Background: Pregnancy-associated injury death due to drug use, homicide and suicide continues increasing in the U.S. However, limited studies evaluated integrated strategies to address their co-occurring precursors: maternal depression (MD), intimate partner violence (IPV) and substance use (SU), and self-harm ideation (SHI) has never been included.

Methods: We performed secondary data analyses of a 3-wave longitudinal randomized, controlled trial. Findings on IPV were published. In Oregon, 238 first-time, low-income pregnant mothers of the Nurse-Family Partnership (NFP) program were randomized into a standard or augmented program when trained nurses integrated the Within My Reach curriculum with NFP workflow to work one-on-one with mothers at home. At pregnancy, 1-year and 2-year follow-up, research assistants interviewed mothers with the Edinburgh Postnatal Depression Scale including an SHI item, Alcohol Use Disorder Identification Test, and Drug Abuse Screening Test. Multilevel analyses and generalized estimating equations were performed, adjusting for race/ethnicity, age, education level, and nativity status.

Results: Probable Major Depression (PMD, 25%), SU (36%), and SHI (8%) were common. Mothers in the augmented group reported more stable relationships with their child’s father (66% vs. 50%, p=0.01). Compared to the standard program, the NFP augmented program did not reduce PMD, SHI, or SU because the wave-intervention interaction terms were not significant [p >0.05].

Conclusions: Large trans-disciplinary studies are needed to develop mechanisms of change, integrated and equitable strategies (e.g., engage fathers, enhance coparenting), and improve nurse home visiting models to prevent MD, SHI, and SU collectively, thereby setting the stage for improving equity in safe motherhood.

Background: Postpartum women are at higher risk for depression and anxiety after delivery. This risk was heightened dramatically during the COVID19 pandemic, especially prior to vaccination approval and availability. Prescribing anti-depression and anti-anxiety medications is one strategy for the effective treatment of postpartum mood disorders.

Methods: We used a retrospective pooled cross-sectional design and a sample of privately-insured women in U.S. claims data from January 2016 to December 2021. Using deseasonalized time trends, we measured changes in the prescribing patterns of drugs used to treat anxiety and depression in the six month period after delivery in our sample of postpartum women. We use Ordinary Least Squares (OLS) regression to measure the probability of receiving a script in the pre-pandemic period compared to the post-pandemic period, in addition to the number of days supplied among those receiving a prescription.

Results: We find statistically significant increases in diagnoses of PPD and PPA. We also find statistically significant increases in prescription of pharmaceuticals to treat these conditions, including SSRIs and benzodiazepines. Additionally, we find that there is disparity in diagnosis and prescribing in these patterns by race.

Conclusions: Treatment of Postpartum Depression (PPD) and Postpartum Anxiety (PPA) using pharmaceutics increased significantly after the onset of the COVID19 pandemic, and is particularly notable in the period between March 2020 and April 2021 when there were no approved vaccines for the pregnant and postpartum population. We find that the probability of receiving a prescription and the days supplied increased, especially for women delivering via Cesarean section.

Background: Community Doulas (CDs) are culturally reflective and attuned to the needs of their community. They are vital for underserved birthing families of color and positively impact birth outcomes. However, many families in Paterson, NJ do not have access to CDs due to financial barriers and lack of awareness.

Methods: Based on the data collected via focus groups conducted with community members of Paterson, Community of Caring (CoC), a pilot program of the Partnership for Maternal and Child Health of Northern NJ in collaboration with New Destiny Family Success Center, and St Joseph’s Health, was developed with the aim to certify 13 Paterson residents as CDs. The training used the HealthConnect One model which follows a health equity approach. The trainees completed required clinical observations at St Joseph’s Health, allowing CDs to shadow perinatal providers and establish rapport with the birthing team.

Results: 13 CDs completed the doula training and observations in the hospital setting that allowed more interaction between birthing professionals and created a collaborative and respectful working relationship benefiting birthing families and medical providers. CDs expressed that the training and clinical observation increased their knowledge and confidence in working with clinicians and supporting birthing families.

Conclusion: Incorporating community voices, working with a trusted community organization, and building a relationship with the hospital, allowed the ability to collaboratively train CDs and develop a doula policy for St. Joseph’s Health. The CoC program is a model which can be replicated to ensure a successful doula/provider collaboration in a hospital-based environment.

Background: Recent studies have highlighted the advantages of midwifery care among low risk deliveries, particularly among women of color. We investigated the role of providers in the relationship between maternal race and desire for and experience of medical interventions during vaginal childbirth.

Methods: We used the Listening to Mothers in California (n=2539) survey which documented respondent attitudes regarding medical intervention in childbirth, labor and birth attendant, the number of eight specific interventions (e.g. IV, augmentation, rupturing membranes) received, and interest in having a midwife as a care provider in a future birth, with differences assessed by Chi-Square (p<.05).

