Breastfeeding

Twenty-four Lactation consultants were provided a significantly discounted rate for participation in the GOLD Lactation online conference.  10 were IBCLC and 14 were CLC credentialed.  A planning meeting was held with Mid-Atlantic Mother’s Milk Bank to discuss ideas for increasing donor milk usage in WV.  Topics discussed included contact with the WV MCOs to discuss coverage of donor milk for certain preterm neonates including a new project to promote the use of donor milk for substance exposed infants. The Partnership conducted a survey of WV birthing facilities that included questions on breastfeeding polices and support. The WV Breastfeeding Alliance was instrumental in updating nurse managers regarding infant feeding and practice guidelines during the COVID-19 pandemic.

Engaged in a contract with ZipMilk to establish and maintain a directory of lactation resources in WV.

Preterm Delivery

Provide evidence-based labor support education for nurses in birth facilities.

The Kick-off meeting of the Preterm Birth Reduction committee was held in January 2020.  Dr. Holls presented WV data and discussed the past efforts to combat the PRT problem including the First Baby Initiative to reduce cesarean sections among nulliparous women, education on the use of progesterone treatment and training sonographers on cervical length assessment.  The second meeting was cancelled due to the pandemic and the challenges of provider preparation of their obstetrical units as they were meeting the virus head-on.

Provided Lamaze evidenced based labor support (EBLS) training for intrapartum nurses and staff to reduce the rate of nulliparous, singleton, vertex, term babies via cesarean delivery. Fifteen nurses representing four hospitals participated in Lamaze’s Evidenced Base Labor Support.  Two other trainings were scheduled but cancelled due to the pandemic. “The Impact of Nursing Care on Birth Outcomes: Tracking Performance to Outcomes” was presented at the Perinatal Summit during the lecture focused on nurses’ Cesarean Section rates.

Provide Lamaze childbirth education courses to increase the number of childbirth instructors.

The DPWH continued to provide funding to the WV Perinatal Partnership to conduct statewide Lamaze childbirth education workshops. The target audience is uncertified childbirth educators, nurses and others interested in providing childbirth education. Individuals trained will be strongly encouraged to share their knowledge by providing childbirth education. Due to COVID-19 pandemic some activities have been delayed.  There is funding set aside for this project to purchase Lamaze Learning Guide and seats for the Lamaze Certified Childbirth Educator (LCCE) credential for 14 participants.

Fifteen nurses representing 4 hospitals participated in Lamaze’s Evidence Based Labor Support.  A Lamaze 3-day seminar will be offered in October 2020 due to the cancellation of face to face instruction.  This may be one of the first in the nation to be offered in a virtual format.  Online Lamaze EBLS course is not yet offered via web-based training.  Labor support materials for use with patients in several hospitals who have received an EBLS workshop and plan on continue this program in 2020-2021.

Promote childbirth education for first-time mothers statewide.

RFTS provided childbirth education through both home visits and group childbirth education through enhanced services.  Currently there are 26 licensed nurses or social workers in RFTS trained to provide enhanced services to pregnant women.  Enhanced services can be provided to any Medicaid eligible pregnant woman regardless if she enrolls in the home visiting component of RFTS. 

A PRSI referral is made to RFTS for any Medicaid eligible pregnant mom and to a MIECHV funded home visiting program for non-Medicaid eligible women.  First time pregnant women are a priority for MIECHV funded programs. 

Since COVID19, all home visiting programs have transitioned to virtual visits.  During the transition the State team worked with State partners, Medicaid, National models and federal funders to ensure a smooth transition to virtual visits.  Childbirth education has continued with all programs through approved virtual platforms. Many programs have developed private Facebook pages for expectant moms to participate with other expectant moms and share experiences.  This has developed into a strong support system for women during quarantined times and helped with the absence of group education activities.

Provide increased public awareness about the risks of labor induction and cesarean section deliveries that are not medically indicated.

The Kick-off meeting of the Preterm Birth Reduction committee was held in January 2020.  Dr. Holls presented WV data and discussed the past efforts to combat the PRT problem including the First Baby Initiative to reduce cesarean sections among nulliparous women, education on the use of progesterone treatment and training sonographers on cervical length assessment.  The second meeting was cancelled due to the pandemic and the challenges of provider preparation of their obstetrical units as they were meeting the virus head-on.

