Decrease preterm and low birthweight infants

 

The OMCFH, in partnership with the Perinatal Partnership’s CDC Perinatal Quality Collaborative capacity grant, is participating in the Risk Appropriate Care (RAC), a quality improvement strategy that endeavors to assure that babies are born in a hospital with the appropriate level of nursery, and that mothers with high-risk conditions give birth in a facility that is best prepared to meet their needs. The OMCFH participates in the Pre-Term Birth workgroup.  An analysis of preterm birth incidence in each facility, as well as by county of mother residence was completed using data from Project Watch. There were 9,601 infants born preterm out of 86,447 singleton births during the 5-year reporting period between May 2018 and April 2023. The rate of preterm birth was 111 per 1000 live births (11.11%). The rate of preterm birth was statistically significantly higher during the pandemic at 11.41% vs. 10.64% during the pre-pandemic time. Out of the 55 counties in West Virginia, there were 6 counties where the preterm birth rate was more than 14% (140 per 1000 live births) (Boone, Wyoming, Mingo, Mason, and Mineral). The preterm birth rate was significantly higher in urban vs. rural regions of the state. Using the NCHS classification system, data showed that metropolitan areas had significantly higher rates of preterm birth. This includes small metro and medium metro areas vs. non-core regions.

 

Preterm birth increased as the maternal age increased. The black race had the highest rate of preterm births than any other race. Those with less than a college education had higher rates of preterm birth. Pregnant individuals enrolled in the Medicaid health insurance program had higher rates of preterm birth compared to those on private health insurance. Those with diabetes (Type 1, Type 2, gestational) were more likely to have a preterm birth compared to those with no diabetes. The preterm birth rate increased as the number of pregnancies increased. Smoking and substance use during pregnancy included opioids, cannabinoids, stimulants, antidepressants, sedatives, gabapentin, and alcohol use in pregnancy were associated with preterm birth.

 

Preterm birth increases the risk of infant death before hospital discharge, low birth weight (< 5 lbs. 8 oz), NICU admission, low 5-minute Apgar score (< 7), longer length of hospital stay, and high Birth Score. Moreover, preterm birth infants were less likely to be exclusively breastfed for the duration of their hospital stay from their birth to the hospital discharge.

 

To expand community outreach, the OMCFH supports efforts to promote education on risk factors for pre-term birth. The WV Perinatal Partnership (WVPP), in partnership with the Marshall University Office of Minority Health, held a live webinar with in-person and online offerings at Marshall University on November 30, 2023. Information regarding risk factors for preterm birth, preterm birth risk statistics, and information on self-care for pregnant women was presented.

 

A session on Harnessing Breast and Cervical Cancer Screening Program (BCCSP) and WV Family Planning (WVFPP) Health Visits to Identify and Manage Undiagnosed Hypertension, Emphasizing Preconception Care was conducted at the Second Annual Breast and Cervical Cancer Screening Training Collaborative on April 9, 2024. Post-test results showed a 34% increase in learning about low-dose aspirin being safe for pregnant women with high risk factors for hypertension. The Training Collaborative included BCCSP and WVFPP providers and staff, community health workers, volunteers, and Medicaid Managed Care Organizations. There were 134 attendees in total, with 62 of those in-person and 72 virtual.

 

Provide evidence-based labor support education for nurses in birthing facilities

 

Promote Doulas in WV Perinatal Care

 

The Doula Advisory Committee meets bi-monthly and is represented by the OMCFH Division of Women’s and Family Health (DWFH), the OMCFH Division of Infant, Child, Adolescent, and Young Adult Health (DICAYAH), obstetricians, nurse midwife, representative from a Medicaid Managed Care Organization, doula, labor and delivery nurse, and WV Perinatal Partnership. The committee is currently reassessing the committee members’ make-up, with plans to broaden representation to include community members, including parents and community organizations.

 

The DWFH Special Projects Coordinator was hired in March 2024 with funds from the Preventive Services Block Grant. This temporary position coordinates special projects related to Women’s and Family Health. Work on the Doula Listening Sessions was initially delayed due to a lag in hiring this position. Work is now back on track. The Division has secured facilitators and Listening Sessions are scheduled for July and August 2024. 