Results: Non-Hispanic Black (NHB) (84.6%) and Hispanic (80.1%) women were more likely than non-Hispanic Whites (68.5%) (p<.01) to agree childbirth is a process that should not be interfered with unless medically necessary. While midwives were less likely to intervene in vaginal birth (mean of 4.95 interventions vs 5.69 for obstetricians; p<.01), NHB mothers were least likely to have a midwife as a birth attendant (9.8% vs 15.4%) and had the highest rate of medical interventions in vaginal birth (5.82 interventions). The difference between experiencing midwifery care (9.8%) and openness to midwifery care in a future birth (68%) was greatest among NHB mothers who perceived lack of insurance coverage for midwives as the leading cause of this gap.

Conclusions: Expanded access to midwives may help non-Hispanic Black mothers achieve their goal of fewer medical interventions in birth.

Background: Childbearing women living in rural underserved communities hit by disaster are challenged to find mental health support. The purpose of this project was to develop guidelines for implementing the prenatal emotional support intervention, Mentors Offering Maternal Support™ (M-O-M-S^TM) post-disaster, using the EPIS (Exploration, Preparation, Implementation, Sustainment) framework. Methods: A formative community needs assessment was conducted with stakeholders hit by Hurricane Ida, including women (n= 20) who were pregnant/postpartum at the time of the storm or during the following year, and caregivers (n=20) including obstetricians/midwives/pediatrician, nurses, mental health counselors, and community health workers. Interviews were conducted and transcribed, with thematic data analysis findings used to guide adaption of the intervention. Results: Maternal health caregivers described vulnerabilities and mental health needs of women caused by health disparities and changes in lives resulting from disaster, through the themes, Health disparities impacting vulnerability, Women’s emotional/mental health needs after disaster, Modifying care, and Absolute need for the M-O-Ms. Women’s perspectives of their emotional needs emerged in themes, Motherhood interrupted and Emotional help needed! Women recommended suggestions for intervention delivery in the theme, Barriers to the M-O-M-S™ intervention. Conclusions: Community stakeholders welcomed a mental health support intervention for rural pregnant women and provided recommendations for local recruitment, provision of sessions, and overcoming barriers. Sessions were adapted to include childbearing disaster preparation. This study provided the groundwork for initial implementation and evaluation of a project aimed to improve post-disaster maternal mental health.

Objective

Racial disparities in maternal health outcomes persist in Alabama. Our multidisciplinary team sought to identify provider and community perspectives on the potential use of digital health interventions (DHIs) to reduce racial disparities in maternal and child health (MCH) and to inform tailored DHI interventions for Black pregnant women Alabama.

Methods

A semi-structured interview guide was developed using Andersen’s Behavioral Model of Healthcare Utilization with input from a Community Advisory Board. We conducted 20 qualitative in-depth interviews with purposively selected participants including MCH providers (N=10: doulas, social workers, government agency staff) and community leaders (N=10: pastors, educators, and community-based organization representatives). Coding and analysis of transcripts using the NVivo software resulted in emergent themes.

Results

Participants identified DHIs currently available across Alabama including texting programs, mobile/computer applications, telehealth/telemedicine, and patient portals. Facilitators for DHI utilization included patient awareness and user friendliness of DHIs. Participants felt that the advantages of DHIs, including easy access to health information and improved communication with the health system, outweighed disadvantages such as lack of internet/WiFi access in some areas, cost of smartphones, or privacy issues. Participants emphasized the importance of determining the optimal timing, frequency, and content of messages in texts, as well as ensuring ease of access to patient portals and applications for local communities.

Conclusion

Results indicate that DHIs show promise for addressing maternal health needs of Black pregnant individuals in Alabama. Future MCH interventions for this population can include the development and testing of accessible and user-friendly DHIs in collaboration with local communities.

BACKGROUND: Alliance for Innovation on Maternal Health Community Care Initiative is a community-based, quality improvement program designed to increase maternal health equity by improving access to care in both urban and rural communities, particularly among Black and Indigenous women and birthing persons. This effort employs a Collective Impact model to 1) facilitate interprofessional collaboration by convening local maternal safety workgroups (LMSW), 2) implement non-hospital focused maternal safety bundles (MSBs) in outpatient clinical settings and community-based organizations, and 3) collect and analyze data to drive continuous improvement. This study is designed to assess each LMSWs experience of using Collective Impact as a model to guide their work, with particular attention to the challenges, best practices, and lessons learned to guide future community-level maternal health equity interventions.

METHODS: Focus groups and individual interviews were conducted with LMSW leadership and membership. MAXQDA Qualitative Software was utilized to conduct constant comparison analysis to identify emergent themes.

