1. Sarah Verbiest, DrPH, MSW, MPH Center for Maternal and Infant Health Every Woman Southeast Webinar February 10, 2011 Postpartum Plus Prevention Program (P4)

2. Program Objectives Provide high-risk mothers with the medical services, education, resources, and support they need to make positive improvements in their health and to implement a reproductive life plan. Increase knowledge and understanding of the needs of this population and the best way to provide services to them.

3. Target Population Mothers of medically fragile infants – from 25 counties across the state Recruitment UNC Newborn Critical Care Center – Regional Tertiary Care Center Intervention Immediate Care & Intensive

4. Immediate Care CNM available via pager to assess and treat mothers of infants in the NICU. NICU Nurses most common referral source Previously these mothers were sent to the ER >400 patient service points Intensive Care Wellness Kit Medical care and advice – in NICU and beyond Referrals Psychosocial support Telephone contact – 3,6,9,12 months Available via pager or email Served 46 women

5. Immediate Postpartum Services The CNM provided prescriptions during 40% of encounters and provided referrals for 10% of the encounters. Location of Services 24% of the encounters were at the bedside 76% were in the clinic Duration of Services 31% of the encounters were under 10 minutes 49% were over 30 minutes (most well over an hour!)

6. Immediate Postpartum Health Issues Primary Care (41%) Depression (20%) Family Planning (15%) Breastfeeding (13%) Wound Check (11%) Blood Pressure (8%) Postpartum Visit (7%) Other Issues: Bereavement Domestic violence Health insurance Oral health Smoking STIs

7. Intensive Postpartum Services Spent a lot of time helping mothers navigate the health care system. Location of Services ~ 60% were via telephone ~ 40% were in person via NICU, SICU or infant FU clinic Duration of Services Served mothers longer than planned (~18 mos) No attrition More frequent contact with mothers than expected

8. Post Traumatic Stress Disorder Family Planning Reproductive Life Planning Chronic Disease Management Coping with Depression and Anxiety Learning to Navigate the Health Care System Setting Health Goals: lose weight (62%), exercise more (47%), manage stress (20%), other goals (20%), no goals (16%) Ongoing Postpartum Health Issues

9. It is difficult to provide services to only some women in the NICU – programs need to serve everyone in some capacity. Program perceived favorably by NICU staff – seen as a valuable resource. The NICU setting is not an appropriate place to conduct wellness programs. Mothers’ needs are more immediate, basic and critical. Wellness messages need to be tailored to the woman’s current situation, including her baby’s health status. It really is all about the baby. Lessons Learned

10. Women still have significant challenges at 6-18 months postpartum. There are significant primary care and obstetric needs among this population – both while in the NICU and beyond. Some services, such as access to contraception, need to be immediately available in the NICU postpartum, but true RLP is difficult to initiate before 6 months. Lessons Learned

11. Recruiting from NICU doesn’t capture “near misses”. Many pathways to NICU admission. Broken system of postpartum care for mothers. Need stronger research data on impact of care coordination. Inadequate pediatric resources to support parents of medically fragile infants. Challenges

12. Allocate adequate time and resources to allow for relationship building with mothers prior to program recruitment. Increase attention to and quality assurance of postpartum care to NICU moms (tobacco use). Offer some services at baby’s bedside. Consider reaching women through services provided to their infants. Recommended Strategies

13. Additional Outreach

15. Integrative Approaches to Optimizing Mental and Physical Health among Adolescents & Women of Reproductive Age 7-Part Webinar Series launching on March 16, 2011 Webinars and related resources will be housed at Every Woman SE Training grant funded by U.S. Health Resources and Services Administration’s Maternal and Child Health Bureau Women’s Integrated Systems for Health WISH

16. 3 rd National Summit on Preconception Health June 12-14, 2011 Tampa, Florida Register at beforeandbeyond.org Every Woman SE has been invited to be a partner in convening this Summit!

17. Sarah Verbiest sarahv@med.unc.edu or 919-843-7865 www.mombaby.org Contact Information