Maternal and infant health are a national concern as mortality rates – and racial disparities within these — continue to climb. To reduce these rates, organizations are focusing on whole-person approaches to family health that center birthing parents and address more than just physical care.
The Maternal Health Webinar Series offered by the Health Resources and Services Administration (HRSA) explores the disparities in maternal and infant health and potential solutions to improve these gaps. Advancing Maternal Health, featuring speakers from Nurture KC and Healthy Birth Day, Inc., discussed evidence-based approaches to improving maternal and infant health outcomes.
Nurture KC: Offering Families a Healthy Start
Nurture KC is a bi-state organization with services available in both Kansas City, Kansas and Kansas City, Missouri. The organization serves 14 target zip codes across Wyandotte County, Kansas and Jackson County, Missouri where infant mortality rates are highest.
Nurture KC began as a coalition of volunteers in response to a 1983 report on high infant mortality rates in Kansas City, Kansas and Kansas City, Missouri. Today, their mission is to reduce infant death and improve family health across the KC metro area. To achieve this, they offer three approaches:
- The Mid-America Immunization Coalition (MAIC), a bi-state group dedicated to disease prevention.
- The Fetal Infant Mortality Review (FIMR), which identifies trends in fetal and infant losses and recommends actions to improve.
- Healthy Start Initiative, a federal grant program that employs a community health worker (CHW) model to assist families from preconception through 18 months of life for the baby.
These approaches work collaboratively to identify and address gaps in the health care system and treat family health as a continuum. Together, these approaches support expecting families by providing direct services and resources that improve maternal and infant health.
“We are an organization that is committed to reducing infant mortality in Kansas City,” said Tracy Russell, executive director of Nurture KC. “What we’ve seen is in Missouri we rank within the bottom ten states in the country.”
Shannon Williams, program director of Nurture KC’s Healthy Start Initiative, believes the flagship program’s unique CHW model is key to its success in advancing health among families across the KC metro area.
“The goal of Healthy Start programs is to improve birth outcomes in the communities that we serve,” Russell said. “We do that by addressing both their health and social service needs for not only mom, but baby, child, and the male involved partner to complete whole family wellness.”
Parenthood can be challenging and expecting parents aren’t always sure of what to do, what they need, or where they can go for help. The CHW model offered by Healthy Start provides parents with a confidant to help address fears, reduce anxieties, and offer advice. CHWs also help connect parents to direct services and resources as needed.
The Healthy Start program is free with very few enrollment requirements. Program participants must be pregnant still and live within the target zip codes. However, Nurture KC makes exceptions for the zip code requirement if the birthing parent is living in a shelter, as they are considered high-risk.
A total of eight CHWs, some of whom also speak Spanish, are available to offer home visits to program participants. The program recently received a scholarship that also allows all CHWs to train to become certified lactation counselors, in addition to their extensive training.
The CHW Model: A Continuum of Care
The Healthy Start program’s CHW model is unique to other maternal and infant health approaches because of its focus on the entire family. The CHW becomes a part of the family’s system – not only to provide information and resources related to pregnancy, but to discuss concerns, educate on topics like infant car safety, provide family immunizations, screen for maternal and postpartum depression, and more.
Because the CHW visits with the family regularly, they can also help ensure families remain up to date on physical and mental health concerns and changes in infant care, as well as social determinants of health. For example, if a family is experiencing housing instability or food insecurity, CHWs can act as a bridge between the family and service providers to ensure these needs are adequately met.
Healthy Start also offers a points reward program, where parents set goals with the CHW and receive points for achieving these goals to “purchase” material items such as diaper bags, strollers, books, and even self-care items for mom and dad. Examples of goals can include going back to school, securing housing, or finishing an online degree. Points are awarded on a scale, with 25 points earned just for attending regular visits with the CHW.
Healthy Start also offers some material items directly, including cribs, car seats, diapers, breastfeeding equipment, and more. Each month, parents in the program can receive 50 diapers per child through a service called Happy Bottoms. Participants who are breastfeeding and looking to go back to work or increase their milk supply can receive a breast pump.
The Nurture KC website houses a Healthy Start family portal, available in both English and Spanish, where families can access resources specifically catered to them. The portal also offers a bilingual video series covering health-related topics such as virtual yoga classes, nutritious cooking recipes, and more.
In addition to addressing maternal and family health through the CHW model, Nurture KC also focuses on infant health specifically. The organization’s Fetal Infant Mortality Review (FIMR) committee identifies drivers of infant and fetal death in the KC metro and passes on recommendations to the community action team. The top priority of this team, brought in-house just this year, is addressing safe sleep as the number one driver of infant death in KC.