 

The OMCFH is obtaining technical assistance from nearby states on implementing doulas into perinatal healthcare.  The WVPP held a Doula Day in March 2024, and sessions included representatives from New York and North Carolina, with information on payment schedules, residency training, health disparities and building supportive partnerships. OMCFH Physician Director and DWFH and DICAYAH Division Directors participated in meetings in February 2024 with the Maryland Department of Health and is currently scheduling site visits. 

 

The OMCFH is collaborating with the WVPP on doula initiatives. Lunch and Learns on Doulas were presented in January and March 2024 at Logan Medical Center and Charleston Area Medical Center Women’s and Children’s. Attendees included obstetricians, Nursing Directors, Nurse Managers and Labor and Delivery staff. Themes emerging from these sessions included increased awareness of the role of doulas and lack of trust in doulas due to the labor and delivery nurses having no prior relationship with the doulas.

 

To increase reach, a Doula Directory is being created on the Perinatal Partnership website as well as on the OMCFH Home Visiting Resource Directory. To date, 27 doulas have provided contact information and agreed to be listed in the directory. The term “directory” is being used to avoid confusion with “registering” doulas in the state, which is not a current requirement. There are 39 doulas participating in a network (email group) who receive regular information from the director of the WVPP doula project. To date, more than 50 doulas have participated in the Doulas of North America (DONA) training.

 

Love Your Birth Control

 

To promote optimal spacing during pregnancy, the Love Your Birth Control (LYBC) continues to be provided free to any healthcare facility or community group that requests training. From July 2023 to March 2024, five sessions were held. A session at the West Virginia School for Osteopathic Medicine included healthcare providers, medical students, and community health workers. In the last quarter of 2023, two training courses were held for a total of 25 participants. One training course for 30 individuals was held at the Bluefield School of Nursing in March 2023. The Doula Day Workshop included the LYBC course on March 25, 2023, in which 28 people, including 15 doulas, were trained. Materials were displayed and distributed at the Perinatal Summit in September 2023 with new contacts arranging future training.

 

OMCFH encourages and supports community outreach on perinatal health issues. The Perinatal Partnership conducted community outreach at the Fifth Annual Minority Health Fair in Huntington in September 2023. Materials on hypertension, preterm birth, contraception, smoking cessation, and substance use in pregnancy were distributed.

 

Provide Lamaze childbirth education

 

A Lamaze two-day Seminar for Lamaze Certified Childbirth Educators was held in May 2023. OMCFH supports the WVPP credentialing of this program.  One Lamaze Evidence-Based Labor Support 1-day course for intrapartum nurses with doulas added to the invitation was conducted on June 1, 2023, in Lewisburg with a total of 10 attendees.  The West Virginia Home Visitation Program developed a Home Visitor Resource Directory which included locations of certified Lamaze childbirth educators for use with referrals for prenatal clients requesting Lamaze education.

 

Promote childbirth education for first-time mothers statewide.

Count the Kicks, a stillbirth prevention program, has provided no-cost literature for hospitals and clinics through the support of OMCFH. There are business sized cards and refrigerator magnets, brochures and posters encouraging mothers to count the baby’s kicks in a 10-minute window each day, beginning in the third trimester. In addition, a robust mobile phone app is downloadable for mothers with no charge.

A Count the Kicks webinar was held in November 2023 for stillbirth prevention training for healthcare professionals and community workers.  A Count the Kicks webinar was held in February 2024 for doulas. There were 28 in attendance. The webinar included information regarding having movement monitoring conversations with expectant parents and how to use the Count the Kicks app. 

Between October and December 2023, 4,455 pieces of Count the Kicks materials were sent out to healthcare professionals and community workers. From January 2024 to March 2024, 2,515 pieces of Count the Kicks materials were sent out to healthcare professionals and community workers.  This included 700 magnets for use as a visible reminder on the refrigerator about the importance of monitoring fetal movement.

The Count the Kicks app, a free tool for women in the 3rd trimester saw 104 new users and 20 returning users during October to December 2023, and 1,439 people in West Virginia visited the Count the Kicks website for an average of 480 people per month and a 49% increase from the 1st quarter. The Count the Kicks app, a free tool for women in the 3rd trimester saw 83 new users and 8 returning users during this quarter. During January to March 2024, 327 people in West Virginia visited the Count the Kicks website for an average of 109 people per month.

