a. Ann Dacey: Work with the Governor,
legislators, perinatal professionals, and state officials to plan to
institutionalize the Perinatal Partnership as an ongoing monitoring
process for WV and the health outcomes of maternal and infant health.
b. Establish and implement a statewide educational
outreach program for maternity providers that provides continued
education to community hospitals and maternity care providers on the
following:
c. Ann Dacey: The guidelines for obstetrical
and neonatal practices designed during 2007; including a focus on first
time mothers and the high rate of labor induction; and the high rate of
cesarean section in WV. Educate hospital officials and payers regarding
the ACOG guideline for elective labor induction to occur only after 39
weeks gestation. Specifically, Marshall University School of Medicine
and Cabell Huntington Hospital will actively work to reduce and
ultimately eliminate elective cesarean sections, repeat cesarean
sections and elective inductions prior to 39 weeks gestation at their
facilities, as models for the State.
d. Pat Moss: To modify the uniform prenatal
risk assessment tool selected by WV providers during 2007 and to educate
maternity providers and payers on it use.
e. Ann Dacey: Continue work with the State
Medical Emergency System and tertiary care hospitals to implement a “one
call” connection for rural and community hospitals to assure a
sophisticated consultation and transport system for high risk pregnant
women and newborns.
f. Ann Dacey: Complete the
telecommunications-telemedicine project established through the work of
the WV School of Osteopathic Medicine, the Greenbrier Valley Hospital
and CAMC Women and Children’s.
g. Ann Dacey: Replicate the telemedicine
technology with other community hospitals and tertiary care centers.
This technology allows the perinatal provider to consult with specialist
regarding pregnant woman and infants under their care and keep them
close to home. The technology can be utilized with ultrasounds and other
diagnostic care, and helps eliminate unnecessary travel. In addition, WV
Osteopathic School will expand to inpatient telemedicine consultations
at Greenbrier Valley Medical Center in the OB/Labor & Delivery/Newborn
areas. It is hoped to use the equipment for consultations on medically
stable newborns who have suspected anomalies, such as congenital heart
defects.
h. Nancy Tolliver: Serve as advisors on the WV
Health Care Authority Committee to identify a NICU bed needs in WV.
i. Nancy Tolliver: Establish a Maternal
Mortality Review Team and Process for West Virginia. Chair: Luis Bracero.
2. Identify and Address
Obstetrical Provider Shortage Areas: Angie Nixon
a. Angie Nixon: Work to encourage WV nursing
education programs to collaborate with existing schools of nursing that
offer certificates and or master degrees in Nurse Midwifery. Two WV
educational institutions have indicated an interest in investigating
such collaborations. In addition, two out of state existing CNM programs
have indicated interest in forming such collaboration.
b. Angie Nixon – Nancy Tolliver: Promote the
model rural maternity services designed in 2007 to encourage at least
two counties with a lack of maternity care to expand into a maternity
service.
c. Terri Bliziotes: Establish a workgroup of
potential CHC’s that would be interested in expanding scope of service
in perinatal care. Identify funding sources and back-fill coverage to
support the training of nursing staff working in high need areas.
Establish perinatal data registries to measure improvements in access to
care and prevention of poor birth outcomes.
3. Address the Lack of Oral
Health Care in Pregnancy – Bobbi Jo Muto
a. Bobbi Jo Muto, Renate Pore - Work with the
Right From the Start care coordination program to increase the number of
Medicaid pregnant women, ages under 21, who receive dental care during
pregnancy, and to identify barriers to care. Results will be measured
based on the bench mark data identified during 2007, and changes will be
monitored over several years by the WV Health Care Authority.
b. Lois Morgan, Bobbi Jo Muto, and Renate Pore-
Work with the Birth Score Office to measure and track results of oral
health questions on Birth Score tool.
4. Identify Costly Medical
Procedures Associated With Poor Birth Outcomes- Nancy Tolliver
a. Ann Dacey: Promote public awareness
regarding the negative consequences of WV’s high rate of labor induction
prior to 39 weeks gestation for first time mothers.
b. Nancy Tolliver: Once the newborn chart
review identified in # 5, a. below is completed, identify the cost of
treating addicted newborns, and the use of NICU beds in doing so.
