Article

Obstetrics ED is Ascension Wisconsin's latest effort to address maternal crises

February 1, 2021

By LISA EISENHAUER

One of the first patients at the new Obstetrics Emergency Department at Ascension St. Joseph hospital in Milwaukee was in drug withdrawal and having an acute mental health episode. She also was in labor; and, compounding the risk to herself and her baby, she had had no prenatal care.

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A sign points the way to the obstetrics emergency department at Ascension St. Joseph hospital in Milwaukee. The department opened in September.

"The patient's behavior was extremely difficult," recalls Dr. Matthew Lee, who oversees obstetrics and gynecology statewide for Ascension Wisconsin and practices at Ascension St. Joseph. "She was in agony from both her mental health issues and her drug withdrawal."

She was, in fact, the sort of high-risk maternity patient Ascension leaders had in mind when they opened the OB-ED in early September in partnership with OB Hospitalist Group, a company that the health system has contracted with since 2012 for similar departments at its hospitals in New York, Oklahoma, Illinois, Indiana and Florida. OB Hospitalist Group is owned by the private equity firm Gryphon Investors. Founded in 2006, the firm has more than 185 hospital partnerships, according to its website.

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Lee

After the distressed mother delivered her baby at Ascension St. Joseph, the OB hospitalists turned her care over to clinicians at Ascension St. Joseph who could treat her mental illness and substance dependency, Lee says.

Milwaukee's first
The OB-ED is the first of its kind in Milwaukee and the latest of several initiatives that Ascension Wisconsin is undertaking to address the disproportionately high incidences of infant and maternal morbidity and mortality among minority populations, especially those who are Black.

According to data from the Centers for Disease Control and Prevention, Wisconsin has the nation's worst death rate for non-Hispanic Black infants, at 15.58 per 1,000 live births in 2016. Nationwide the rate was about 12 per 1,000 live births. (In both cases the figures are much higher than the comparative ones for infants who are white.) The mortality numbers are also grim in Wisconsin for non-Hispanic Black mothers, who die due to childbirth-related complications at five times the rate of non-Hispanic white mothers.

Ascension St. Joseph long has been known as a "baby hospital," Lee says, because of the skill of its obstetrics department. The hospital is in north central Milwaukee in a ZIP code where census data identifies the population as 75% Black or African American and where the average annual household income is about $32,000 a year.

Exclusive focus
The OB-ED is on the third floor of the hospital, right next to the obstetrics department and two floors up from the main ED. The OB-ED has four patient beds and is equipped with technology to assess the health of both mother and fetus. It is staffed at all times by an obstetrician gynecologist with OB Hospitalist Group who works a 24-hour shift.

"They have no duties other than seeing pregnant women who present there to the emergency department, or other emergencies that may happen within the labor and delivery sphere," Lee says.

The OB-ED specialists also pitch in when needed with noncomplicated births.

The OB-ED is an example of the investment Ascension is making across its ministry to address maternal morbidity and mortality and reduce infant deaths, especially at its urban hospitals, Lee says. Ascension has added certified nurse midwives including one at Ascension St. Joseph last year to encourage healthy behaviors during pregnancy. It is hiring maternal health navigators to help pregnant patients access care and services, including programs that help with transportation, food and housing.

"We're really walking with these patients hand in hand and trying to help them overcome these barriers that they have to access care," Lee says.

Safer care, better access
Just in Milwaukee, Ascension supports a program called Blanket of Love that works with expectant mothers from low-income areas of the city to promote good health practices for themselves and their infants before, during and after delivery. (See sidebar.)

Julia Means, the founder of that program, sees the OB-ED as another way Ascension is backstopping a vulnerable population of women. Many of the young mothers she works with in Blanket of Love don't have the knowledge or confidence to make their needs known to medical staff.

She says the OB-ED, which has doctors trained to care for expectant mothers in high-risk situations, increases the prospect for better outcomes. "The fact that we have an OB-ED that is aware of our young ladies now, this is such a one-up," she says.

Blanket of Love offers wraparound care to at-risk expectant mothers in Milwaukee

It wasn't until Zakkiyya Salahadyn was 39 and pregnant with her ninth child that she learned about Blanket of Love. She was at Ascension St. Joseph hospital in Milwaukee for prenatal care when she saw a flier for the program.

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Zakkiyya Salahadyn, third adult from left, and other Blanket of Love mothers celebrate at a birthday party for their babies in October. Ascension Wisconsin sponsors the program, which offers assistance to dozens of teenagers and women each year as one means to reduce infant mortality in the Milwaukee area.

"At that time, I was in recovery, having a history of addiction and mental health issues, and I was looking for a support group so that I could maintain a healthy pregnancy and continue to live a healthy life," Salahadyn says.