Conduct best practice updates for maternity care providers on the recommendations of the American College of Obstetrics and Gynecologists and the Society for Maternal Fetal Medicine.

The OMCFH has addressed diversity, equity and inclusion in provider education via collaboration with the WVPP, which in turn partnered with the March of Dimes and local presenters to provide education on Diversity, Equity and Inclusion to providers throughout the state. Representatives from the delivering hospitals have completed their education and began conducting presentations for their hospital staff in the fall of 2023. Additionally, curriculum for POST BIRTH, Obstetric Emergency in the ED and fetal monitoring courses include information on racism and bias. Special emphasis was placed on the topic of healthcare provider bias toward black women and impoverished women as well as a focus on hypertension in pregnancy.  These efforts were performed in conjunction with the Alliance for Innovation on Maternal Health (AIM) hypertension and hemorrhage bundle activities in collaboration with WV ACOG and the WV Hospital Association.

The OB Emergency skills training was held at several hospitals during this last reporting year. Topics covered were severe hypertension/preeclampsia/eclampsia, postpartum hemorrhage, anaphylactoid syndrome (code blue), breech vaginal delivery, and neonatal resuscitation program drills. The Noelle simulator as well as the Resus-a-blue baby were used for the drills.

An Obstetric Emergencies in the ED was held in April 2023 at Wetzel County Hospital.  There were 11 in attendance including emergency department nurses and local EMS. From July 2023 to September 2023, an OB emergency skills training was conducted over two days at Reynolds Memorial Hospital with 24 RNs and 1 MD attending (2 Registered Nurses from Weirton Medical Center & 1 Registered Nurse from Wheeling Hospital attended).

In October 2023, OB Complications in the Emergency Department was presented at the Summersville Arena and Conference Center.  There were participants from Summersville and Braxton hospitals as well as local EMTs and FQHCs in the area.  Included in the attendance were 5 MDs, 27 nurses and 17 “others”.  The event was well received with primarily positive evaluations.

Training was provided at WVU Ruby and Camden Clark Medical Center in November 2024. This training, along with POST BIRTH discharge education, was held at Wheeling Hospital in November 2024 for OB and emergency department staff and residents attending.

Advanced Fetal Monitoring classes were held in Lewisburg and Bridgeport with 18 in attendance (17 Registered Nurses & 1 Certified Nurse Midwife). In October 2023, an Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN) Advanced Fetal Monitoring course was held at Princeton Community Hospital with participants from Princeton Community Hospital and Greenbrier Valley Medical Center.  There were 11 Registered Nurses in attendance, one certified nurse midwife and one physician.

An Intermediate Fetal Monitoring class was held at Stonewall Jackson Hospital in Weston with 4 Registered Nurses in attendance. An AWHONN Intermediate Fetal Heart Monitoring course was presented at Weirton Medical Center in March 2024.  There were 9 Registered Nurses in attendance including the nurse manager and nurse educator.

The AWHONN Obstetric Patient Safety (OPS) course was held twice in early December and led by staff from AWHONN.  The classes were attended by a total of 15 Registered Nurses and 1 obstetrician.  Four Registered Nurses and 1 Physician have completed their “teach back” for the OPS course and are now able to teach the OPS class.  Previously there were no instructors in the state.  An additional Registered Nurse is an instructor candidate and anticipates completing the required “teach back” in March 2024.  This course is a combination of online didactic education and in-classroom short didactic presentations followed by simulation and skills stations.  Topics include the following: general information regarding maternal mortality in the United States, maternal mental health, cardiac complications, sepsis, malignant hyperthermia, preeclampsia, and severe hypertension, anaphylactoid syndrome of pregnancy, postpartum hemorrhage, quantitative blood loss, prolapsed umbilical cord, uterine rupture and post birth warning signs. A presentation was held at Weirton Medical Center with a total attendance of 21, including nurses, physicians, and case managers.  Materials were distributed and discussion around post discharge care was conducted with full participation of their team. 