5. Develop An Approach to
Identify and Treat Drug Use During Pregnancy: Amy
Tolliver-Nancy Tolliver – Michele Grinberg:
a. Study the medical and legal issues surrounding drug
use and testing during pregnancy; determine existing laws that may
impact on the ability of medical personnel to screen for drug use during
pregnancy and what changes may be needed so that pregnant women are
protected from prosecution if they come in early for prenatal care and
treatment; thereby protecting WV newborn infants.
i. Report an understanding of existing state and
federal legal issues that affect pregnant addicted women;
ii. Report other states’ best practices;
iii. Engage the WV legislature’s judiciary
committees in discussion and design of solutions to identified
problems
iv. If indicated, Work to draft appropriate
legislation
b. Stephanie Nicodemus: Draft medical
guidelines for obstetrical providers to use statewide for treating for
drug use during early pregnancy and referring for treatment. Base
guidelines on the ACOB and AAP guidelines.
i. Marshall University School of Medicine and
Cabell Huntington Hospital will conduct lab testing and risk
screening tools to aide in identifying and treating drug use in
pregnancy, and will to provide basic guidelines for maternal
maintenance or detoxification with the more common drugs encountered
during pregnancy.
ii. Ann Dacey: Develop a training program
to be taken statewide to train maternity care providers regarding
the implementation of the recommended medical legal guidelines.
iii. Cabell Huntington and Marshall University
School of Medicine will complete and publish the data relating to
maternal drug abuse and neonatal abstinence syndrome. With this
information we hope to be able to provide basic guidelines for
maternal maintenance or detoxification with the more common drugs
encountered during pregnancy.
c. Sandy Young: Develop a tool kit and training
program on recommended medical guidelines for maternity hospital
personnel regarding the identification and testing of newborns for
addiction, and updates on the most appropriate detoxification treatments
available.
i. Specifically, Thomas Hospital will work to
design a toolbox for newborn nurseries for this purpose.
ii. And, plan for an educational program for
community hospitals on its application.
d. Lois Morgan: Study and report the current
situation of infants born affected by maternal drugs/alcohol use.
Research the current situation of infant deaths and the relationship
with maternal drug/alcohol use.
5. Nancy Tolliver: Study the economic impact of
detoxification of newborns compromised by drug addiction as compared to
normal newborn care. Utilizing data found in #4 above, apply the study
provided by Center for Business and Economic Research of Marshall
University on neonatal drug detoxification.
6. Encourage the Development of
Perinatal Worksite Wellness Programs: Ann Dacey Establish
two WV worksites addressing perinatal worksite wellness. The Center Of
Excellence in Women’s Health will work towards promoting the idea to
businesses in West Virginia and getting it into the goals of West Virginia
Vision Shared.
7. Promote and Support
Breastfeeding: Cinny Kittle
a. The WV Hospital Association will establish a
statewide coalition, or network of current and future healthcare
professionals, and other breastfeeding advocates to:
i. identify needs for continuing education and
seek ways to address those needs through the WV Hospital
Association.
ii. facilitate the exchange of information and
resources among these professionals.
iii. Advocate for programs and policies to promote
and support breastfeeding among WV mothers.
b. CAMC Women and Children’s Hospital will:
i. Increase lactation consultant time to expectant
and new mothers.
ii. Purchase and utilize two new hospital grade
breast pumps; the best choice for stimulating and maintaining a
healthy milk supply.
8. Increase In-Home Visiting for
WV Families: Work with the Right From the Start and other in-home
visiting programs to increase the number and percentage of expectant and new
families that are provided in home advice and education related to pregnancy
and newborn care.
9. Reduce Tobacco Use During
Pregnancy: Cinny Kittle
a. Establish a committee of the Perinatal Partnership
to conduct research related to what other states have done to make
significant reductions in smoking among pregnant women and women of
childbearing age, and further develop the plan to address this issue in
West Virginia.
b. The West Virginia Legislature should adequately
fund a statewide, comprehensive tobacco prevention program at no less
than the Centers for Disease Control and Prevention minimum set for West
Virginia (currently $14.1 million)
c. Establish a workgroup to collaborate to assure all
providers of obstetrical and newborn services are knowledgeable in, and
have resources to utilize the guidelines established by the Agency for
Health Research and Quality (AHRQ) for smoking cessation and counseling
and treatment, which could include pharmacological adjuncts, with all
pregnant women and parents.
10. Study the impact of teen
pregnancy and single woman pregnancy
a. Work with The National Campaign to Reduce Teen and
Single Woman Pregnancy. Joyce Daniels
b. Develop a white paper regarding teen and single
woman pregnancy in WV. Margaret Chapman
