One of MiHIA’s comprehensive initiatives is the Region 5 Perinatal Quality Collaborative (PQC). Connected to THRIVE’s Phase 1 interventions of Prenatal, Infant, and Maternal Health, this area is one of the most active in population health improvement efforts in our region. The PQC has the goal of making sure that mothers and babies are thriving. The eight counties of concentrated effort are: Arenac, Bay, Clare, Isabella, Gladwin, Gratiot, Midland, and Saginaw. Putting this into action involves setting up a locally linked and coordinated network of services for mothers and their babies, committed to the highest attainable standard of health available in our state. The PQC defines the components for such a network as having to include:
- Quality health care
- Mental and behavioral health services
- Community resources and support
- A comprehensive continuum for care
- Innovative payment models.
Evidence-based practices are chosen by the PQC to improve mother and infant health. Considering that infant mortality is one of the most important indicators of the health of a nation and a predictor of the health of the next generation, the PQC effort is both immediately imperative and far-reaching.
Along with regional partners Saginaw County Community Mental Health Authority (SCCMHA) and the Michigan Department of Health and Human Services (MDHHS), the PQC held two summits in 2019, in June and December. The summits focused on tackling the problems holding back the health of both infants and mothers: the need for better maternal and infant health outcomes, growing a breastfeeding community, building the network for healthier futures, responding to the use of both marijuana/e-cigarettes/vaping during pregnancy, the necessity for health equity, and how to tackle implicit bias with its implications for maternal and perinatal healthcare.
CenteringPregnancy is one of the programs being implemented to improve outcomes. This is an innovative model for enhanced prenatal care, given in an empowering group setting. Participants receive 10x more time with their provider while creating lasting friendships and connections with the other 8 to 12 women in their group. In addition to regular health assessments and individual check-ups, there is an educational focus on topics like labor and delivery, nutrition, breastfeeding, stress management, common discomforts, benefits of good dental hygiene, and the importance of follow up care after the baby is born. So far, babies delivered by participants are more often full term, have lower rates of C-sections delivery, have no need for a neonatal intensive care unit (NICU) stay, and are more likely to be breastfed. This model of care was widely discussed at the June summit along with ways to grow a stronger breastfeeding community.
Both summits discussed and offered Implicit Bias training– the unconscious and negative stereotyping of a group of people. Implicit bias is the culmination of what society directly and indirectly teaches its children and chooses to continue as social conditioning. This negative bias has routine unintended negative consequences for certain groups across the nation, and certainly in Michigan. For women and babies of color, it is now a recognized health crisis.
For example, in Michigan, infant mortality (death rate of a baby newborn up to a year old per 1,000 births) significantly differs between racial groups. Specifically, African American infants had a 3 ½ times greater infant mortality rate than white infants in 2015-2017. The current situation for maternal health is not one suited for a developed country. According to the Centers for Disease Control and Prevention, African American women are three to four times more likely to die during or after delivery than are white women. The agency also states that about half the maternal deaths and half of near-death experiences are from preventable causes, and the women most affected are disproportionately African American.
At both PQC summits, audiences were receptive to this issue and its enormous implications. June’s summit involved specific training and December’s summit also addressed the issue further. Implicit bias was also further looked at through the lens of health equity. Health equity means equal access to good healthcare and having the same statistics for general good health and lifespan across socio-economic levels. The summit addressed ways to strategize the advancement of health equity.
Another topic discussed was smoking: e-cigarettes with nicotine, marijuana, as well as traditional smoking. Considering human studies regarding e-cigarettes are not yet complete, discussions revolved around the newest studies conducted on small animals and invertebrates like frogs, and the resulting negative structural (lung) effects and negative neurological effects. Assessing patients and the challenges of the broad study of usage were discussed. Suggestions were given to participants as to how to discuss usage with patients in general, considering denial of use is high as well as suggestions on how to approach patients who admit to using. E-cigarettes are a new frontier and will be a topic for the medical community on which to stay current. Marijuana was discussed and negative effects on newborns were mentioned as well as elevated risk for NICU stays for infants born to mothers who used marijuana. While traditional smoking is an older topic, its negative effects were discussed as well.
The PQC has been working diligently on significant short term and long term strategies to continue to build our regional health network. We specifically want to recognize the dedication of our stakeholders, volunteers, and staff. Keeping up the pace of professional education and energy, the PCQ will be at the Mother Infant Health Summit March 30-31, 2020 in Lansing, MI. More work on these issues will be taking place every day of the new year. Our PQC has its eyes on the success of having a region with robust babies and healthy mothers.