Docstoc

Neonatal sei

Document Sample
Neonatal sei Powered By Docstoc
					Improving Outcomes
  Through Pre and
  Interconception
       Health
   January 11, 2011
             • Describe the components of
               pre and inter-conception
               care
Objectives
             • Describe the provision of
               culturally competent care
             • State the implications of
               outcomes on fetal and infant
               mortality
                • Preconception-before birth
                  • Effectiveness of prenatal
Preconception       care-timing?
                  • Essential part of primary and
                    preventative care
                     • Risk reduction
                  • Recognition of the
                    importance of life course
                    perspective
                  • Health of mother prior to
                    pregnancy impacts outcome
                  • Period of time from the birth of
                    one child to the birth of the next
                    child
Interconception   • Opportunity for wellness
                    promotion between pregnancy
                  • Pregnancy planning
                     • Combines
                          • Prenatal care
                          • Ancillary services
                          • SELF-ADVOCACY
             • Family         • Folate
               violence         supplements
             • Infections     • Clinical exam
Risk         • Immunization   • Psychosocial
Assessment   • Nutrition      • High risk
                                 • Chronic HTN
             • Depression        • Gestational
             • Stress              hypertension
             • Health            • Pregestational
                                   diabetes
               promotion
                                 • Gestational
             • Exposures           diabetes
             • Family            • Overweight/
               Planning            obesity
             • Preterm birth        • Clinical
             • Health promotion       interventions
                • Smoking              • Progesterone
                  cessation
Risk                                • Psychosocial
                • Substance
Assessment        abuse               interventions
                • Optimal pre-         • Children with
                  pregnancy BMI          special
                • Omega 3 intake         needs
                • Family Planning
                                       • Home
                • FAMILIAL
                  SUPPORT
                                         visitation
                  • Goals
                    • 1. Improve the knowledge and
                      attitudes and behaviors of men
Recommendations       and women related to
to Improve            preconception health
Preconception
Health              • 2. Assure that all women of
                      childbearing age in the US receive
                      preconception care services
                       • Evidence based risk screening
                       • Health promotion
                       • Interventions
                 • 3. Reduce risks indicated by
                   previous pregnancy outcome
                   through interventions during
Recommendation
                   the inter-conception period
                 • 4. Reduce the disparities in
                   adverse pregnancy outcomes
• Individual responsibility across the
  lifespan
• Consumer awareness
• Preventative visits
• Interventions for identified risks
• Inter-conception care
• Pre-pregnancy checkup
• Health Insurance Coverage for low
  income women
• Public health programs and strategies
• Research
• Monitoring Improvements
(Recommendations to Improve Preconception Health and Healthcare---United
   States, MMWR April 21, 2006)
• The Infant Mortality
  Rate is commonly
  used as a measure of
  a community’s overall
  health.
Map of
Milwaukee
Infant Deaths
                Zip Code 53206
(2003-2007)     had the greatest
                number of infant
                deaths (62)
(N=629)         and the highest
                infant mortality
                rate (18.42).




                Wisconsin Dept. of Health Services, Division of Public Health, Bureau of Health Inf ormation and Policy,
                Wisconsin Interactive Statistics on Health data query system, http://dhs.wisconsin.gov/wish Inf ant Mortality
                          2005 Medicaid Births in Selected Counties
                        (Dane, Kenosha, Milwaukee, Racine, and Rock
                                          Counties)

                  $180,000
Financial         $160,000
                                                                                   $165,032 $163,672


Cost:             $140,000

Birth Weight      $120,000

and Infant        $100,000                                             $98,505

                   $80,000
Hospitalization
                   $60,000
Average            $40,000                               $36,086
Charges            $20,000                    13,022
During the                $0
                                $3,514

First Year of                    Normal 2,000-              1,500- 1,000-               750-        <750g
                                 Weight 2,499g              1,999g 1,4999g              999g
Life (2005)

                   Katcher & Johnson (2008). Moving Toward Equity in Birth Outcomes: Where We’ve Been, Where We’re
                   Going; Data Trends and Evidence, Wisconsin Infant Mortality Summit, Racine, WI (May).
                                                                        African
                        Cause of Death                                 American                        White

              Perinatal: Disorders related to                                                         14.2%
Milwaukee’s   Preterm birth and Low Birth
              Weight
                                                                    30.7%
Leading       Congenital malformations/
              birth defects
                                                                          9.3%                       20.8%
Causes of
              SIDS (Sudden Infant Death                                 14.0%
Infant        Syndrome)                                                                              19.8%
Mortality     Perinatal: Maternal                                         7.1%                          9.4%
              Complications of Pregnancy
(2003-2007)
              Respiratory Distress                                         2.9%                            X
              Syndrome (RDS)