As a result, Nurture KC has been working on getting children’s hospitals to prioritize sleep certification, which consists of three main components: implementation of a safe sleep policy, training staff on safe sleep, and having staff educate parents and caregivers on the importance of safe sleep.
Nurture KC also fights for families through policy change, pushing for initiatives such as extending postpartum health coverage, eliminating sales tax on food, and providing legal counsel for families facing eviction.
According to Russell, the organization considers what issues outside of pregnancy can help or harm the families they serve. “It really takes both that direct service to move the needle, as well as broad-based policies, to ensure that cultural change,” she said.
Although direct assistance from community programs like Nurture KC’s Healthy Start makes a major impact, efforts to improve maternal and infant health outcomes can begin within the family. Educational tools that empower parents to play an active role in their baby’s health, like Healthy Birth Day’s Count the Kicks initiative, are proven to improve birth outcomes.
Count the Kicks
Webinar speaker Emily Price, executive director of Healthy Birth Day, oversees national expansion of the Count the Kicks public health campaign. This campaign educates and empowers expectant parents to track their baby’s movements throughout the third trimester of pregnancy.
The stillbirth prevention campaign was proven to help lower the stillbirth rate in Iowa, where it was founded, by nearly 32% in the past decade. In addition to this decrease, the stillbirth rate among Black women in Iowa decreased by 39% in the first five years.
Price leads the campaign’s vision for an overall goal of realizing a 32% stillbirth rate reduction nationally, saving 7,500 babies every year. According to Price, about 22,000 babies are lost to infant mortality each year. In addition to this, about 23,500 babies are stillborn each year.
On average, one out of every 169 pregnancies nationally will end in stillbirth. One out of every 204 pregnancies among white mothers will end in stillbirth. Racial disparities that affect maternal and infant mortality rates also persist in stillbirth rates. Among Black mothers, one out of every 96 pregnancies end in stillbirth. Among Hispanic moms, one out of every 199 pregnancies.
A variety of factors contribute to infant mortality rates, including sudden infant death syndrome (SIDS) which kills about 3,400 babies annually. However, according to Price, families are 10 times more likely to lose a baby to stillbirth than they are to SIDS.
“That’s not to take anything away from the tragedy of SIDS,” Price said. “It is just a data point that we wanted to share…because stillbirth is not talked about in this country very often. We recognize that stillbirth persists – it is a public health crisis and a tragedy for thousands of families each year.”
Tracking fetal movement in the third trimester is a non-invasive way for expectant parents to monitor their baby’s health. When parents know their baby’s normal movement patterns, they are more in tune to early warning signs that could be indicative of complications.
Although the campaign is focused on stillbirth prevention, there is still a strong connection between stillbirth and maternal mortality and morbidity. “There is proof that Count the Kicks is not only a good warning system for baby, but it is also a good warning system for mom and her health,” Price said.
According to campaign research, the risk of severe maternal morbidity is four to five times higher among stillbirth deliveries compared to live births. Women most at risk for severe maternal health outcomes may also be at higher risk for stillbirth based on pre-existing or demographic characteristics and conditions related to their stillbirth.
Speaking up about a change in baby’s movements can help mothers not only keep their baby healthy, but also identify and address pregnancy complications that puts their own lives at risk. Counting kicks can help recognize and treat pregnancy-related issues like cardiovascular conditions, hemorrhages, and more to save mothers.
Due to the importance of early intervention to improve maternal and infant health outcomes, it is imperative that providers proactively discuss stillbirth prevention and risk factors with their patients, as well as provide educational tools.
The Count the Kicks app is available in 14 languages and helps parents track the strength and frequency of the baby’s daily movements. Parents can also review their kick counting history, which can help providers identify any abnormal changes.
Count the Kicks also offers stillbirth prevention and research resources, FAQs, and program testimonies that include more than 100 stories from parents whose babies were saved by this education. The website also offers a provider academy for educators, doulas, community health workers, and all other provider types to access educational videos and testimonies.
- National Maternal Mental Health Hotline: 24/7 free confidential support for expecting parents including resources and referrals before, during, and after pregnancy. Help is available in English and Spanish. Call or text “Help 4 Moms” to 18339 or call 1.833.943.5746.
- Suicide and Crisis Lifeline: Call or text 988 or chat with someone online. Access maternal mental health resources.
- CDC Maternal and Infant Health Resources.