BY: LORI HOLLY
When Kalia Yang discovered she was pregnant with twins, she was uneasy. She had suffered two previous miscarriages and knew she was going to have to do some things differently if she wanted a better outcome. She knew she was going to need some help.
A relative referred Yang to the Women's Outpatient Center at Wheaton Franciscan-St. Joseph, which specializes in providing prenatal care to women in high-risk situations. With its many programs and services aimed at improving outcomes for women and their babies, the center, located in Milwaukee, has become a leader in the city's fight against infant mortality.
"Because of my history I was very concerned, and still am," said the 22-year-old Milwaukee mother-to-be.
Milwaukee has one of the worst mortality rates in the nation. Here, babies die during their first year of life at a rate greater than all but six of the nation's 53 largest cities — 11 out of every 1,000 infants die before their first birthday. The rates are comparable to that of some Third World countries. The problem is worse among African-Americans, whose babies die at a rate about 2.5 times that of whites.
Most experts agree that high-quality prenatal care is essential to decreasing preterm births — responsible for 54 percent of the infant mortality cases in Milwaukee. But many women in Milwaukee cannot get prenatal care as early as they want or even find a qualified health care provider to see them, experts said.
"The safety net that so many of us think is out there simply isn't," said Mary Mazul, a certified nurse midwife with Wheaton Franciscan-St. Joseph's Women's Outpatient Center. "Insurance, lack of essentials such as a phone or transportation, literacy, poverty, violence, chronic stress, socioeconomic discrimination, racism and so many others are barriers that prevent women from being able to create a healthy environment for their unborn baby. It can be overwhelming when we really look at all the issues."
St. Joseph is located in the ZIP code with the highest infant mortality rate in Milwaukee — 19.5 deaths per 1,000. About 500 women receive care for their pregnancies at the hospital's Women's Outpatient Center each year. Many of these women have no other resources available to them, Mazul said.
The Women's Outpatient Center addresses disparities in health care by providing free OB/GYN services to low-income women and by offering a network of resources that give patients access to social workers, language interpreters, financial counselors, dieticians and more. And the efforts are paying off, Mazul said. Patients of the Women's Outpatient Center at St. Joseph had 520 babies during the budget year that ended July 1. The preterm birthrate for African-American patients was 12 percent, she said. Seven years ago, the rate was 16 percent.
The center's staff strives to understand the barriers that women face in accessing quality health care for their pregnancies and has developed a variety of programs to address some of those barriers. In addition to the wide range of obstetric and gynecological services they offer — everything from general wellness checks and screenings to advanced treatments for a variety of conditions — the Women's Outpatient Center has developed a system of programs and educational opportunities for women that are proving to be effective in improving outcomes for expectant mothers and their babies.
For Kalia Yang, the Milwaukee woman expecting twins in November after experiencing two miscarriages, the center has made all the difference.
"I'm just so happy that the Women's Outpatient Center is here," she said.
Yang has been coached on nutrition and the importance of breastfeeding, and she is enrolled in the center's classes on providing a safe sleep environment and on proper use of a car seat. She has also received much-needed support in her effort to quit smoking, a habit she was not able to break during her prior two pregnancies.
Though no doctor has told her that smoking was the cause of either miscarriage, Yang believes it was a factor. That belief motivated her to stop smoking the minute she found out she was pregnant again.
"The babies don't like the smell of smoke," she said, while gently stroking her stomach.
So far, she has been successful at giving up the addictive habit. But Yang worries about whether she can sustain the effort once the babies are born. "I've had a few friends who started smoking again after their babies were born because of the stress," she said.
That's where the center's "First Breath" program comes in. The smoking-cessation program is just one of the many resources available to women who come to the center. Mothers-to-be learn not only about the dangers of smoking and secondhand smoke, they also learn how to recognize certain triggers that can derail their efforts to quit and how to cope with them.
Among the many other services offered through Wheaton Franciscan-St. Joseph are:
Early Engagement Project: In 2008, the Wheaton Franciscan-St. Joseph Emergency Department received more than 3,300 visits from over 2,000 low-income pregnant women. Of that number, almost 100 percent were uninsured, 14 percent visited the emergency department multiple times during their pregnancies and many had a history of a stillbirth or preterm birth.
The emergency department is an inefficient and costly way to provide prenatal care. To correct this situation and improve birth outcomes, St. Joseph developed the Early Engagement Project, which engages pregnant women in prenatal care with a particular focus on women in their first trimester. Patients are guided to the Wheaton Franciscan-St. Joseph Women's Outpatient Center or other similar health care resource, and they are provided assistance in finding insurance coverage through sources such as BadgerCare, a Wisconsin state program for uninsured working families.
The Early Engagement Project is funded through a grant from Anthem Blue Cross and Blue Shield Foundation (Anthem Foundation) and is an offshoot of Wheaton Franciscan's Healthy Beginnings Initiative that seeks to reduce fetal and infant mortality rates in the communities the hospital serves.
Stork's Nest: The center's Stork's Nest program encourages women to embrace strong prenatal care. Administrated in collaboration with the March of Dimes and Zeta Phi Beta sorority, the program offers incentives for women to make and keep medical appointments. After baby is born, Mom can cash in points for supplies, clothing and more.
Before the Stork's Nest, patients of the Women's Outpatient Center made and kept an average of eight medical appointments during pregnancy. That average has climbed to 10.5 appointments.
"Because we offer so many services here, it is hard to say scientifically that they come for their appointments specifically because of the Stork's Nest," Mazul said. "But I can tell you that many of them watch the educational videos and take some of the education classes because they want the points, so it's definitely making a difference."
Baby Safe Sleep Program: Offered by the St. Joseph Foundation, the program addresses another key cause of infant mortality — unsafe sleep environments. St. Joseph provides education to new parents about the importance of a dedicated sleep space for their baby.
Free Pack 'N Play playpens and Halo sleepers are provided to women who complete an educational course on safe sleep. The playpens create a safe, convenient sleep environment and the zip-up Halo sleepers eliminate the need for additional blankets which sometimes create a breathing hazard and have been implicated in sudden infant death syndrome.
Car Seat Safety: The center's car seat program is a joint program with the state department of transportation. Women receiving their prenatal care in the center have the opportunity to take a class with a certified car-seat instructor. At the end of the class, the families receive the car seat for free.
LORI HOLLY is director of communication and public relations for Wheaton Franciscan Healthcare in Milwaukee.
Copyright © 2011 by the Catholic Health Association of the United States
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