The OMCFH also supports the West Virginia Perinatal Summit, which was held in early September with 220 in attendance. Topics covered during the Summit included:

• Current State of Perinatal Health in West Virginia
• Intimate Partner Violence, Substance Use, and Substance Use Coercion:
• Implications for Perinatal Providers
• Learning from Lived Experience: A Conversation with Peer Recovery Support
• Specialists
• Brexanolone and New Frontiers—Recent Innovations in Perinatal Psychiatry
• HRSA Resources for Advancing Maternal health in West Virginia.
• Creating an Inclusive and Affirming health System
• Freestanding Birth Center Updates and How to Facilitate Seamless Transfers of Care
• Adolescent Pregnancy Prevention
• Congenital Syphilis: An overview of Cases in the Mountain State
• Dynamics and Impact of Human Trafficking
• Perinatal Mood and Anxiety Disorders—A Real Mother!
• What Can Postpartum Support International WV Do for You?
• Enhanced Recovery After Surgery for Postoperative Cesarean Delivery Pain: Current Trends
• Perinatal Hepatitis C Exposure: A Multidisciplinary Approach to Management in the Mountain State
• 10,000-foot View: WV State Perinatal Priorities
• Health Consequences to Offspring due to Exposure from Vaping During Pregnancy
• Avoiding Pot Holes: Navigating the Cautionary Trail of Cannabis
• Advanced Life Support in Obstetrics (ALSO) courses, an emergency provider training, was offered pre-Summit with 6 Registered Nurse participants.

The AIM Task Force created and supported an Obstetrical Hemorrhage Escape Room at the WV Perinatal Summit. Multiple teams went through the creative learning activity and positive feedback was received. This escape room is available to travel among the hospitals to utilize for additional training on-site.

The Severe Hypertension Pregnancy Escape Room materials from the 2022 Summit have been available to loan to birthing facilities. Five birthing facilities have used the materials to present this opportunity on-site to their staff. Of approximately 220 attendees, there were 166 evaluations submitted to Survey Monkey. The presentations were highly rated, and largely positive comments were noted.

A Perinatal Spring Conference was held in April 2023 for nurses, physicians, doulas, social workers, and home visitors. There were 104 in attendance with 59 post-conference evaluations completed. The evaluations were positive overall.  There was a break-out session for doulas offered. Topics included the following: Avoiding Unnecessary Supplementation, Risk Appropriate Care, Continuous Labor Support, Project Watch Update, Social Determinants of Health: Acceptance of Deviance, Bereaved Motherhood: Supporting Mothers with Substance Use Disorder, Peer Counseling for Mothers with Substance Use Disorder, The Golden Hour, What was Old is New – Syphilis: Diagnosis, Care and Treatment, The Business of Doula Care, and Intimate Partner Violence.

Implement Nurse Family Partnership for first time moms in highest risk counties

WVHVP is near completion of the implementation phase of NFP.  The agency profile was developed and approved by the National model.  The population characteristics and service area analysis were completed.  The organizational mission, culture and structure was finalized and submitted to the National Center.  Letters of support from medical partners, community stakeholders and agencies that will be relevant to the success of the program were completed.  A draft of advisory board members has been submitted to the National center for review and approval and a contracted staff to provide initial nursing support has been completed.  Services will be started in Kanawha County by late Fall 2024.

 

Increase dental care specifically during pregnancy

Continue oral health surveillance of perinatal population through the Basic Screening Survey (BSS) to inform program and policy development

The Oral Health program perinatal surveillance ended in December 2023.  OHP plans to conduct BSS for the adult population during 2023/2024.

Establish a data sharing agreement with Medicaid and CHIP to monitor pregnant women use of available dental services.

The Oral Health program updated the surveillance plan.  Perinatal surveillance ended in December 2023.  OHP plans to conduct BSS for the adult population beginning in the Fall of 2024.

Decrease smoking specifically among pregnant women and decrease smoke exposure among children in the household.

 

OMCFH continues to participate in the Tobacco Free Families Advisory Council.

 

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

 

A Help2Quit/tobacco education training was held in coordination with the WV Oral Health

Coalition at Stonewall in August 2023. The tobacco physician champions training included over 120 Oral Health providers.

 

Help2Quit provider trainings were presented during West Virginia University Grand Rounds with 140 residents/providers and Marshall University Grand Round Training with 44 residents and providers participating in Fall 2023.