(N=613)       Perinatal: Newborn
              Complications of Placenta/
                                                                           3.1%                            X
              Cord/Membranes


              Wisconsin Dept. of Health Services, Division of Public Health, Bureau of Health Inf ormation and Policy,
              Wisconsin Interactive Statistics on Health data query system, http://dhs.wisconsin.gov/wish Inf ant Mortality
              Module, accessed 11/19/08.
                       Biological,
                      Psychosocial,                                Stress                  Protective
Factors                       and
                     Environmental
                                                                                            Factors

Contributing to            Stressors
                                                           Perinatal Morbidity
Infant Mortality                                                 Low Birthweight
                                                                  Preterm Birth
                                                         Intrauterine Growth Restriction
                                                            Small for Gestational Age
                                                               Caesarian Sections
                                                              Congenital Anomalies




                                                              Infant Mortality




                   Katcher, M.L. & Onheiber, P.M. (2008), af ter James, 1993.
                                                                 •   Maternal age <18 or > 40 years
                                                                 •   Maternal Low Birthweight
                                                                 •   Lack of pre-conceptional and inter-conceptional health care
                                                                 •   History of prior poor birth outcomes
                                                                 •   Absence of high-quality, culturally-competent, evidence-based,
                                                                     prenatal care
Maternal                                                         •   Unplanned pregnancy/lack of family planning
Biological                                                       •   Short inter-pregnancy interval (<18 mo)
                                                                 •   Poor nutrition and vitamin intake
Factors                                                          •   Inappropriate weight gain; obesity; diabetes
                                                                 •   Hypertension/preeclampsia/eclampsia
                                                                 •   Anemia
                                                                 •   Tobacco, alcohol, and/or other drug or medication use
                                                                 •   Strenuous work and/or high stress
                                                                 •   STI/STDs (Chlamydia, gonorrhea, bacterial vaginosis); HIV/AIDS
                                                                 •   Group B beta-hemolytic strep
 Biological,
Psychosocial,            Stress                   Protective     •   Bacteriuria and urinary tract infection
     and                                           Factors
Environmental
   Stressors
                                                                 •   Periodontal disease
                  Perinatal Morbidity
                        Low Birthweight
                          Preterm Birth
                                                                 •   Cervical or uterine anomaly
                                                                 •
                Intrauterine Growth Restriction
                   Small for Gestational Age
                      Caesarian Sections
                                                                     Multiple pregnancy
                     Congenital Anomalies

                                                                 •   Polyhydramnios
                     Infant Mortality


                                                               Katcher, M.L. & Onheiber, P.M. (2008).
                                                                       • Lack of social support
                                                                       • Racism
Maternal                                                               • Stress
Psychosocial                                                           • Intimate Partner Violence
Factors                                                                • Perinatal depression and other mental
                                                                         health conditions
                                                                       • Inadequate education
                                                                       • Lack of resources


 Biological,
Psychosocial,            Stress                   Protective
     and                                           Factors
Environmental
   Stressors
                  Perinatal Morbidity
                        Low Birthweight
                          Preterm Birth
                Intrauterine Growth Restriction
                   Small for Gestational Age
                      Caesarian Sections
                     Congenital Anomalies




                     Infant Mortality



                                                               Katcher, M.L. & Onheiber, P.M. (2008).
                                                                        •   Unsafe sleep environment
                                                                        •   Second- and third-hand smoke
Environmental
Factors                                                                 •   Poverty
                                                                        •   Poor housing conditions
                                                                        •   Pollution
                                                                        •   Crime/unsafe neighborhoods
                                                                        •   Neighborhood segregation

 Biological,
Psychosocial,            Stress                   Protective
     and                                           Factors
Environmental
   Stressors
                  Perinatal Morbidity
                        Low Birthweight
                          Preterm Birth
                Intrauterine Growth Restriction
                   Small for Gestational Age
                      Caesarian Sections
                     Congenital Anomalies




                     Infant Mortality




                                                               Katcher, M.L. & Onheiber, P.M. (2008).
                                                                           • Culturally Competent Pre-
                                                                             conceptional and prenatal care
                                                                           • Resiliency
Protective
                                                                           • Health education and empowerment
Factors                                                                    • Family planning
                                                                           • Good nutrition
                                                                           • Comprehensive coordinated care
                                                                           • Breastfeeding
 Biological,
Psychosocial,
     and
                         Stress                   Protective
                                                   Factors
                                                                           • Safe sleep
Environmental

