For some moms, getting ready for a new baby might mean cribs and car seats, baby showers and painting a nursery. Beyond that, it might mean having a lot of family and community support, plus having regular access to a doctor to make sure both mom and baby are healthy. But for some moms-to-be, there are barriers that can make that difficult.
Take Laney, for instance. Laney* was a 31-year-old mother-to-be in Florida. But her pregnancy was considered “high risk.” She previously had two stillbirths after pre-term labor, as well as an ectopic pregnancy (when the embryo attaches outside the uterus). She was living with her mother, and the father of the baby was not involved in her life.
And for other pregnant moms, getting healthy meals for two, finding a safe ride to OB/GYN appointments and living in a house free from violence are not always givens. Along with a lack of access to coordinated care, these factors can have a direct, and at times devastating, effect on the health of both mother and baby.
Maternal health in the United States is a growing concern, with the highest maternal death rate among developed countries. Maternal mortality has increased by 27 percent in the United States since 1990, while falling by 44 percent in other developed countries during the same time period. Hypertensive disorders such as high blood pressure during pregnancy have been rising, as well as rates of diabetes during pregnancy.
What’s more, stark racial disparities exist for the rate of infant mortality. Studies have shown a link between black women reporting racial discrimination in their experience of maternal care and having higher rates of pre-term and low-birth weight babies.
Healthy First Steps is a UnitedHealthcare Community & State program in 21 states to help moms and babies who receive Medicaid benefits find holistic, compassionate care, as well as addressing broader social needs when it’s needed. The Healthy First Steps nurses reach out to moms — or receive a referral – and connect them with the information they need both during and after pregnancy. This might involve things like finding a provider, help with appointment scheduling or setting up an in-home visit.
For some moms, this might also mean housing or outpatient opioid treatment.
“We’re hearing stories about moms where they just don’t have a place to live,” said Kelli Hammit, national director of Healthy First Steps. “We’re often taking a step back and saying the best thing we want to do is making sure they have early and consistent pre-natal care. But sometimes they need a place to stay or just food. So if we solve that, we can get them the care they need.”
The Healthy First Steps nurses engage with high-risk members as early in the pregnancy as possible, and provide services up to 60 days after the birth of the child. High-risk might mean a lot of different things, such as a difficult previous pregnancy, substance abuse or homelessness. The nurse is also able to bring in a team of community health workers, housing navigators and others to make sure the member has what she needs for a successful, safe pregnancy.
Another crucial piece of the puzzle is the nurse connecting with the OB provider, which might be an OB/GYN, a midwife, or someone else, in order to provide evidence-based best practices and help them keep the mom’s barriers to access in mind.
“What we really want to see the nurses do is if the member has an OB provider or even a whole slew of specialists, then we absolutely expect that nurse to be interacting with [them] — behavioral health, perinatal health, cardiac, whoever — and make sure the members’ needs are being met,” Hammit said. “I’ve had [nurses] tell me about two-hour phone calls, where they’re just coordinating on behalf of this mom.”
Healthy First Steps helped to support over 13,000 high-risk members in 2018, including moms like Laney. After their initial connection, her Healthy First Steps nurse, Jo Stigale, realized the precarious situation mom and baby might be in. She recommended a progesterone medication to Laney, and also connected with her OB provider to explain how this medication can help reduce the possibility of a pre-term birth.
Laney started the medication injections at 20 weeks. In-home nursing services, including the injections, began a few weeks later. Sometimes it was the connections that seemed small on the surface that had the biggest impact. “Once, the nurse that gave her the medication injection was coming too late in the day,” Stigale said. “She was on bedrest, and she needed the nurse to come earlier when someone was with her to open the door. It was causing her extra stress so it was good to be able to address her need like that.”
Although her baby spent time in the NICU, Laney and her baby eventually came home happy and healthy. She credits her Healthy First Steps nurse Jo and her OB provider with helping to make that happen.
“Needless to say,” Stigale said, “I was so touched and thankful for being able to help her become a mother.”
*Name changed to protect member’s identity.