 

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

 

Right From the Start, the Medicaid case management home visiting model, continued to implement an evidence-based tobacco cessation model to women requesting to quit or reduce smoking.  The model utilizes care coordination Designated Care Coordinators (DCCs) to check with clients during home visits on reduction and cessation progress.  The DCCs use educational materials, including a handbook and small incentives.  In early 2024, a tobacco treatment counseling component was added to the RFTS SCP project.  The OMCFH Smoking Cessation Epidemiologist worked with the 8 Regional Care Coordinators (RCCS) to recruit DCCs who were interested in providing a higher level of education and counseling to clients as a billable enhanced service through Medicaid.  The selected DCCs were involved in an extensive training program with the Epidemiologist, who is a trained Certified Tobacco Treatment Specialist. A cohort of four DCCs were provided 1–2-hour sessions with role plan twice a month from January 2024 to June 2024.  Each of the four DCCs applied for and received a full scholarship to attend the West Virginia University School of Dentistry Certified Tobacco Treatment Specialist training in May 024.  The three-month-long, self-paced training will include a final exam before the DCCs can be certified. 

 

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

 

Baby and Me Tobacco Free Program (BMTFP) – Most of the women who participate in the Baby and Me Tobacco Free Program have Medicaid. Half (50%) of program enrollees have a high school diploma or equivalent and 24% did not graduate from high school.  From January 2021 to March 2023, 201 women have enrolled in the program. There were 463 telehealth referrals, with a 43% enrollment rate.

 

Efforts to promote the program have included training for OB/Gyn offices, and at the WVU Council for Tobacco Treatment Training Program (CTTTP) training in Spring 2023.

 

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

 

RFTS provided information to maternity care providers on the number of DCCs providing tobacco cessation services, including the number of pregnant women enrolled that indicate they want to quit or reduce smoking.

 

Address substance use in pregnancy and in youth/teens

 

The WVHVP submitted a proposal through the Pediatric Mental Health Access federal grant that was approved for increasing workforce development through Nurse Family Partnership. This braided funding opportunity will work in the southern part of the State (Mingo, Boone, Mercer and Fayette counties that works with foster children, adoption agencies and early childhood programs that provides services throughout four identified high-risk counties to support a NFP nurse and social worker, along with initial costs for an infant mental health consultant on a contractual basis.  For that combination of counties, the teen birth rates for the 15-19 age group were:

• Mingo with a birth rate of 41.4
• Boone with a birth rate of 40.6
• Mercer with a birth rate of 38.6
• Fayette with a birth rate of 34.4

The activities outlined with the WV PMHCA expansion funds will engage social service

agencies and OB providers and pediatricians to refer teen moms impacted by substance use or behavioral concerns to a NFP team.  The team will consist of a registered nurse, social worker, mental health consultant and an early childhood specialist that will also focus on the mom and child through age two.  The two-generational approach will assess social determinants of health, emotional well-being, domestic violence, and secondary trauma which will assist with developing a case plan.

 

Use RFTS RLA to educate providers on accurate and complete submission of the PRSI form.

 

The RFTS Regional Lead Agencies provided at least one visit quarterly with OB providers within their region to discuss the importance of accurate and timely submission of the PRSI form.  Barriers identified by providers were shared with OMCFH so that troubleshooting activities could be provided.  The OMCFH PRSI epidemiologist and RFTS coordinator supported new providers with initial login registration and navigating the system once a password had been established. 

 

Support transition from paper PRSI form to electronic data collection system.

 

The Division of Women’s and Family Health Quality Assurance Coordinator (QAC) was promoted from the position of Tracking and Follow-Up Nurse 3 for the Breast and Cervical Cancer Screening Program (BCCSP) in November 2024. Due to staffing issues in BCCSP, the QAC has continued to contribute to BCCSP as the program onboards and trains new clinical staff. Work on the quality initiative project has also been delayed as the Division awaits the results of the Logistical Regression project to identify pregnancy risk factors which will influence new updates to the PRSI. Once the Maternal Risk Screening Advisory Board revises the PRSI form, the QAC will engage obstetrical care providers and nursing/healthcare staff in a quality improvement initiative related to implementing the electronic PRSI into their healthcare practices, including interviews to identify challenges related to maternal risk screening, opportunities to streamline processes, and innovative ways to improve compliance. A candidate for the epidemiology position to focus on the PRSI has been identified and is set to begin employment in July 2024.

 

Inform providers of compliance rate in submission of PRSI forms.

 

Reports will be developed and shared with providers on a regular basis.