MotherBaby Network

advocacy and commentary with a focus on Lane County, Oregon

Tag Archives: Healthy Babies

Stepping Toward A Baby-Friendlier Oregon

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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
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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

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Lane Co’s High Fetal-Infant Loss = Lost Economic Investment

Recently I was listening to Marketplace’s Kai Ryssdal interview a Russia-based NPR health correspondent about the intersection between health and economic prosperity. Much of their discussion applies nicely to Lane County’s poor perinatal outcomes and our prospects for future economic growth and diversification.

Russia, like Lane County, faces a number of complex public health issues that significantly dampen prospects for attracting investors. Increasingly, Russian policymakers are connecting improved health outcomes across the lifespan with national economic development. Accordingly, issues similar to Lane County’s that diminish prospects for good fetal-infant outcomes are elevated to national priority status. In other words, promoting good health and well being become a compelling potential on-the-ground resource for attracting investment and building economic prosperity.

Regarding bad health outcomes, here’s how the correspondent puts it:

That’s not just bad for Russians, it’s bad for Russia’s economic prospects. International investors use certain health statistics — like infant mortality and life expectancy — to gauge a country’s economic future. So to deal with these troubling statistics, the Russian government announced a plan to build 23 neonatal centers across the country with state-of-the-art Western technology.

Ironically, Russia’s plan to build more neonatal centers comes at a time when the March of Dimes suggests checks on the over-supply of NICUs relative to actual need in this country. This isn’t to say that NICUs are not needed in Russia but rather that what may be needed in one place can be in over supply elsewhere with diminishing returns for that population or community.

As Russia strives to correlate infant mortality rates with attracting investment, Lane County, so far, has not. If we did, we would talk about negative ramifications for our high fetal-infant loss in terms of lost investors and an anemic rate of home-grown innovation. We would connect these losses with the current state of the local economy.

Why are health statistics, including infant and fetal-infant mortality rates, predictive of regional economic success? Tragically, fetal-infant losses are the tip of the public health iceberg. Hidden beneath the surface lies a continuum of sickness and suffering that affects homes, schools, and industry. Investors, who want to know a healthy, creative and innovative workforce is ready to move ideas to the next level, look very closely at these numbers before making a capital commitment.

Were we to move Lane County’s response to a much-too-high rate of fetal and infant loss beyond its current niche lodging among public health, social service, non-profit and community-member focus, how swiftly might we move? Healthy Babies, Healthy Communities coalition members would, no doubt, begin to count among its coalition partners representatives from business, hospital administration and university leaders. It would also garner consistent local coverage in the business section of the newspaper.

Current coalition members have a variety of sound approaches to improving perinatal outcomes throughout the community. Elevating the discussion to action through partnership is needed to carry many of worthy ideas forward. One simple and inexpensive idea with the potential to significantly improve the health of Lane County mothers and babies is printing brief facts on paystubs, church programs, explanation of benefit forms and bank statements, etc. about the importance of the last weeks of pregnancy. Non-medical (elective) induction is a common practice despite the solid research condemning its practice. The March of Dimes has championed the correction of this national practice and would be a source of correct information. Employers, employees / expectant parents, extended family and the community all gain from correcting the unnecessary damage done via unnecessary inductions.

March of Dimes: Empower Women, Decrease Disparities

Finishing my childbirth education certification means I can start combing through several maternal and infant health reports I’ve been collecting. What can I say? In addition to providing childbirth education, I like to read wonky reports.

First up is the March of Dimes’ December 2010 Toward Improving the Outcome of Pregnancy III (TIOP III). For the short version, check out this video clip and summary. TIOP III focuses on five themes or action items to improve overall quality of outcomes for the entire perinatal period (preconception, pregnancy, birth and postpartum):

1.       Pursue quality improvement and safety initiatives

2.       Decrease disparities, increase equity

3.       Empower women, encourage shared decision making

4.       Standardize regionalization of services

5.       Improve data collection

I know what you’re thinking. Won’t this report be more likely to collect dust on shelves across the land than affect real change? No, not necessarily. TIOP III hints at where maternal and infant care ought to be going in the next decade or so.

