Case Management-Style Program Improves Pregnancy Health and Outcomes
EXECUTIVE SUMMARY
One way to help improve the health of new mothers and infants while reducing mortality is to implement a case management-style program.
- One program, called Moms2B, begins in pregnancy and helps patients who are uninsured or on Medicaid with weekly educational sessions during pregnancy and support for their health and their infant’s health after they give birth.
- A multidisciplinary team works with women to check their social determinants of health and to ensure they receive follow-up care and answers to any concerns.
- The Moms2B program has helped decrease rates of preterm delivery and infant mortality.
Healthcare providers can help reduce maternal and infant mortality and improve women’s health during pregnancy by implementing a case management-style program that follows women throughout their pregnancy and for up to a year after they give birth.
Called Moms2B, the program begins during pregnancy. The only requirement is for the woman to live within a service area that is targeted because of its high infant mortality rate.1
“We’re a multidisciplinary team of a physician, nurses, dietitians, lactation counselors, community health workers, transition coordinators, early childhood educators, and social workers,” says Kamilah Dixon, MD, MA, assistant professor and vice chair for diversity, equity, and inclusion in the departments of obstetrics and gynecology at The Ohio State University (OSU) College of Medicine. Dixon also is the medical director of the Moms2B program in the OSU College of Medicine.
Educational Sessions
Most patients are uninsured or on Medicaid. Sixty-five percent are non-Hispanic Black.
“They can enter the program at any point, and we have an e-referral program where we get referrals from other physicians, midwives, and institutions we partner with,” Dixon explains. “What I have found is that this is excellent care for the patient, and they’re doing case management.”
Moms2B provides pregnant patients with education about breastfeeding, nutrition, stress reduction, child development, family planning, goal setting, early prenatal care, labor and delivery, maternal-infant health, positive parenting, reproductive health, and more.
The educational sessions are two-hour, weekly sessions that were held in-person before the COVID-19 pandemic and switched to virtual programs during the pandemic. Now, they are offered as a hybrid model of in-person for people who can attend one of three locations and virtual for those who cannot.
“We meet weekly and check in with the mom to go over various social determinants of health screenings: Do they have enough to eat? Do they have housing?” Dixon explains.
Before the pandemic, the program gave new mothers a welcome-to-the-world bag with baby items. Now, they receive a phone call, and someone ensures follow-up visits are scheduled.
As patients go through childbirth, the Moms2B team continues to help them manage their care through the postpartum period.
“Someone from the team calls to see how they’re doing with breastfeeding. How is their mood? What are their plans for family planning?” Dixon explains. “They help facilitate getting them in to see [a provider] sooner, if need be.”
Care management and education continues for the first year of the infant’s life. “We follow the moms until the baby turns 1,” Dixon says. “Today, we had a mom who graduated, the baby turned 1, and we sang happy birthday, and the baby got a little toy.”
An earlier study, based on data through 2018, revealed women who participated in Moms2B saw decreased rates of preterm delivery and lower rates of infant mortality.2
Anecdotal evidence suggests the program is popular with women. Often, women who were part of Moms2B with one pregnancy and birth returned to the program for a second or third birth.
“One woman who is pregnant and came back to the program says she came back because of the community it creates and because she knows this is a group of people who care about her and can provide her with support,” Dixon notes. “We have a lot of moms who enter the program without having a robust support system.”
The program’s success has resulted in other health systems across the United States requesting information on how to start a Moms2B program. OSU is in the process of expanding it to the Dayton, OH, area.
“A lot of people are reaching out and want to replicate it,” she adds. “We’re in the process of talking to some and seeing how they can build it in their areas as well.”
Providers Also Receive Education
The Moms2B team also educates reproductive healthcare professionals about the challenges pregnant and postpartum women face. “We help educate our community of residents, students who rotate with us in various disciplines, social work students, medical students, and dietitian students,” Dixon says. “We take pride in educating others and making sure people know the experiences our moms are having so these [negative] experiences can be changed.”
Dixon has heard from pregnant women who asked to transfer their prenatal care to her because they did not feel their concerns were being heard by their original provider.
“If they don’t feel like they’re being heard, we encourage them to find a provider who will listen,” she says.
Physicians who have given birth can empathize with what these patients are going through and what their fears are.
“I have an 8-year-old son,” Dixon says. “When I think about what my goal is for my patients, it’s that I want them to have the experience I had when I gave birth as a young Black woman in Houston.”
Dixon was a third-year resident, giving birth in an area that had one of the highest rates of Black maternal mortality.
“It gives me chills when I reflect on that,” she says. “I had excellent care, a wonderful attending, and wonderful nurses.”
One of Dixon’s colleagues was on call and stayed to deliver her son via an emergency cesarean section.
“Normally, you would be scared, but I wasn’t because I was in excellent hands and trusted my providers. That’s the feeling I want to give to every one of my patients,” Dixon explains. “It’s important to make sure communication is there, because if patients don’t trust their provider, they won’t tell them everything that’s going on.”
REFERENCES
- Dixon-Shambley K, Gabbe PT. Using telehealth approaches to address social determinants of health and improve pregnancy and postpartum outcomes. Clin Obstet Gynecol 2021;64:333-344.
- Hade EM, Lynch CD, Benedict JA, et al. The association of Moms2B, a community-based interdisciplinary intervention program, and pregnancy and infant outcomes among women residing in neighborhoods with a high rate of infant mortality. Matern Child Health J 2022;26:923-932.
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