The ‘Fourth Trimester’

The Importance Of Continued Care After Birth

BY SAVANNAH BEHRENDS

Local organizations are advocating for a “fourth-trimester” approach to help mitigate complications after birth.

“It’s not just the pregnancy that is important but taking care of the mother’s physical and mental needs after birth,” said Dr. John Coté, a physician with CHI Health.

Life-Threatening Conditions Common

A growing number of women are developing hypertensive disorders due to an increase in obesity and diabetes.

In 2021, the Centers for Disease Control and Prevention reported the hypertension mortality rate for Nebraska was 16.7 per 1,000 individuals. The only state with a higher rate was Mississippi.

“[Hypertension disorders] can appear at any time,” said Dr. Ann Anderson-Berry.

Anderson-Berry, among other appointments, is the medical director for the Nebraska Perinatal Quality Improvement Collaborative (NPQIC). In 2019 NPQIC launched the Severe Maternal Hypertension Initiative in collaboration with 28 hospitals, which included discharge education and recommended follow-ups.

Unfortunately, this initiative may not reach individuals who are statistically more at risk; Black women are three-to-four times more likely to die from preventable pregnancy-related complications.

“There’s a lack of knowledge about the resources and a lack of trust in the health care system,” said Shanika King, who co-founded A Mother’s Love with Nikeya Traynham.

Sharing Knowledge

Jaime Bland, CEO of CyncHealth, said many Black and minority women are less likely to have a personal physician for a multitude of reasons.

“Without a single physician to oversee the patient’s health, gaps in care can occur,” she said.

Recognizing this, CyncHealth created the Maternal Health Program of Nebraska.

“Partnering with Innsena, a health technology consultancy, and our technology partner, PointClickCare, we designed the program to make it easier for doctors and care teams to identify at-risk mothers and infants, and more easily share information and insights before, during, and after delivery,” Bland said.

The pilot program was launched in Omaha in 2022, and as of early 2023 has been rolled out statewide.

Calling Friends, Family

Anderson-Berry said another way we can improve outcomes for Black and minority women is by giving “women a voice.”

NPQIC is partnering with I Be Black Girl and the Nebraska Black Doula Collective to train culturally-matched doulas in hopes of empowering Black and minority women with high-risk pregnancies.

“We’re hoping to see doulas improve outcomes and give patients the voice to ask questions they’re too scared to ask or raise concerns when symptoms arise,” Anderson-Berry said.

The initiative, funded through the CDC with matching support from UnitedHealthcare, will provide training for 40 Black women.

“We were hoping for eight applicants … we had over 100,” AndersonBerry said.

Barriers to Care

Unfortunately, many state health insurance plans do not cover doula services, despite research that shows it can improve pregnancy outcomes and increase cost savings.

Through the Culturally Matched Doula Support Initiative, 30 Black and minority women from high-risk ZIP codes will receive support from the newly trained doulas.

Another challenge is advocating for peripartum depression screenings, not only at hospitals and birthing facilities but at providers’ offices.

“Through The Maternal Health Program, we’ve seen that mental health disorder is far and away the most common reason that postpartum women are admitted to the emergency room,” Bland said.

Earlier this year the Policy Center for Maternal Metal Health, in collaboration with George Washington University, released the inaugural Maternal Mental Health State Report Card. It looked at three categories: providers and programs, screening and reimbursement, and insurance coverage and treatment payment.