: sen.jeffkruse@state.or.us

Hospital breastfeeding practices key to moving forward

Media coverage of Pediatrics’ recent analysis concluding that exclusive breastfeeding through six months could save more than 900 babies and $13 billion every year stimulated considerable discussion on the blogosphere this week.

The importance of reforming hospital policy and practice, as I stress in my previous post, figures prominently. Why? Hospitals without consistent, transparent Baby-Friendly practices are the first and, too often, the final barrier to sound breastfeeding initiation. Following are a few favorite posts for your reading pleasure.

Best for Babes: ABC News: Get Your Facts Straight on Costs of Low Breastfeeding Rates

ABC News: “The biggest barrier to mothers continuing to breastfeed seems to be the fact that more mothers are in the workplace,” said Dr. Lillian Beard, an associate clinical professor of pediatrics at the George Washington University School of Medicine and Health Sciences and an assistant professor at the Howard University College of Medicine. [. . . ] ‘I think this report puts an unfair slant on it,’ Beard said. “It’s not taking into account that for almost two thirds of U.S. families, women are either the co-breadwinner or the breadwinner. Returning to work is germane for the survival of the family.” Beard said that while a majority of women may want to breastfeed, outside constraints make it difficult and there is a drop-off in breastfeeding once they have to return to work.

BfB: Actually, the biggest barrier to continuing to breastfeed is not the workplace, but the fact that 70% of hospitals perform poorly on breastfeeding support.   If moms can’t even make it through the first few days without 25% of healthy, full-term babies being unnecessarily supplemented, often against the parents wishes, how are they supposed to continue breastfeeding when they go back to work?   Unnecessary supplementation is a ”booby trap” that undermines the supply and demand mechanics of breastfeeding, wrecks the baby’s latch, gets breastfeeding off to a lousy and often painful start, and is practically guaranteed to make moms want to throw in the towel.   And we don’t blame them.

Blacktating: Study: Lack of Breastfeeding Costs Lives, Billions of Dollars

Blacktating also takes issue with ABC news coverage for featuring Dr. Lillian Beard:

A quick Google search shows that maybe Dr. Beard has more of a stake in this issue than she’d like to admit. See, Dr. Beard is a member of the “Nestle Family“! She serves on their board and answers questions about infant nutrition for their Nestle and Gerber web sites. This is a woman who has been quoted as saying that Nestle’s infant formula is almost as digestible as breast milk. I wonder why ABC left that part out? She’s credited as a professor at both George Washington University and Howard University, no mention of Nestle.

Breastfeeding saw a boost from public policy recently with the “right to pump” provision that mandates that employers with 50 more employees must establish reasonable spaces (other than the bathroom, thank you very much) for women to be able to express breast milk, for up to one year.

Employers are probably next up on most new mothers’ breastfeeding road map…..

RH Reality Check: Got Breast Milk? First We Need Equity.

Even though we spend more, per capita, every year on health care, we rank 37th in infant mortality in the world. According to Momsrising.org, when paid family leave is instituted we see a 25 percent drop in infant mortality rates. One of the reasons? It allows mothers the time to establish a breastfeeding relationship with their new baby.

Breastfeeding saw a boost from public policy recently with the “right to pump” provision that mandates that employers with 50 more employees must establish reasonable spaces (other than the bathroom, thank you very much) for women to be able to express breast milk, for up to one year.

Congress has a role, too….

Perhaps Pediatrics’ findings and the subsequent discussion taking place in Congressional districts across the land will percolate? 90 national and state organizations, including the Oregon Breastfeeding Coalition and the Community Health Partnership – Oregon Public Health Institute, recently requested $15 million per year from Congress to promote and protect breastfeeding mothers’ rights. Here’s the request letter.

Introduction

The majority of U.S. childbearing women and their babies are healthy and at low risk. Among all healthcare sectors, the maternity care system leads the nation in annual hospital charges of more than $86 billion. Much of this money pays for costly and overused childbirth procedures performed on minimal- to low-risk women and newborns. Procedures proven to be safer and less expensive are underutilized. At the same time, women and babies in need of specialized care have insufficient access. In short, there is a gap between contemporary practice and evidence-based care. Most women become consumers of maternity services without knowledge of this gap.

National organizations and leaders across the healthcare system are beginning to grapple with the complex barriers between women and top-quality maternity care. Earlier this year, Childbirth Connection released a framework for revamping care: “2020 Vision for High Quality, High Value Maternity Care System.” The 2020 Vision is powerful for the diversity of participants coming together. Because the nation’s maternal and newborn health indicators are moving in the wrong direction, even as we spend more than any other country, reform is more important than ever before.

As a mother-baby advocate and childbirth educator in training, I look forward to examining and grappling with local barriers to top-quality maternity care in Lane County, Oregon. The good news is that Lane County is blessed with a wide variety of settings and providers for women and families.

That said, Lane County outcomes are not what they should be. Local cesarean rates are at or above national levels, which are more than twice the recommended rate. The Lane County fetal-infant mortality rate is higher than national and state averages. Fetal- infant mortality is a community-wide problem affecting all socio-economic, age and education level groups.

My role is twofold. First, I empower women, the consumers of maternity services, to identify and require mother- and baby-friendly care. Second, I encourage maternity service providers to provide individual-centered and evidence-based care supporting normal birth, bonding and breastfeeding.

Empowerment occurs when a woman sees clearly that her body and her baby belong to her. She is informed and knows she has the right to be in charge of what happens to her body and her babies. She can identify mother- and baby-friendly care, i.e. evidence-based care.  This form of care occurs when practices and statements by providers reflect confidence in normal birth. It occurs in environments in which rare complications are not referenced as normal bridges to unnecessary medical intervention. And, finally, it occurs in settings where women’s desires and feelings are honored. Compliance and complacency are not part of mother- and baby-friendly settings.

Working with women and maternity service providers, I hope to play a positive role in reducing the gap between contemporary practice and what we know to be best for mothers and babies.