She called the number on the flier and was soon connected with a support group and a staff of experts who offered education on how to care for herself and her unborn child and tips on good parenting. They also made sure that she had access to prenatal care and healthy food.

She credits the assistance and encouragement she got through the program for a healthy pregnancy that led to the uncomplicated birth of her healthy daughter, Rosemary, in August 2019. It also helped her get firmly established in a productive, addiction-free life that includes taking college-level courses toward her goal of becoming a social worker. "I really feel very strongly that I am in a very good place because of Blanket of Love," she says.

Addressing infant mortality
Ascension Wisconsin sponsors the program that enrolls dozens of teenagers and women each year as a means to reduce infant mortality in the Milwaukee area, with a special focus on Black residents. Data compiled by the Milwaukee Health Department show that Black infants there are three times more likely than white infants to die before their first birthday.

The program uses an evidence-based model to promote women's and infant's health before, during and after pregnancy to improve the likelihood of good outcomes. It is administered by a registered nurse, social worker, community outreach coordinator and community health worker who work with participants from pregnancy to their baby's first birthday.

Blanket of Love includes these services:

  • Support groups and networking opportunities.
  • Case management of mothers and infants, including telephone consultations.
  • Personalized referrals to public and private community resources to help with needs such as food and housing.
  • Childbirth, safe sleep and breastfeeding education classes.

Blanket of Love Sanctuaries, a partnership between the program and 36 churches and faith communities in the greater Milwaukee area, provides additional resources such as meals, mentorship and spiritual guidance to an estimated 4,700 families annually.

Determined to help
Julia Means, a registered nurse with the parish nursing program at Ascension Columbia St. Mary's Women's Hospital Milwaukee, is Blanket of Love's founder. She is so renowned in Milwaukee for her work with expectant and new mothers that last year Mayor Tom Barrett proclaimed Oct. 22 as "Julia Means Day." Means serves on the city's board of health, advising officials on policies and practices to improve population health outcomes.

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Means

Means says she started the program in 2004 after attending a conference convened by the Milwaukee Health Department on how to address the city's high infant mortality rate among Black residents, despite not having any training as an obstetrics nurse. She was so jarred by statistics shared at the conference, including that the rate of deaths for Black infants in the city was higher than in some developing nations, she knew immediately that she wanted to act.

The city department was about to join a national effort to help expectant mothers considered to be at risk of poor outcomes. Means says she and several of the volunteers she worked with through the parish nursing program were eager to join the effort, but they wanted it to be faith-based. That didn't mesh well with the national program, Means says, so that's when she came up with Blanket of Love.

She got training through the obstetrics department at Ascension Columbia St. Mary's Hospital Milwaukee and staffers there helped her write a curriculum to guide young mothers through the self-care required for a healthy pregnancy. The program is now offered to women at 16 sites including hospitals and churches in and around Milwaukee. Pregnant women are referred by clinics and community groups. Normally, the expectant mothers meet in person weekly with program staffers. They share a meal and then take part in group discussions on topics such as proper prenatal care or what to expect during the first days, weeks and months of parenthood. Because of the pandemic, those meetings have moved online.

Learning to pray
Means says Blanket of Love is grounded in Christianity and traditional family values. "The first thing that I teach the girls is, as a mother, you must learn how to pray. You are going to be praying for the rest of your life for this child.

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In this December 2019 photo, Zakkiyya Salahadyn holds her baby, Rosemary, then 4 months old.

"I do promote marriage. I promote normalcy of what a family is supposed to be, that this is your responsibility, God has blessed you with this child," she says.

In its first years, most of the mothers-to-be in the program were in their middle teenage years. These days, Means says most are 19 or 20. Despite the participants being older, the problems that imperil their pregnancies are just as complex. Many of the women are from low-income one-parent homes and dealing with the effects of substance abuse and domestic violence. "Most of them don't come from stable homes and so they really enjoy having older women near," Means says. "And I always say the Bible says that the older women are supposed to teach the younger women, and we do."

Salahadyn says she wishes she could have been part of Blanket of Love long ago. It might have prompted her to take better care of herself during her earlier pregnancies, prevented some of the health issues she deals with now and caused her to rethink some relationships that weren't healthy.

"But, listen, I'm grateful that they were there when they were," Salahadyn says. "I think it matters the most for me now."

The program has helped her manage her mental health and move on to a better life. She's built a stable home for her family in the suburb of Waukesha and she's managing to juggle parenthood with two jobs and college classes. Little Rosemary is healthy, walking and learning to talk.

Lasting connections
Means calls the program's participants her "Blanket girls" and, like Salahadyn, many have continued to come to meetings or reach out to staffers for parenting support long after their babies are born. "That's why we have kept going with the parenting program, because they would not leave," Means says. "Once they had the babies and the babies met their first birthday, they still stayed connected to us."

