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Column 5 – Other local measures improving postpartum maternal health

September 13th, 2018 by

DMH DMHS are you Memorial Hospital feltPart of a multi-column series focused on Maternal and Infant Health in Southeast Arkansas

By Kristen Smith, RN, director of Labor & Delivery/Nursery and Education at Drew Memorial Health System

In my recent columns, we have considered the national stories about maternal health and the staggering statistics of maternal mortality, including how Arkansas as a state, and Drew Memorial, as a county hospital are making strides to reduce those national statistics with great local outcomes. Maternal mortality is one major issue that all of us in the healthcare realm will continue to improve upon and monitor, especially because of the national news stories that focus on it. However, as a mother and as a nurse manager very familiar with the post-partum stage, health care providers also have a responsibility to ensure maternal and infant health far beyond delivery. There is so much we can do before mothers and babies are discharged to set them up for success. I’m going to mention a few aspects of maternal care I’m most proud if in my own hospital, but wherever you or your loved ones deliver, make sure you’re aware of the well-researched, clinical best practices that your care team should be implementing, and why.

As I have discussed, labor and delivery teams, along with your OB/GYN team, screen expectant mothers for risks and complications during pregnancy – even if you’re far from your due date. Your prenatal health care should be regular- monitoring mom is (literally) vital to identify any risks we may foresee during your delivery, like an increased likelihood for high blood pressure which can lead to a hypertensive emergency, or an increased likelihood of post-partum hemorrhage. With the Safety Bundles developed by UAMS which we helped pilot in Monticello, those two major maternal emergencies still happen, but they are not causes of death in our hospital.

We are committed to all aspects of maternal and newborn health, beyond the inpatient setting and outside the aforementioned emergent situations. So, while mom and baby are still in our labor & delivery unit, we have a number of safety measures, processes and available resources to ensure long-term health and positive recovery outcomes for both mom and baby.

Locally we have expanded best practices for screening new moms for two issues that affect many women after discharge – post-partum depression and post-partum suicide. In the national media, there have been devastating stories shared by loved ones of women who are visibly healthy, who love their families, but who, after giving birth, are affected by severe, crippling mental health issues. Postpartum Depression is a mood disorder that can cause great strain in relationships, affect the health or care of their infant, and may result in them harming themselves. PPD does not have a single cause, but rather a number of causes, none of which are caused by the mother. Some contributors include things that happen to any delivering mother – chemical changes in the brain, hormonal changes, and severe overtiredness. Obviously, the goal is to prevent any self-harm or harm that can occur to the newborn, and to improve overall quality of life for women showing signs of post-partum depression.

Any pregnant woman admitted to our facility after twenty weeks gestation is admitted directly to Labor & Delivery, regardless of diagnosis or reason for admission. She is immediately screened for early indicators of maternal depression. As you can imagine, catching signs of depression in new mothers early (even before delivery) can be a life changer for that family. Early identification of risk factors can lead to appropriate treatment plan that is proven to prevent a full post-partum depression diagnosis. This is a maternal health issue we don’t often like to talk about, but PPD affects as many as 1 in 9 women, according to the CDC.

Another tool we use before mom and baby are discharged is the “Miracle Hour.” This hot term found in new parenting resources is used to describe an intentional calm time- the baby’s first hour of life, which is spent in close contact with her mother and father, usually in a quiet, darker room, with the intent of helping her to bond closely with both parents. During this first hour, a baby experiences skin-to-skin contact with the mother (especially if she intends to breastfeed), and the father. It is often during this time that the baby begins to instinctively attempt to eat for the first time by making sucking motions and rooting. She familiarizes herself with the mother through touch and smell and often finally can begin to rest in this calm environment. We observe and encourage this miracle hour after birth not only because it is proven to improve breastfeeding success and leads to strong bonding between the infant and new parents, but also because it helps begin the mother’s recovery process.

Skin-to-skin contact is proven through research to improve maternal and newborn outcomes, regardless of how the baby is fed. Mothers and babies have a physiologic need to be together after birth and keeping them together as much as possible improves their long-term health. Oxytocin is released during skin-to-skin contact, and this promotes maternal/newborn attachment, reduces physical stress for both mom and baby, and helps the baby transition into life outside the womb. That being said, whenever possible, we wait at least one hour to perform any routine procedures like assessments of the newborn.

In addition to encouraging skin-to-skin contact, we invested in a full-time Internationally Board Certified Lactation Consultant on our staff. We’ve offered breastfeeding classes for over a year now, and are excited to begin offering them free of charge.  Our IBCLC breastfeeding consultant Rebecca Traugott, RN, is a patient advocate who educates women both before and after childbirth about how the mother can successfully breastfeed, and what the benefits are to mom and baby. Exclusive breastfeeding can be a challenge for women for a number of reasons, but individualized counseling and education have enabled us to continuously increase our exclusive and partial breastfeeding rates ever since she began working here full time.

Our labor and delivery staff also offers childbirth classes for expectant parents, and these are led by the only International Childbirth Education Association (ICEA)-certified childbirth educator south of Little Rock, Chelsea Gulledge RN. We are proud to use a family-centered approach with the maternity care curriculum Chelsea utilizes, and her education credential makes her another invaluable resource to our patients. Having informed, prepared mothers is another wonderful way to ensure positive delivery outcomes and make sure new parents know what to expect in the first newborn stages.

It’s essential to proper patient care for our hospital staff members to be vigilant in identifying the most common, emergent situations during and after delivery so we can avoid maternal death and create ideal patient outcomes. But, that’s not all a hospital owes its maternity patients. We have to provide prenatal screening to avoid long-term serious issues and also offer them resources that will help them succeed as parents. In my next column, I’ll talk about the smaller patients we owe a great deal of responsibility to- newborns- and how we can also set them up for long-term positive health outcomes.

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