TIOP I (1976) and II (1993) continue to influence the delivery of motherbaby services today. The emergence of neonatal intensive care unit centers can be traced to the TIOP I recommendation that more of these resources be made available. Interestingly, TIOP III now suggests an oversupply of NICUs exist today relative to total annual births. This oversupply has been described as playing an unfortunate role in the dangerous trend of non-medical inductions. The babies who are born too early to thrive outside the womb create an unnecessary demand for NICU care.

As a consumer advocate and childbirth educator, I especially like TIOP III’s first three objectives for improving overall care and outcomes. Here are a few thoughts on each…

Perinatal quality improvement and safety initiatives

TIOP III supports quality improvement efforts like those underway by The Joint Commission on Accreditation of Hospitals, the primary accrediting body for most health care facilities. The Joint Commission is now including new performance measurements for accreditation including tracking for elective delivery, cesarean section, and exclusive breastmilk feeding.

The decision by The Joint Commission, an influential and powerful organization, to monitor infant feeding, no doubt, plays a role locally. Sacred Heart Medical Center plans to pursue the Baby Friendly designation for evidence-based infant feeding.

Pursuit of this designation is an important development for mothers, babies and the community because facility-based practices play a critical role in supporting families to initiate, establish and maintain exclusive breastfeeding after they leave the hospital or birth center. I’ve posted extensively on the importance of local hospitals becoming designated Baby Friendly providers of evidence-based infant feeding care.

Decrease disparities, increase equity

Addressing disparities in access to perinatal services is of critical importance to local families and communities. Lane County’s fetal-infant mortality rates are the highest in the state (among the highest in the nation?). Maternal and infant mortality are long-accepted markers for community wellbeing and potential. Lane County outcomes for all demographic groups lag. While lack of healthcare access is a problem throughout Oregon, our fetal-infant mortality rate means local communities suffer even more than similar communities from disparities in access and a lack of general healthcare equity. That Lane County is also home to the University of Oregon and Sacred Heart Medical Center, a major regional hospital, is incredible. Sadly, and despite the efforts of the Healthy Babies, Healthy Communities coalition, there has been an impressive lack of civic leadership / engagement devoted to closing these gaps.

Empowering women and families for full partnership with providers and shared decision-making

TIOP III provides organizations and individuals committed to excellent motherbaby outcomes with an updated mission statement:

Empowering women and families with information to enable the development of full partnerships between health care providers and patients and shared decision-making in perinatal care

These are more than nice words. They describe practices that are increasingly associated with desirable outcomes. Here’s what TIOP III goes on to say:

… evidence-based practices — CenteringPregnancy®, Kangaroo Care and exclusive breastmilk feeding — have been shown to improve perinatal health outcomes by empowering patients: positioning them, their newborns and their families at the center of their care and making them an integral part of their health care decision making team.

The PeaceHealth Nurse Midwifery Birth Center is the only Lane County provider of Centering Pregnancy. It is a recipient of March of Dimes funding for this evidence-based prenatal care.

Looking to the future, TIOP III goes on to acknowledge the Institute for Healthcare Improvement for being on the right track where empowerment and decision making are concerned. IHI develops various care models to describe the future direction of healthcare excellence – its perinatal model of the future puts women and families at the center of future care structures as the source of control – IHI’s ideal model of perinatal care. As a childbirth educator and motherbaby advocate, I am fully on board with this!

That’s all for now…..

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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.

Considering maternal mortality in Lane County

Yesterday, I attended the UO Women’s Law Forum discussion of maternal mortality. Among the invited speakers was certified nurse midwife Hilary Prager from the PeaceHealth Birth Center.

Anyone remotely interested in or familiar with maternal and infant well being knows US rates are significantly higher than those in other developed and developing countries. Recently, Amnesty International issued a report – Deadly Delivery: The Maternal Health Care Crisis in the USAoutlining the total disconnect between US maternal health care spending (more than any other country) and maternity outcomes. Women in this country have a higher risk of dying from pregnancy-related complications than their counterparts in 40 other countries. The report also describes the extreme variations among women. Perhaps the starkest disparity is that African-American women are nearly four times more likely to die of pregnancy-related complications than white women.