Provided outreach education to 3 delivering hospitals with over 1,000 births, on the standardized approach to obstetric triage to prioritize the woman’s urgency for provider evaluation using the Maternal Fetal Triage Index (MFTI).  Wheeling Hospital, United Hospital Center, and Berkeley Medical Center were provided the MFTI education course. Each hospital is currently in the implementation stage, which takes months to accomplish.  We require a presentation from each hospital related to their “Lessons Learned” upon completion of the implementation stage.

The Premature Birth Team of WV held a meeting in January 2020.  OMCFH Title V representatives attended Prioritizing Action in Preterm Birth in March 2020 and brought information from the webinar series to the team which includes partners from WV Vital Statistics, WV Perinatal Partnership, obstetric physicians, and third-party insurance representatives.  While the team did not continue meeting after the onset of COVID restrictions, the Special Projects Consultant with our Collaborative conducted research into benefits of doula care and the potential of engaging payer groups for available reimbursement options. This information will be included in future agendas to determine how the OMCFH may be able to reduce low risk first time cesarean births.  

Infant Mortality

Count the Kicks materials were provided to all home visiting programs to share with pregnant women.  In addition, promoting the Count the Kicks app with women.  All home visitors were provided the opportunity for continued professional development in Count the Kicks during the Safe Sleep annual competencies training on improving birth outcomes.  Ninety-one home visitors were trained during the virtual event.

Over 24,555 pieces of educational materials to WV providers were distributed.  277 expectant parents have downloaded the Count the Kicks phone app.  Over 1,141 West Virginians have visited the Count the Kicks website to get more information on kick counting.  64% of visitors are viewing on mobile devices. A local television station ran a story about the launch of CTK in WV and CTK WV Ambassador presented at the WV Perinatal Summit.  10,000 magnets with CTK Dr. Seuss type logo were ordered for distribution to physician offices to share with the OB patients in the last trimester of pregnancy.  

Conduct best practice updates for maternity care providers on the recommendations of ACOG and the Society for Maternal Fetal Medicine.

An intermediate Fetal Monitoring 2-day session was held at Princeton Community with 8 participants and 2 instructors completing the course.  Camden Clark Medical Center had 5 participants and 1 instructor completing.  An online Advance Fetal Monitoring Course has been developed and is scheduled.  Plans are underway to hold an Instructor Training Course.

Oral Health Continue oral health surveillance of perinatal population through Basic Screening Survey to inform program policy and development.

During the last year, the Oral Health Program maintained its surveillance system for children and pregnant women to assess progress and assure evidence-based program planning. In addition, the Program continued to provide training to help dentists become more comfortable in providing dental care to pregnant women. This work was completed in conjunction with the WV Healthy Start/HAPI Project, as well as partners in home visitation and prenatal care programs. In addition, the Program has continued to work with insurance providers to increase dental coverage for pregnant women. As a result of this effort, adults including the perinatal population will have access to comprehensive oral health services beginning January 1, 2021.

Provide education to medical and dental care providers on national consensus statement 2012.

The Oral Health Program has continued to educate both medical and dental providers on the 2012 National Consensus Statement for Oral Health Care during Pregnancy. The program utilized training materials and resources from the National Maternal & Child Oral Health Resource Center to educate providers on the best practices related to oral health and pregnancy.

Smoking

Offer evidence-based training to maternity care providers to promote tobacco cessation during each prenatal visit.

Over 200 health care providers have been trained, provided technical assistance and resources, facilitated information sharing and provided support to multiple groups working on tobacco cessation.  A pediatric provider tool kit on tobacco/nicotine cessation was developed and a consistent and unified message among stakeholders regarding the important of tobacco/nicotine cessation was promoted.

Program staff have worked from home since mid-March. Activities have successfully adapted to needed virtual platforms and trainings have transitioned to either WebEx or Zoom.  The Help2Quite trainings can now be offered through a variety of modalities upon provider preference, including webinars, in-person and hybrid options.

Offer evidence-based cessation curriculums to pregnant women via home visitation services.

