1. Maternal Options that Matter - MOM

2. MOM-One Goal To increase the proportion of Wyandotte County infants who reach their first birthday.

3. MOM-Our Mission To promote and deliver the highest quality medical care services for mothers and their children in Wyandotte County. To train Family Medicine Resident Physicians and Certified Nurse-Midwives in the clinical care of mothers and young children.

4. Training Providers The provision of labor and delivery services by family physicians is especially important in largely rural states such as Kansas. 80 of the 105 counties in Kansas do not have obstetricians, most of those counties rely on family physicians for prenatal and delivery services. There is a need for additional trained professionals to provide access to prenatal and delivery services throughout the state. MOM is positioned to help increase the number of trained providers in the community and in the State of Kansas.

5. MOM- Our Vision Healthy mothers, healthy children

6. Wyandotte County Infant Mortality The infant mortality rate in Wyandotte is higher than the State rate (per 1,000 births)

7. Causes of Infant Mortality in Kansas & WyCo 200920102011 Anomalies 726659 <Gest/Low Birthwt 363528 Maternal Complic 523949 SIDS 393230 Other External 171013 Other 747168 Total 290253247

8. Causes of Infant Mortality in Kansas 200920102011 Anomalies 726659 <Gest/Low Birthwt 363528 Maternal Complic 523949 SIDS 393230 Other External 171013 Other 747168 Total 290253247

9. Targeting the need. 2009 report noted Black infant mortality was highest in five Kansas zip codes of which three are in Eastern Wyandotte County: 66101, 66102, and 66104. The zip codes with greater than twenty infant deaths include five located in Eastern Wyandotte County- 66101, 66102, 66103, 66104, and 66106.

10. Contribution of Poverty- Difficult to Assess, Impossible to Ignore % < FPLAreaPer Capita $ 39.8%66101$10,986 28.9% 66103$18,723 29.9%66105$12,614 21.9%Wyandotte$19,214 12.6% Kansas$26,545 14.3% US$27,915 2007-2011 American Community Survey 5-Year Estimates US Census

11. MOM-Objectives Assumption- High infant mortality in Kansas/Wyandotte County has modifiable causes. (As shown through previous research.) MOM will improve outcomes through changing modifiable risks in an immediate and concrete way through the use of proven or promising interventions targeting identified causes of infant mortality.

12. Causes of Infant Mortality in Kansas 200920102011 Anomalies 726659 <Gest/Low Birthwt 363528 Maternal Complic 523949 SIDS 393230 Other External 171013 Other 747168 Total 290253247

13. Contributing to Infant Mortality- Low Birth Weight

14. Causes of Low Birth Weight Smoking Drug abuse Maternal malnutrition (anemia) Preterm delivery

15. Causes of Low Birth Weight Smoking Drug abuse Maternal malnutrition (anemia) Preterm delivery

16. Low Birth Rate- smoking Maternal Smoking  Smoking during pregnancy was noted in 24.3% of infant deaths compared to 15.2% of live births in Kansas. (2007-2011)  Multiple studies show about a 2-2.5 times increased rate of low-birth weight and growth retardation in infants of women who smoke compared to those who do not smoke.

17. Intervention- Smoking Cessation Cartoon/Poster detailing smoking cessation whys and hows in exam rooms. Brochure for pregnant women and new mothers about tobacco cessation.  (>80% of women who quit do so “for the baby.”) Staff education about smoking effects on pregnancy and use of “Five A’s” evidence based intervention.

18. Reduce maternal smoking- Five A’s Ask about tobacco use. Advise to quit. Assess willingness to make a quit attempt. Assist in quit attempt. Arrange follow-up.

19. Low Birth Rate- malnutrition Maternal Malnutrition is associated with LBW- studies show women with adequate weight for height have about one-half the rate of low birth weight infants (10.8%) as those who have low weight for height ratios (23.6%). Anemia is a marker of poor maternal nutrition.

20. Intervention- Nutrition Cartoon/Poster in exam rooms detailing healthy diets in pregnancy. Social Services support for food- stamps/WIC. Early start (free) prenatal vitamins. Nutrition information/counseling. Grocery.

21. Contributing to Infant Mortality- Preterm Delivery

22. Effect of Preterm Delivery on Infant Mortality One reason for the higher infant mortality in our community is that the rate of preterm deliveries in Wyandotte County is higher than the State average (10.2 per hundred compared to 9.3- 2008 figures.) The preterm delivery rate is even higher among black women in our County (13.2 per hundred in 2008.)

