Postpartum Plus Prevention Program (P4)

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

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 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 • 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

5. Immediate Postpartum Services • 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!) The CNM provided prescriptions during 40% of encounters and provided referrals for 10% of the encounters.

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

7. Intensive Postpartum Services • 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 Spent a lot of time helping mothers navigate the health care system.

8. Ongoing Postpartum Health Issues • 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%)

9. Lessons Learned • 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.

10. Lessons Learned • 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.

11. Challenges • 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.

12. Recommended Strategies • 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.

13. Additional Outreach

15. Women’s Integrated Systems for HealthWISH 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

16. 3rd 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. Contact Information Sarah Verbiest sarahv@med.unc.edu or 919-843-7865 www.mombaby.org