Home visiting programs continued to conduct an assessment of prenatal and postpartum client’s smoking status and exposure to environmental smoke exposure as routine Program protocol.  Documentation of client interest in smoking cessation and/or reduction was completed and the client was provided opportunity to participate in SCRIPT. The SCRIPT Program Procedures (P) includes:

• Assessment and biochemical confirmation of self-reported CO levels at the 1st visit and once during 3rd trimester,
• A tailored patient guide (5th-6th grade reading level), “A Pregnant Women’s Guide to Quit Smoking”,
• A tailored 8 minute counseling video, “Commit to Quit: During and After Pregnancy”,
• A trained provider (DCC) delivering SCRIPT methods during a home visit and systematic reinforcement by all providers (MD’s/RN’s),
• Promotion of QUITLINE counseling sessions and
• Encouragement of a non-smoking home policy and partner social support to reinforce quit attempts and cessation. 

For women who may not want to participate in SCRIPT, the WVHVP is compiling a list of evidence-based smoking cessation strategies and referral sources to provide families.  Home visitation programs have found to have better success with smoking rates by including multiple strategies for families to find the best option for that individual to reduce or quit smoking. The WVHVP will continue to work with other OMCFH perinatal programs to maintain a resource list for home visitors to better assist with appropriate referrals for families. SmokeFree Moms and the WV Quit Line are two resources readily available to meet families’ needs. 

Continue to seek out innovative evidence-based strategies to support women in quitting tobacco products before, during and after pregnancy.

The Partnership trained  over  200  health  care  providers, provided  technical  assistance  and  resources,  facilitated  information  sharing  and  provided support to  multiple  groups  working  on tobacco  cessation  in the  state, developed  a pediatric provider toolkit on tobacco/nicotine cessation; and promoted a consistent and unified message among  key  stakeholders  regarding  the  importance  of  tobacco/nicotine  cessation  among  the target population.

In continuous efforts to broaden our reach of stakeholders working on perinatal cessation issues, we added several new members to the Advisory Council this year.  They included the Coalition for Tobacco Free WV, The American Lung Association, and the American Heart Association.  These groups are focused on tobacco control for the general population, but they have expressed interest and willingness to work with us to address special considerations for the perinatal population through this project. 

Project staff also participate on related statewide groups to ensure consistent and unified messages are promoted.  Project staff participated in the March 11, 2020 public health meeting to develop a statewide strategic plan for addressing tobacco.  Project staff participate on the monthly calls of the Coalition for Tobacco Free West Virginia. 

The Help2Quit tobacco cessation project will provide support for women to stop using tobacco products before, during and after pregnancy. The WV Family Planning Program asks about tobacco use on the Patient Data Form and tracks referrals to tobacco cessation providers. The OMCFH will monitor tobacco cessation on the 7 providers sites that participated in the Certified Tobacco Treatment Specialist (CTTS) training in May 2019.  An evaluation of the success of a CTTS within the provider sites increases tobacco cessation by patients. 

The WV Perinatal Partnership distributed over 75 “Up in Smoke” posters and 1000 “Up in Smoke” patient handouts to obstetric, family practice and pediatric providers, along with March of Dimes materials on smoking and pregnancy. Planned and facilitated four Tobacco Free Families Advisory Council meetings and added the Coalition for Tobacco Free WV, the American Lunch Association and the American Heart Association to the Advisory Council.  

A pediatric provider toolkit was developed in collaboration with the WV Chapter of the AAP, including motivational interviewing tools, resources for parents, nicotine replacement therapy (NRT) dosing guidelines for adults, NRT guidelines for adolescents, research and resources related to vaping and other emerging nicotine harms, and coding to bill for screening and counseling.

Dr. Lefeber was elected to represent the state as the West Virginia E-Cigarette Champion for the American Academy of Pediatrics.  Dr. Lefeber will receive training on vaping and on an evidence-based curriculum for addressing e-cigarette use.

Follow-up with maternity care providers after receipt of evidence-based training to assess increase of tobacco cessation with pregnant women.

Follow-up with provider sites trained in Help2Quit, the 5A’s and 5R’s of tobacco cessation will continue to assess if training has changed how smoking cessation is provided, if it has increased and any suggestions for future trainings. Technical assistance and refresher training will be available.

The COVID-19 pandemic has affected some of the follow up in a number of ways.  It has impacted the ability to communicate with health care providers to schedule training, provide resources and offer technical assistance.  Maternity and pediatric providers have been focused on learning as much as they can about the novel coronavirus and keeping up with the latest research.  Clinicians have been forced to develop new policies and procedures to keep their staff and their patients safe.  Seeking new skills and resources about an ongoing health issues has not been a priority and getting their attention to address smoking cessation has been a challenge.

