Community Spotlight: Improving birth outcomes with Project Swaddle


Crawfordsville, Indiana, a city of about 16,000 in the west central part of the state, is part of a desert — a maternity care desert, to be exact. This means there is limited or no access to maternal health care.

After the labor and delivery unit closed in 2013, firefighter paramedics saw a dramatic uptick in deliveries in the field — especially concerning in such a high-risk population, where few women had the support they needed.

“Rural Indiana is already lacking in the access to care when it comes to infants and pregnant moms, but there is also that huge issue of substance use disorder,” said Amnah Anwar, senior director of Indiana Rural Health Association. “The culmination of the two has resulted in a very high infant mortality rate and high-risk pregnancies.”

Indiana currently ranks among the highest in the U.S. for infant mortality rates20% higher than the national average. The situation was dire, and a solution was needed.

Enter Project Swaddle — a prenatal and postpartum care program offering in-home treatment or transportation services for in-clinic visits, for at-risk mothers and their babies. The program, which began in 2018, links local Crawfordsville paramedics, physicians and community resources with expectant mothers and follows their journey up to 16 weeks after giving birth. With the help of a UnitedHealthcare investment, the program is being replicated throughout Indiana.

“Project Swaddle is wrapped services,” said Darren Forman, director of Project Swaddle with the Crawfordsville Fire Department. “We see high-risk mothers, we wrap them into social services or mental health treatment, if needed. I’ve helped with housing; I’ve helped with transportation. I’m an extension of the OB provider.”

Having a dedicated community paramedic for program participants helps provide a long-term relationship for a new mother — including 24/7 access for questions or emergencies — and also creates a first point of contact that extends all the way into getting care by an OB/GYN. As the main community paramedic with Project Swaddle, Darren usually connects with mothers at 7 to 10 weeks of gestation — with an emphasis on the earlier, the better.

Calli, a mother-to-be and participant of Project Swaddle, receives regular check-ins to ensure she’s maintaining a healthy pregnancy.

“Being at-risk like I’ve been, anytime of day — day or night — I can pick up the phone and call Darren if I’m panicking or if something is truly wrong,” she said. “It gives me a lot of peace of mind.”

To qualify for the program, the mother must be referred by a social service agency or a phyisican. Over 200 women have taken part in the program with more than 99% of expectant mothers achieving full-term delivery — with appropriate birth weights, according to the Crawfordsville Fire Department.

UnitedHealthcare, seeing the success of Project Swaddle, worked with the Indiana Rural Health Association to see how the program could reach more mothers in need throughout the state.

“We’ve invested about $240,000 into both project management as well as startup funds for the expansion sites,” said Keith Mason, director of Advocacy and Engagement at UnitedHealthcare and a Crawfordsville resident. “And we’re making sure we’re capturing all those learnings so we can replicate and scale this otherwise. So, we can have healthier moms and healthier babies in all those places.”

With the program now launching in three other communities, the hope is that Project Swaddle will help not only with full-term pregnancies, but also help set up a lifetime of improved health for the children receiving care.