I don’t know what Lane County’s maternal mortality rate is but I do know its fetal-infant mortality rate tops Oregon counties and hovers around or above national rates. Despite being home to a major university and hospital system in the developed world, Lane County’s fetal-infant mortality rate is more in line with developing world outcomes. It would be useful to know what local rates for maternal mortality are, too. At the UO Women’s Law Forum I asked if maternal and infant mortality rates tend to track similarly and was told they do not. That said, where there is a poor maternal mortality rate, there will also be a poor infant mortality rate (or vice versa). ). In other words, our maternal mortality rate probably isn’t so great.

Mother and baby mortality rates are the gold standard report card for local and national entities. They are a significant metric for overall public wellbeing because pregnancy often happens to women who otherwise would not interface with the healthcare system. As pregnancies progress, the capacity for a community to provide adequate care is revealed. Bad outcomes suggest systemic, community-wide problems made apparent by but reaching beyond women and babies. Maternal and fetal-infant mortality are among the most extreme of negative outcomes euphemistically described as the “tip of the iceberg.” They frequently occur where access to healthcare and social service systems is inadequate or limited.

According to the latest Lane County data for fetal-infant mortality, 62 women suffered a fetal or infant mortality between July 2007 and June 2009. Barely two-thirds of these women accessed prenatal care during the first trimester. Among candidates for the Oregon Health Plan, many no doubt delayed or skipped coverage due to the OHP requirement of a certified birth certificate at application time.

Bureaucratic barriers are not limited to OHP-eligible pregnant women. These kinds of barriers plus significant financial obstacles, as reported on NPR’s health blog, make it extremely difficult for pregnant women to purchase individual policies, too. At the same time, recent coverage by the Washington Post connects a healthy nation with healthy pregnancies:

“Investing in maternal health would return larger and longer-lasting dividends than almost any other comparable public health investment.”


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Congrats to Friends’ Katharine Gallagher and Midwife Cindy Hunter for Healthy Babies Awards!

Originally posted on Lane County Friends of the Birth Center‘s blog…

Congratulations to the Lane County Healthy Babies 2010 Award Recipients recognized at yesterday’s second-annual reception!

Awards were given to an individual, a practitioner and an organization in acknowledgement of their contributions toward reducing fetal-infant mortality and increasing community health in Lane County. Former KEZI news anchor Rick Dancer served as the master of ceremonies. Dancer encouraged Healthy Babies to use social media to increase its reach. Commissioner Rob Handy and Lane Co. Health and Human Services Rob Rockstroh both emphasized the critical importance of reducing Lane County’s uniquely high rates of fetal and infant mortality.

Individual. Katharine Gallagher, chair of the Lane County Friends of the Birth Center, was recognized in the individual category. Katharine touched on the importance of evidence-based mother- and baby-centered care in improving community outcomes and on the need for ongoing county support for the Healthy Babies initiative. (See Katharine’s comments below)

Katharine Gallagher and Cindy Hunter

Practitoner. Cindy Hunter, former Nurse-Midwifery Birth Center midwife and currently the Nurse Educator for Labor and Delivery at Sacred Heart, was recognized in the practitioner category. Cindy shared her inspiring story about discovering the importance of and ultimately in finding ways to ensure dignified care for women and babies. LaneCoFBC looks forward to its upcoming October 5 fireside chat with Cindy. She will be sharing her recent experiences volunteering in Haiti. (Learn more here.)

Organization. Project FEAT (Family Advocacy and Treatment) coordinators Kristin Funk and Liz Twombly reflected on the lessons learned and insights gained throughout their 5-year project funded by the Department of Health and Human Services to develop policies and procedures for addressing the special needs of substance exposed newborns. Kristin and Liz highlighted the importance of nurturing and protecting mother-child bonds and the power that this connection can have to inspire women to move beyond substance abuse.

