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Fueled by a decades-long, higher-than-average rate of preterm birth and infant mortality in this region, Cincinnati Children’s physicians and researchers have a vested interest in determining why babies are born too early.
Experts here are tackling the problem on multiple fronts, but answers remain elusive. Until we know more, we continue to expand community-based efforts to curb the incidence of premature births among the most vulnerable women.
One such effort has brought Cincinnati Children’s, the University of Cincinnati (UC) and the Cincinnati Health Department together in a novel approach to reducing the incidence of preterm births. The program targets poor, uninsured minority women, the group most at risk of giving birth to very early, small and fragile babies.
The program grew out of an innovative program started by Elizabeth Kelly, MD, an obstetrician-gynecologist with UC’s Department of Obstetrics and Gynecology and Director of the Division of Community Women’s Health. Kelly has worked with disadvantaged women for more than two decades. She is well acquainted with the inequities and obstacles they face in receiving prenatal care. Giving birth to the earliest and most frail preterm babies is one of the most devastating results of those inequities.
Kelly knows that a major obstacle facing the women she serves is making and keeping prenatal appointments. Lack of transportation, no child care, job demands, struggles with food and housing all contribute to a perfect storm of reasons why disadvantaged women do not receive needed prenatal care. So a few years ago, she began offering same-day access to prenatal care at one of the Cincinnati Health Department’s health centers.
“A woman could walk into a health center, get a pregnancy test, and we offered her care that day,” Kelly says. The clinic made allowances in staffing and schedules to accommodate the enthusiastic response. It was a positive first step.
Before long, quality improvement (QI) specialists in the Anderson Center for Health Systems Excellence at Cincinnati Children’s learned about Kelly’s same-day program and asked if they could work with her.
Together, they identified four evidence-based interventions that are crucial to ensuring a healthy pregnancy and reducing infant mortality:
The program now operates in the Cincinnati Health Department’s Elm Street and Price Hill Health Centers and receives strong support from community organizations. Women who receive prenatal care at those centers have access to most of the interventions; the tobacco cessation portion is still in development. The QI specialists ensure that interventions are offered systematically and track outcomes – which they hope will be healthy, full-term babies.
Robert Kahn, MD, MPH, Associate Director of General and Community Pediatrics at Cincinnati Children’s, worked with the QI team and Kelly to put the interventions in place.
“It’s been fantastic to have an obstetrician as a partner because child well-being is so dependent on a healthy pregnancy,” Kahn says. “Dr. Kelly and her team at the Cincinnati Health Department clinics are incredibly committed to the women they serve and to achieving improved birth outcomes.”
Kelly welcomes “putting science behind” what her years of experience have taught to be major obstacles to receiving good prenatal care.
“Until a woman is free of things like being a victim of domestic violence, and has heat in her home, and food, and a ride to her appointments, it’s pretty hard for her to adhere to her health care,” she says. “The QI team is providing their expertise in improvement science to implement and measure the impact of removing some of these barriers.”
Although it remains too early to report the program’s impact, Kelly has already seen some positive results.
“Our patients love it,” she says. “They are genuinely concerned about their health and the health of their babies. This program allows more of their basic needs to be met so they can focus on staying healthier.”
For many disadvantaged women, prenatal care falls to the end of a long list of basic needs that must be taken care of first, says Dr. Elizabeth Kelly. A new program will attempt to remove barriers so that women can stay healthier during pregnancy and deliver healthy, full-term babies.
Key to ensuring the health of moms and babies
It is one thing to identify evidence-based actions that help determine a healthy pregnancy. It is quite another to make sure those actions take place. That is where the community health worker comes in. Lauren Bostick is a community health worker with the Cincinnati Health Department. She acts as coach, helper and confidante to women throughout their pregnancies. “Our primary responsibility is to establish a relationship with the women we care for,” says Bostick. “The relationship is the key. It’s why we do what we do.” What she does ranges from helping a homeless pregnant woman find housing to providing food and other essentials to a mother struggling to feed her family. She makes sure mothers get to their medical appointments. And if the mother’s children need immunizations or other healthcare, she makes sure they get to the pediatrician. It is challenging work, sometimes requiring many visits with a woman to establish trust and to keep her on track. Bostick takes pride in the fact that many of the women she cares for are able to improve their life circumstances. Nearly all deliver healthy babies. And many keep in touch after their babies are born. “We may not always see immediate results, but I know that I sowed a seed in an individual’s life, and eventually things will change for the better,” she says. “What keeps us going is that every pregnant mother, and every child, matters.”
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