RESULTS: Major themes including Capacity, Sustainability, Investments, and Community Creation emerged, highlighting the challenges and successes identified during the process of implementing a Collective Impact approach.

CONCLUSIONS: Collective Impact calls for innovation in the way that organizations work both internally and interprofessionally. This may better equip maternal health initiatives to address the structural barriers to quality maternity care. Investments are necessary with regard to time and funding to adequately support communities as they establish infrastructure to effectively respond to the needs of their mothers and birthing persons. Doing so will increase the impact and sustainability of their efforts.

Issue: Black mothers are 3 to 4 times more likely than White mothers to experience adverse health outcomes. Black maternal health has become a “crisis” due to racial health inequities driven by experiences of institutionalized racism in healthcare settings.

Description: The Maternal Child Health Equity Initiative collaborated with community-based partners to connect Black birthing people to trauma-informed doulas to help mitigate harm caused by institutionalized racism that Black mothers experience during their birthing journeys. The initiative also included the Black Maternal Health Circles program, holding forums with Black mothers to create space for them to voice their experiences and help build trust in underserved communities.

Lessons Learned:

Participants in the Initiative have seen:

• Decrease in adverse birth outcomes compared to Blue Shield, California, and national averages.
• All mothers reported that having a doula helped to navigate challenges and that they would recommend a doula to their peers.
• Doulas create space to capture the near misses and consider the impact of systemic racism for black birthing people.
• The Black Maternal Health Circles revealed that being exposed to the participants’ firsthand experiences and having the opportunity to co-design with members of impacted communities validated opportunities in reimagining care for Black women and babies.

Recommendations: Actions health plans can take to address the Black maternal health crisis include:

1. Interact early with providers to facilitate a relationship between providers and Doulas.
2. Facilitate co-creation of expectations and roles for both providers and Doulas.
3. Provide Doulas with comprehensive platforms for data collection.
4. Engage communities for firsthand experiences.

Background: A telehealth program was implemented as part of a grant with the Florida Department of Health to provide maternity support and address social determinants of health (SDOH) to a minimum of 1,000 underserved patients in Orange County, Florida. Aware of significant differences in receipt of care among underserved patients, the telehealth program was utilized to identify the SDOH needs of patients.

Methods/Approach: During the program patients were monitored during their pregnancy and postpartum period to address significant social factors that can impact healthcare access and utilization. As part of the telehealth program, we partnered with community stakeholders to address SDOH needs to include food insecurities, homelessness, nutritional support, mental health counseling, and prenatal care. Community health workers (CHW) and nursing staff provided additional support to patients throughout the program. To address SDOH and mental health needs patients were screened utilizing the THRIVE tool and the Edinburgh Postnatal Depression scale (EPDS).

Results: To date we have consented 1,183 patients into the program. Among those patients, a total of 947 SDOH needs were identified. The most common needs identified included food, housing/utilities, transportation, and help with medicine with a total of 1,096 unique referrals to community resources. A total of 1,111 EPDS screens were completed and referrals for mental health services were made.

Conclusion: Utilization of a telehealth program provides access to care and resources to patients in underserved communities with significant mental health and SDOH needs.

Background

Substance Use Disorder (SUD) during pregnancy results in adverse maternal and fetal birth outcomes. Approximately 5% of individuals report using one or more illicit substances during pregnancy. This study describes changes in remission status among patients receiving services at Magdalene Clinic (MC), a collaborative care model that integrates trauma-informed prenatal care and SUD/behavioral health treatment.

Methods

At each visit, patients see prenatal providers, a peer support specialist, an LPC, and a social worker. Approximately half of patients enroll in intensive SUD treatment services with a local rehabilitation services organization. Patients complete an assessment at intake and discharge that provides a DSM-V SUD diagnosis(es). Following patient consent, demographic, SUD diagnoses and treatment, and remission data are abstracted from the medical record and entered into REDCap.

Results

MC has provided services to more than 550 pregnant individuals. The most common SUD diagnosis was opioid use disorder (57.4%), followed by methamphetamine use disorder (52.0%), cannabis use disorder (31.4%), alcohol use disorder (12.3%), and sedative use disorder (10.3%)., with 43.8% of patients having one or more diagnoses. Among those with opioid use disorder, 37.9% of patients were not in remission at intake compared to 12.3% at discharge. Among those with methamphetamine use disorder, 52.5% were not in remission at intake compared to 22.6% at discharge.

Conclusion

Among patients enrolled in intensive services, there was a significant increase in the percentage of patients in remission at discharge. Integrated prenatal and SUD treatment has promise to promote early remission during pregnancy and improve birth outcomes.