Breastfeeding

The OMCFH will continue to support the WVBA to maintain educational support for birthing hospitals to improve their mPINC scores through the CDC.  Technical assistance was available to hospitals, medical schools, and nursing schools to increase breastfeeding rates, such as sample breastfeeding policies and achieving Baby Friendly designation. 

The WVBA will continue working to create an online directory for breastfeeding support and exploring the option to join ZipMilk, a project of the Massachusetts Breastfeeding Coalition, Inc.  ZipMIlk is a website that provides listings for breastfeeding resources sorted by zip code.  It is designed for use by consumers interested in helping or support for breastfeeding, as well as by healthcare providers who want to give their clients access to resources. The data on ZipMilk is collected and maintained by state breastfeeding coalitions and other organizations, which are responsible for the state-specific listings on the web site.  Reasonable verification is required annually.  

The OMCFH supports WIC to increase breastfeeding rates.  WIC has partnered with the WV Chapter of American College of Obstetrics and Gynecology to promote infant nutrition including breastfeeding during the prenatal period. Preprinted prescription pads will be distributed to all maternity care providers in 2019.  WIC outreach workers will visit providers to promote the program.    

Preterm Delivery

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

Using the pre-labor strategies identified in the “First Baby Initiative”, as most successful, very successful, and somewhat successful, the DPWH, in partnership with the WV Perinatal Partnership, will work to educate and implement these strategies. Evidence-based labor support education will be provided in three birth facility locations targeting at least 45 nurses. Each participant will be expected to share education and skills with at least three colleagues. Cesarean section deliveries at each participant’s hospitals will be monitored.

The OMCFH will continue funding to the WV Perinatal Partnership to offer evidence-based labor support training for intrapartum nurses and staff free of charge to reduce the rate of low-risk cesarean delivery.

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

The DPWH will continue 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.

Promote childbirth education for first-time mothers statewide.

The DPWH will continue to promote education services to all pregnant women enrolled in home visitation programs. Some home visitors are even certified childbirth educators and can provide education during the home visit.

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

The DPWH will provide public education materials to maternity care providers, home visitors, and childbirth educators. Materials will stress that if the pregnancy is healthy, it’s best to wait the full 40 weeks for delivery. The DPWH will provide the March of Dimes brain cards to all maternity care providers to give to all maternity clients to illustrate the importance of waiting for labor to begin.

The OMCFH, the WV Perinatal Partnership, and the March of Dimes will continue to promote the March of Dimes Banner Program and will continue to support collaborative projects to address low risk first-time cesarean births. Working with the WV Perinatal Partnership and the WV Chapter of the March of Dimes, evidence-based activities will be implemented to bring hospital administrators, physicians, nurses and other health care professionals together to address changes in practice and sustained education.

The Perinatal Partnership is investigating the use of doulas and insurance/Medicaid reimbursement for services. A doula is a professionally trained individual in childbirth, providing emotional and physical support during pregnancy, childbirth and postpartum.  The use of doulas has reduced the need for cesarean deliveries.   

In collaboration with the WV Perinatal Partnership, OMCFH will continue to train providers and birth facilities on how to address recurrent preterm labor. Through on-going education from maternal-fetal medicine physicians, education will be provided on the use of progesterone in women with a history of preterm birth. Training will continue to be offered to diagnostic medical sonographers statewide to enhance their skills for assessing cervical length to help to reduce preterm birth.

Education on fetal monitoring will continue to be provided for clinicians by the Perinatal Partnership. The course will provide standardized methods in the assessment of the fetal heart rate status, including interpretation, documentation.

Infant Mortality

In an effort to reduce infant mortality, OMCFH will implement Count the Kicks for all maternity care providers.  Count the Kicks is an evidence-based stillbirth prevention public health campaign that teaches moms to monitor their babies’ movement daily in the third trimester.  Count the Kicks will mail educational materials to all maternity care providers and share directions for an App for mothers to use also. 

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

The OMCFH will provide funding to the WV Perinatal Partnership to conduct best practice updates in multiple locations and at the annual Perinatal Summit for maternity care providers to share any new guidelines from the American Congress of Obstetrics and Gynecologists (AGOC) and Society for Maternal

Fetal Medicine. The target audience includes physicians, nursing staff, childbirth educators, and medical and nursing students.

