Perinatal Workgroup
Terri Bliziotes, RN, MPH
1. West Virginia Demographics regarding Childbearing, access to perinatal care, costs of care, high risk needs.
2. Overview of current federal, state, philanthropic initiatives shaping or driving perinatal care for uninsured or medically underserved, at risk populations as well as major barriers to providing effective and efficient care to WV populations.
3. Define levels of care delivery that community health centers could implement given community need/resources; i.e.
a. (1) Screening, referral, education, outreach services
b. (2) Screening, education, outreach, prenatal and birthing
c. (3) Screening, education, referral, post birth pediatrics/family care
5. Literature review of CHC and perinatal programs and rural health
The Blueprint to Improve West Virginia Perinatal Health
September 2006
Executive Summary
If West Virginia could achieve improvements fewer babies would be lost and more dollars saved by health insurance payers and by the State of West Virginia. The State provides health coverage for over 56 percent of the pregnant women and newborn infants, supports three medical schools and numerous medical residency programs, and consequently has a vested interest in the quality and the cost of that care.
West Virginia health care professionals voiced a strong desire to participate in the process to improve perinatal care. They indicated that although many elements of a cohesive system are present in the State, we must move towards a statewide system rather than a fractured regional approach. We need to utilize new methods of communication, provide better support for medical professionals in rural areas, better utilize our intellectual resources, and more fully implement parent support and education programs.
Through the Study process, the Partners developed ten primary policy recommendations to improve the system. The Blueprint reports on these recommendations and describes how to make the improvements needed. The first policy recommendation is seen as essential to moving forward and to our ability to adequately address the other nine recommendations.
Policy Recommendation 1
Establish a Statewide Coordinated Partnership to Address Perinatal Care
Policy Recommendation 2
Save State Dollars by Reducing Costly Medical Procedures
Policy Recommendation 3
Reduce Exposure to Tobacco Smoke During Pregnancy
Policy Recommendation 4
Reduce Drug and Alcohol Use Among Pregnant Women
According to one in-state study at a tertiary care hospital, 144 babies were born to West Virginia mothers with a diagnosis of maternal drug use during 2005. This number represents 5 percent of the newborns cared for in that facility. Although the extent of maternal drug use, both legal and illegal, is unknown in West Virginia, forty-five percent of the respondents to the Key Informant Survey perceive drug use and addiction among pregnant women as one of the top contributing factors of poor perinatal health. A State-level advisory panel should be chartered to continue to study the issues of maternal drug use and addiction, coordinate resources and formulate additional policy recommendations.
Policy Recommendation 5
Improve Support for and Promotion of Breastfeeding
Policy Recommendations 6
Improve the Health and Perinatal Outcomes of African American Women
Policy Recommendation 7
Recruit and Retain More Obstetrical Providers
The State of West Virginia should adopt a long-term focus on reducing poor birth outcomes by placing the recruitment and retention of rural obstetrical providers at the forefront of its concerns. Closely reviewing and replicating programs that have worked in the State is important. The Local Availability Program (LAP) that paid for registered nurses in the State to become Certified Nurse Midwives (CNMs) is one such success. Initiated in the early 1990s, the program educated and placed 19 CNMs in areas where there was not adequate care. By 2006 the number of practicing CNMs had climbed to 41. Soon, many will be retiring their practices. The State should make plans to continue to develop CNM providers in the State. In addition, the State needs to place a greater emphasis on educational and emergency backup support for our rural obstetrical providers.
Policy Recommendation 8
Expand Newborn Screening to 29 Conditions
Newborn screening is a public health program that provides early identification and follow-up care of infants affected by certain genetic, metabolic, hormonal, or functional conditions. Many of these conditions produce no observable symptoms until the infant is already ill. However, they can be detected and treatment begun shortly after birth allowing for a healthier infancy and childhood. The American Academy of Pediatrics and the March of Dimes recommends that all babies be primarily screened for 29 core conditions. Screening for the 29 core conditions is universally required by rule or law in Colorado, Mississippi, New Jersey, Wyoming, Iowa, Maryland, Virginia, Rhode Island and the District of Columbia. In West Virginia, we test for some, but not all, of the 29 conditions. West Virginia is one of two states and the District of Columbia that do not charge for newborn screening services. West Virginia should expand the existing newborn screening panel to offer screening for all 29 core conditions and should follow the lead of the majority of states and begin charging for the testing.
Policy Recommendation 9
Encourage West Virginia Businesses to Offer Perinatal Worksite Wellness
Across America more and more businesses are incorporating prenatal wellness programs into their work places. This is because prenatal worksite wellness saves companies money by improving the health of mothers and babies. Worksite wellness gives expectant parents support, information, and access to educational programs that enhance the chances of healthy outcomes for mother and infant. Worksite wellness programs also assure support for lactating mothers. The National Business Group on Health says that one unhealthy birth can cost anywhere from $20,000 to more than $1,000,000, compared to about $6,400 for a normal healthy birth.
Policy Recommendation 10
Improve the Oral Health of Pregnant Women Through Policy and Education
To view the entire Blueprint to Improve West Virginia Perinatal Health,
please visit our web site www.wvhealthykid.org