Substance Use Disorder

The Family Planning Program has continued to promote the utilization of LARCs for those seeking contraceptive services, especially those with substance use disorder.  Collaboration with harm reduction clinics helps speak to those with the disorder as they engage professionals to aid them in recovery.  Currently there are three harm reduction clinics participating and providing access to Family Planning services, including long acting reversible methods of contraception.

Since June of 2018 collaboration with the Division of Corrections and Rehabilitation has provided 2,278 inmates access to a family planning provider.  All 2,278 inmates have received education about reproductive health and contraceptive methods, including LARCs.

• 1,616 pregnancy tests were completed. 
• 740 women of childbearing age were provided at least one method of contraception.
• 2019 – 2020 65 inmates preparing for release at Lakin received a two part training conducted as part of Family Planning’s community outreach and education, which dealt with healthy relationships, birth control methods and sexually transmitted infections with a strong emphasis in LARC efficacy and connections to Family Planning services and service sites..

The Family Planning Program was instrumental in development of the 2017 LARC Initiative Toolkit which is still being used and shared with providers. This toolkit is designed to highlight the importance and benefits of immediate postpartum LARC and help providers navigate institutional barriers to implementation. Over the past decade there has been a dramatic increase in NAS incidence in the United States, with West Virginia having some of the highest reported rates. Primary prevention of NAS includes decreasing unintended pregnancies among those patients with drug addiction, which includes promotion of LARC methods. In women enrolled in substance abuse programming throughout the state, immediate postpartum LARCs, as with other populations, can decrease the risk of short interval pregnancy.

A STABLE course was held at Wheeling Hospital in September 2019 with nurses from both Wheeling and Reynolds hospital in attendance.  All participants received the training books.  Additional STABLE courses trainings had to be canceled due to the COVID-19 pandemic.  Plans to transition to a virtual platform is ongoing.

The “Eat, Sleep, Console” scheduled for Princeton Community Hospital as a pilot for the state, postponed due to pandemic.  Yale university is under contract to provide technical assistance and guidance to Princeton Community Hospital moving forward with the implementation of the innovative approach.

PRSI

The PRSI made strides in becoming a web-based tool. The system is now in development and testing has begun. The goal is to improve completion and submission of the PRSI. Technical assistance will be provided during the transition period.

Maternal Mortality

Partnered with hospitals and birth facilities to hold three workshops on Emergency OB Simulations with low fidelity equipment to support the “Patient Safety Bundles” as recommended by the Alliance for Innovation on Maternal Health and ACOG and AWHONN.  The kick-off for the Hypertension Bundle was delayed to give hospitals time to adjust their policies and procedures in anticipation of COVID positive mothers. “In the shadows of Preeclampsia” by the CEO of the Preeclampsia Foundation was presented at the 2019 Perinatal Summit.

Twenty-three hospitals signed onto the AIM Patient Safety Initiative working on process and structure measures at their facilities based upon the patient safety checklists.  Each facility attending the simulation train-the trainer sessions received a free Mama Natalee simulation model to continue regular drills at their facilities.  The rate of maternal morbidity among hemorrhage cases, excluding those that only received 1-2 units of blood, has decreased from a high of 9% in 2015 to the current rate at the end of 2018 of 4.5%.

Addressed Maternal Safety in Rural Emergency Departments related to the recognition and timely treatment of common obstetric complications in three rural emergency departments. Provided outreach education to three delivering hospitals with over 1,000 births on the standardized approach to obstetric triage to prioritize the woman’s urgency for provider evaluation using the Maternal Fetal Triage Index.

• Assigned case ascertainment of one hundred thirty-three (133) 2017 infant mortality cases. 7/1/2019-6/30/2020:
• Completed case ascertainment/medical record review of 133 (100%) of 133 assigned cases (2017).
• Assisted in alleviating backlog of 2016 infant death cases; 28 additional cases assigned, for 161 total infant cases completed.
• Average case completion rate 2.38 cases/week.
• Obtained birth/death certificates for 2017 infant death cases.
• Developed Master Infant Mortality 2017 tracking system using 2017 Infant Mortality spreadsheet prepared by Health Statistics Center, Division of Vital Statistics. 
• Generated letters of request for medical records from birthing hospitals and smaller facilities that referred care to larger Level III tertiary care centers.