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

Over the next year, the Oral Health Program will maintain its surveillance system for children and pregnant women to assess progress and assure evidence-based program planning. In addition, the Program will continue to provide training to help dentists become more comfortable in providing dental care to pregnant women. This work will be 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 will continue to work with insurance providers to increase dental coverage for pregnant women. As of January 1, 2018, all four state Managed Care Organizations (MCO) have value adds that cover basic preventive services (x-ray, cleaning and examination) for women during pregnancy and up to 56 days (8 weeks) postpartum (Aetna, The Health Plan, UniCare and WV Family Health Plan).

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

The Oral Health Program will continue to educate both medical and dental providers on the 2012 National Consensus Statement for Oral Health Care during Pregnancy. The program will utilize 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.

The OMCFH and the Division of Tobacco Prevention will continue to partner with the WV Perinatal Partnership to address smoking during pregnancy through the Smoking During Pregnancy Project. The primary focus of the project is to develop training and intervention programs using evidence-based strategies targeted to prenatal and pediatric providers to reduce smoking during and after pregnancy. This training provides physician leadership and engagement, consultation and recommendations on provider and practice policies in order to reduce the rates of pregnant women who smoke. The initial focus of the program is a training and educational effort to ensure that all maternity and pediatric providers in the state are provided the tools to give consistent and ongoing messages regarding the importance of tobacco cessation before, during and after pregnancy.

The Project is led by physician champions and other health care professionals and experts who can advise, implement changes, and coordinate efforts. Trainings are taken to the physicians and conducted by physician

champions. The training titled Help2Quit focuses on the use of the 5A’s and 5R’s of tobacco cessation. Providers also receive tools to assist with promotion of smoking cessation. Providers that were trained will be recognized at the 2019 Perinatal Summit. Trainings are conducted on an on-going basis and the practice of offering the training in provider offices will continue.

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

The Office will continue to deliver evidence-based messages regarding the importance of protecting children from secondhand smoke in all of its direct service programs, particularly in child-serving programs like Home Visitation and Right From The Start.

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

The Tobacco Free Pregnancy Advisory Council was launched in February 2015 to educate and coordinate efforts between the agencies working to address smoking during pregnancy. The advisory decided to change the name to Tobacco Free Families Advisory Council.  This group will continue to meet quarterly to develop and implement evidence-based strategies, address concerns from stakeholders and to support on-going tobacco cessation.

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. 

Dr. Timothy Lefeber has received training on the Clinical Efforts Against Secondhand Smoke Exposure (CEASE) Program.  Dr. Lefeber hopes to implement this program in his pediatric practice at West Virginia University.  The program provides tobacco cessation information to the parents on site and nicotine replacement therapy (NRT) to those requesting the product.  This program has proven successful in the Pittsburg area.  Funding is being sought to purchase the NRT to provide at the office site. This project will also collect agreed upon data points and will share results with OMCFH.

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.

Substance Use Disorder

The Family Planning Program will continue to promote the utilization of LARC for those seeking contraceptive services, especially those with substance use disorder. Collaboration with harm reduction clinics, corrections and hospitals for immediate postpartum LARC insertion during the delivery visit will continue.  OMCFH will continue to support the DFMB programs to provide care and support for pregnant women with substance use disorder during the prenatal period and follow-up for 2 years.  

The Perinatal Partnership Bereavement Team will expand to include educational resources for women that lose custody of their infant at time of delivery.  This is usually caused by substance use disorder.  Mothers with substance use disorder often grieve their loss of custody in much the same way as mothers that experience an infant death. Support will continue for the STABLE program education to birthing hospitals.  STABLE is a neonatal education program to focus on the post resuscitation/pre-transport of high risk sick infant.   Many infants with NAS are transported to tertiary care centers. Referrals from the Birth Score program to CSHCN is an ongoing process.  The goal is to track infants with NAS long term. 

The Perinatal Partnership is supporting hospitals that would like to implement Eat, Sleep, Console (ESC) for infants diagnosed with NAS. Started at Yale New Haven Children's Hospital, the model emphasizes keeping the infant with the mother; encouraging breast feeding, skin-on-skin contact, and other comfort measures. 

PRSI

The PRSI will be transitioned to a web-based document.  The goal is to improve completion and submission of the PRSI. Technical assistance will be provided during the transition period.

Maternal Mortality

The OMCFH will continue support for the Perinatal Partnership post-birth warning signs to share lifesaving information regarding common causes of maternal mortality. The Perinatal Partnership will update a chart for all emergency departments providing algorithms for care of postpartum women. OMCFH will participate in another AIM safety bundle, and the  focus will be on hypertension.  This safety bundle will start in fall 2019 and outcomes will be provided in the 2019 annual report.