Means says many of the mothers and their families also stay involved with the churches that came to their aid through the Blanket of Love Sanctuaries program. They join the choirs and Bible study groups and develop long-term nurturing relationships with older members.

While she can't point to studies or statistics to show that Blanket of Love has lowered Milwaukee's high infant mortality rate, Means says that to her knowledge all of the babies born to the hundreds of mothers who have taken part in the program have survived. She also is unaware of any of the girls born to her earliest Blanket girls becoming teenage mothers themselves.

"I don't think or believe that it's just because of us. I believe that this program is anointed and appointed by God, and that God has covered our children because that is the prayer that we have," she says. "We pray that our babies are safe, and that they reach adulthood, and be able to be excellent members of the community."

Donations to Blanket of Love can be made through Ascension Wisconsin Foundation here.

— LISA EISENHAUER

Ascension Saint Agnes promotes healthy feedings with musical pacifiers

Devices help improve babies' nutrition, sleep

By JULIE MINDA

Whether because of health problems related to prematurity or congenital conditions, babies in the neonatal intensive care unit can struggle to get the nutrition and sleep they need to gain strength and to grow healthfully.

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In the NICU at Ascension Saint Agnes in Baltimore, musical pacifiers give an audial reward to babies working on improving their sucking skills to overcome eating difficulties and self soothe.

To help NICU infants develop good feeding habits, and to calm them, Baltimore's Ascension Saint Agnes is using musical pacifiers. These high-tech devices reward babies with soothing lullabies or other pleasing recorded sounds as they strengthen the sucking reflex that is key to effective eating.

Deborah Christino, a nurse on the unit, said it is common for preterm babies to be intubated, and that sometimes causes them to have an oral aversion that interferes with usual development of sucking techniques. She said the pacifiers are helping preterm and other babies who are having trouble with feedings to develop more endurance in sucking, and this helps them ingest more nutrition.

Babies suck to self-soothe, too. Kathy Goad, nurse manager of maternal child health and the Ascension Saint Agnes NICU, said, "When the babies are more calm, they have more of an energy reserve, which means that they can have more food intake, more weight gain, and more successful weaning" in the case of babies born dependent on drugs. "They then can go home sooner and also have a lower chance of readmission."

She said that when babies are less agitated and better fed, they also are better able to bond with their parents.

Rewarding progress
Goad said she came across the musical pacifier idea in research literature several years ago. Developed around 2012 by researchers at Florida State University and manufactured by Powers Medical Devices, the Pacifier-Activated Lullaby device plays a lullaby or other selected sound when a baby sucks on it properly.

A probe inserted in the pacifier measures the quality of the suck. Goad explained that there are good sucks that are strong and effective for bottle and breastfeeding and ineffective sucks that are weak and inefficient for drawing nutrition.

The probe connects by wires to a machine that can be programmed to reward the baby for a less powerful suck then adjusted upward to motivate progress in the baby's technique and sucking strength. The machine comes with a selection of lullabies, and parents can record their own music choices, or their voices, to be used as rewards for their baby's sucking.

The hospital's foundation raised funds to buy the pacifier system principally through a Giving Tuesday social media pitch in 2018. The campaign push brought in $13,740, 94% of the funds needed to purchase the devices, and the foundation kicked in the remaining $915. (The drive was so successful that the philanthropy council of Ascension Saint Agnes' parent company Ascension gave the foundation an additional $1,000 toward the pacifier program and $1,000 to the foundation for staff development.)

The Ascension Saint Agnes NICU used the money to purchase five machines and 10 reusable probes that stay at the hospital. The individual pacifiers that attach to the probes go home with baby. The pacifiers can still play music, but cannot be programmed with custom music and sounds, nor can they be adjusted for different reward thresholds.

Initial success
The NICU began using the musical pacifiers in August 2019, and Goad is conducting research to measure their effectiveness.

Goad said she is hopeful the pacifiers will benefit the growing number of NICU patients with neonatal abstinence syndrome. These babies were exposed to illicit drugs in the womb and must be weaned off the drugs in the NICU before they can be discharged. Goad said babies with this syndrome often are prone to frantic, high-pitch crying and chaotic sucking that wears them down to the point that they cannot feed successfully. She believes the pacifiers will be an important tool in soothing these babies, promoting their healthy feeding and improving their scores on a developmental test that is used to determine readiness for discharge.

Goad added that clinicians try to limit their use of pharmaceuticals with babies, when possible, and so this non-pharmacological intervention is a welcomed tool.

She noted that the staff also will use the musical pacifiers to help parents learn about healthy feedings. The bonding that can result as parents learn to calm their babies is vital, Goad said, "especially for families who may not have good coping skills. This can help them to navigate" ways to nurture their babies' development.

 

 

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