23. Preterm labor is associated with: Late entry to care Infections (genital, dental) Street drug and alcohol use Smoking Close pregnancies Domestic violence Long work hours and strenuous work Maternal health conditions (HTN, DM, etc.)

24. Interventions to reduce preterm deliveries caused by: Late entry to care Infections (genital, dental) Street drug and alcohol use Smoking Close pregnancies Domestic violence Long work hours and strenuous work Maternal health conditions (HTN, DM, etc.)

25. State and County % Inadequate PN (began >16 wks)

26. Prenatal Care Wyandotte County No Prenatal Care Live Births1.1% Infant Deaths6.5% (2007-2011)

27. Interventions- Early access to care Information about health behaviors and pregnancy placed at targeted community sites  Outreach to schools and pharmacies in lowest income areas (posters, etc.)  Billboards and PSA’s – Mother’s Day Early diagnosis of pregnancy  Free pregnancy testing at clinical sites.

28. Early Prenatal Care

29. Interventions to reduce preterm deliveries caused by: Late entry to care Infections (genital, dental) Street drug and alcohol use Smoking Close pregnancies Domestic violence Long work hours and strenuous work Maternal health conditions (HTN, DM, etc.)

30. Screening and treatment for genital and dental infections Screening and treatment for dental disease. (Studies have linked peridontal disease to preterm delivery and fetal demise.)

31. Interventions to reduce preterm deliveries caused by: Late entry to care Infections (genital, dental) Street drug and alcohol use Smoking Close pregnancies Domestic violence Long work hours and strenuous work Maternal health conditions (HTN, DM, etc.)

32. MOM- Support Services Resources Screen  Reponses: Referrals - Food, housing, etc. Domestic Violence Screen  Response: Mental Health Therapy  Response: Legal Services (Orders of Protection)  Response: Referral – Shelter (MOM utilizes the social, mental health and legal services of Family Health Care to address positive screening.)

33. Prenatal Care in WyCo L&D Site WyCo JoCo PMC~9 to 3+ KUMC OPR 33 SMMC 72 Other SNC 0

34. County/Hospital Statistics 2010 2010 Reside WyCo Reside JoCo Reside Leavenworth Total Total 20102,7547,39094611,090 Deliver WyCo1,4346711852,290 Deliver JoCo1,1976,2314467,874 Deliver KUMC 1,529 Deliver PMC 1,114 WyCo Hosp2,643

35. Contributing to Infant Mortality- Sudden Infant Death

36. Education to reduce SIDS Cartoon/Poster detailing infant sleeping recommendations in exam rooms and at weighing table. Brochure for pregnant women and new mothers about infant sleeping recommendations. Staff education about infant sleeping recommendations. Ask at each visit.

37. Infant Mortality- No more negative headlines!

38. “Kansas Worst for Black Infant Deaths” Headline The National Center for Vital Statistics ranks Kansas the worst state in mortality rate of black infants. Rank #50- Kansas recorded 19.6 deaths per 1,000 births among blacks; the national average is 13.2 deaths. Rank #40- Kansas ranks in the bottom 10 for overall infant mortality. Sunday, May 1, 2011 Wichita Eagle http://www.kansas.com/2011/05/01/1830329/kansas-worst-for-black-infant.html#storylink=cpy

39. MOM utilizes promising and proven interventions Preconception education  Well woman examinations  Increased maternal folic acid use (PN vits)  Optimal birth spacing encouragement  Improved care and education between births  Social services assessments and support

40. MOM Optimal Prenatal Care (Family-centered, peer-supported)  Early (1st trimester) start of prenatal care  Reduce maternal alcohol, tobacco, or illegal drug use  Appropriate prenatal weight gain and nutrition  Dental evaluations and treatment  Exercise and nutrition information/classes  Direct care for appropriate risk level pregnant women  Assessment and referrals for high risk pregnant women Delivery of patients at KU Hospital & Medical Center L&D Well child examinations

41. MOM utilizes promising and proven interventions Postpartum Care and Education  Safe sleep position and safe sleep environments for infant  Adequately immunized mothers and infants  Increased breastfeeding  Social supports to improve mental health  Parenting instruction and support

42. Gearing Up- Together MOM KUHP Midwife Program KU Family Medicine Family Health Care Income from In-patient provider services Educational Opportunities Provides Faculty/Residents No Income Educational Opportunities ProvidesFaculty/Students Income from Out-patient provider services Provides facility & supports Workforce

43. Outcome: Infant Mortality-Reduced by Proven Interventions Health care Social supports Education

44. Our goal- More first birthdays!