In recent weeks, Lane County Healthy Babies, Healthy Communities received the following media attention:

Lane County State’s Top Fetal-Infant Mortality Rate: That rate is prevalent and statistically significant regardless of other factors

ALIVE AND KICKING | County’s infant death rate improves, but could it be better?

EDITORIAL: A gauge of social health | Reduction in fetal-infant death rate encouraging

Healthy Babies initiative helps (letter to the editor, scroll down)

To get involved or for more information about the Healthy Babies initiative, visit www.preventionlane.org. The next Healthy Babies meeting is on October 7 from 8:30 to 10am at Lane County Mental Health.

Following are LaneCoFBC Chair Katharine Gallagher’s comments:

Thank you very much for this award – I am honored by the acknowledgement.

Little did I know that founding Friends of the Birth Center to encourage construction of the new PeaceHealth Nurse Midwifery Birth Center would be the beginning of a genuinely rewarding endeavor. Like all worthwhile efforts, it’s been a joint one from the start.

Practically over night Friends of the Birth Center brought many, many other women, families and community members together. Families with brand new babies and families with kids graduating high school shared their stories. This evening, three founding members who now serve on the Friends’ board join me: Eleanor Vandergrift, Karen Guillemin, Kathy Lynn. Board member Renee Bailey could not attend.

Karen Guillemin, Katharine Gallagher, Kathy Lynn, Eleanor Vandegrift

And a founding Dad – my husband David Wacks as well as a Birth Center grandfather – my dad Mike Gallagher.

Originally seeking to maintain our personal preference for maternity services in a freestanding birth center, we quickly made connections between the holistic, communal and mother-baby focused approach we know so well and the local and national discussions about the power of preventive, evidence-based and cost effective care to dramatically improve maternal- and infant-wellbeing.

A strong link exists between the care we regularly access at the Birth Center and what is needed to increase community-level wellbeing. Early prenatal care regardless of insurance status, regular postpartum opportunities to meet other new parents, and ongoing breastfeeding support that really works – this is the “standard issue” package for anyone walking through the Birth Center’s doors.

As we were making these connections, the Friends group began to learn about our community’s local rates for fetal and infant mortality. We have been moved to view construction of the new Birth Center as one of great importance for the entire community. This is because it is a living laboratory of the kind of care we need to see more of in Lane County. Accordingly, we remain very grateful to PeaceHealth for making the new Birth Center a reality.

Moving forward, I look forward and I know Friends of the Birth Center does, too, to supporting the County’s initial efforts to focus our collective attention and resources on reducing fetal and infant mortality. The most recent statistics show some improvement and I believe that is a credit to the Healthy Babies, Healthy Communities initiative. If we are to continue making progress, ongoing county and community support are necessary.



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Lane Co. Fetal-Infant Mortality Coalition Coordinator Leaving

Healthy Babies, Healthy Communities, Lane County’s coalition to reduce fetal and infant mortality rate, recently learned its coordinator, Sandy Moses, has taken another position within Lane County Public Health. Coalition members have been assured of a replacement to continue in Moses’ place. This and continued staff and funding resources for the Fetal Infant Mortality Review are critical to improving the health of local families and babies.

Background

In 2007, Lane County Public Health (LCPH) reported an unacceptably high local fetal-infant mortality rate.  Lane County’s rate is the most serious in the state and among the most serious in the nation. The national rate is also high.

Lane County local government and community have responded with the Healthy Babies, Healthy Communities Initiative (HBHC) and, more specifically, the Fetal Infant Mortality Review (FIMR). FIMR is a framework for gathering and analyzing information to develop community-specific responses. Read more about HBHC and the most recent information garnered through FIMR.

September is Infant Mortality Awareness Month

HBHC will host the second annual Healthy Babies award reception on September 30th from 5 to 6:30pm at Valley River Inn. This event celebrates and recognizes organizations, providers and individuals who make significant contributions toward the improved health and well being of babies and families.

Sponsors for the 2010 Healthy Babies Award Reception are welcome. To become a sponsor or reserve tickets contact: Sandy Moses, 541-682-3650, Sandy.Moses@co.lane.or.us