                                                                           • Immunization
   Stressors
                  Perinatal Morbidity
                        Low Birthweight
                          Preterm Birth


                                                                           • Well child care
                Intrauterine Growth Restriction
                   Small for Gestational Age
                      Caesarian Sections
                     Congenital Anomalies




                     Infant Mortality




                                                               Taken f rom Katcher, M.L. & Onheiber, P.M. (2008).
                 Interconception Health Promotion Initiative -
                      Denver, CO
                         •         Reduced risk of recurrent LBW by 1/3
                 Inter Pregnancy Care program - Atlanta, GA
Successful               •         72% increase in interconception care
Demonstration            •         Longer inter-pregnancy intervals than those
                                   not enrolled
Projects         Magnolia Project – Jacksonville, FL
                         •         86% participants were consistently using
                                   contraception at closure
                         •         74% of participants w/ repeated STDs had no
                                   recurrent STDs at closure
                 Northern Manhattan Perinatal Partnership-
                     Harlem, NY
                         •         Increased prenatal care during the first
                                   trimester from 25% in 1990 to 92% in 2006
                         •         Child welfare trends have improved


                Lu, M.C., Kotelchuk, M., Hogan, V., Jones, L., Jones, C.P., Half on, N. Closing the black -white gap in birth
                    outcomes: A lif e-course perspective. Accessed at:
                    http://wphf .med.wisc.edu/specialinitiative/wingspread.php on 12/17/08.
                 • Fetal and Infant Mortality
                   Healthcare Collaborative
                    • Group of health care systems
Pre and Inter-
                    • Work on identifying and
conception
                      implementing solutions at a
Health Care
                      system level
Healthy Mom
Model               • Received grant to explore cultural
                      competency in the delivery of pre
                      and inter-conception health care
                       • Provider Surveys
                       • Focus groups of low-income
                         women in high mortality zip
                         codes
              • 13 questions         • Sample
                                       questions:
              • Topics included:        • If family or friends
                 • Family/friend          give you advice
                   advice vs              that is different
Focus              provider advice        from your
                                          nurse/doctor’s
Group Guide      • Culture and            advice whose
                   health care            advice would you
                                          take and why?
                 • Health care          • How do your
                   expectations           beliefs, values or
                 • How women              traditions affect
                                          what you do
                   ensure their           before, during
                   questions are          and after
                   answered               pregnancy
                                        • What one thing
                 • Barriers/              could make it
                   suggestions            hared to get the
                                          kind of healthcare
                                          you need during
                                          pregnancy
                       • Hmong (preconception) women:
                         heard from family that prenatal
                         visits were not important and
Differences between      agreed
racial/ethnic groups
                       • African American women did not
                         see the importance of culture-
                         were more concerned with
                         general women’s issues: work,
                         money, raising a family
                       • Latina women more torn
                         between American medicine and
                         alternative, cultural medicine
                         • Most related their decision making
                           to their level of acculturation
              • Mentioned at each group:
                • Insurance
Barriers to        • Lack of choices
Care               • Perception of quality of
                     care being directly affected
                     by quality of insurance
                     (public v. private)
                • Time/schedule
                • Transportation
               • Honesty
               • Respect
Expectations   • A solution and an
of provider      expectation
               • Comfort
               • Continuity of care
               Strategies to make sure questions were answered:
               • Written list
               • Persistence-keep asking until they understand for found
                  someone who answered.
                   •   Did not appreciate being asked to make another
                       appointment to answer questions or provider not taking the
                       time to answer questions
                • From family      • From
                  and friends:       providers:
                   • Eat healthy      • Nothing
How to care        • Exercise         • Birth control
for your self      • Reduce
before               stress
pregnancy          • No smoking/
                     drugs
              • Are women receiving
                preconception care?
                • Possibly a communication
Conclusions       breakdown-receiving care but
                  not understanding it as such
              • How can providers cross the
                culture divide?
                • Ask questions
                • Don’t make assumptions
                   • Training Ø cultural
                     competence
              • Educate women on “healthy
                before pregnancy”
Conclusions   • Educate the providers on the
                reality of being culturally
                sensitive
            • www.awhonn.org
              • Preconception care
            • www.cdc.gov/mmwr.rr/rr5506.pd
Resources     f
              • Preconception recomendations
            • www.marchofdimes.com
              • Preconception care
            • www.omhrc.gov
              • Office of Minority Health
            • www.perinatalweb.org
              • Becoming a Parent

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:3
posted:1/9/2012
language:
pages:28