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Children’s Wisconsin helps Milwaukee moms improve pregnancy outcomes

Patricia Dickerson, a busy mom of four with a history of difficult pregnancies, was both excited and worried when she learned she and her husband were expecting another baby. She had experienced miscarriages, two late-term losses and premature deliveries, and she was scared one of those things might happen again.

A phone call from the Healthy Mom, Healthy Baby program made all the difference.

Healthy Mom, Healthy Baby is a prenatal care coordination program provided by Children’s Community Health Plan (CCHP), Children’s Wisconsin’s health plan that offers insurance both through the Exchange and to Medicaid participants. The program is free to Medicaid members enrolled in the health plan. Healthy Mom, Healthy Baby pairs expectant moms with a case manager, helping them achieve a wide range of pregnancy outcomes: full-term birth, good nutrition, regular prenatal doctor visits and breastfeeding support.

In its first six years of existence, the program is showing strong outcomes. In 2015, half as many Healthy Mom, Healthy Baby pregnancies resulted in preterm birth compared to overall births in the City of Milwaukee — 5.18 percent vs. 11.3 percent.

“Babies who are born full term are healthier and have fewer complications. Preterm babies and moms just have a harder time,” said Leticia Herrera, RN, manager of the Healthy Mom, Healthy Baby program. “Plus, avoiding preterm birth allows us to use saved resources to provide improved care for kids and adults.”

One-on-one caring

Healthy Mom, Healthy Baby is an “opt-in” program, so case managers contact newly pregnant moms to encourage them to sign up. The managers, who are registered nurses or social workers, meet with moms at their homes or in community settings, but they’re also just a phone call or text message away.

In addition to her difficult pregnancies, Dickerson struggled with depression, and had experienced thoughts of self-harm. After enrolling in the program, she began meeting regularly with her care manager, Kristin Kroll, RN, and would also text her when she needed extra support.

Evidence shows mobile and texting contact improves outcomes in Medicaid programs. As case managers work with an average of 35 moms at a time, it helps them stay in close touch with their members, too.

“My nurse was a big help in my life who encouraged me and helped me set goals like getting therapy for my depression and working on my weight,” said Dickerson. “She was just as interested in my health as she was in my baby’s health.”

Through her work with Kroll, Dickerson began to make her own health a priority. “She showed me it’s okay to leave my baby with my husband for a while and go for a walk to clear my mind.” She gradually became more active and even joined the YMCA. “It’s healthy for my body and it relieves stress,” said Dickerson.

Kroll also encouraged Dickerson to go to all of her prenatal appointments, something she had not always done with previous pregnancies. This led to Dickerson giving birth at full-term for the first time — to a healthy baby girl named Ah’Myriah.

Building a community

Healthy Mom, Healthy Baby also brings pregnant moms together to learn, connect with resources and celebrate. Members attend the program’s annual baby shower that offers cake and gifts, but also much more. The shower includes breakout sessions where members learn about community resources, network with one another and receive health information and useful baby items. The most popular event at the baby shower is always a question and answer session where members ask Ken Schellhase, MD, medical director at Children’s Community Health Plan, about pregnancy, childbirth and infants. “It’s really a great exchange,” said Herrera.

Members also have a Facebook community where they can obtain information and share insights. The page includes the video health show, “Ask Dr. Ken,” that features answers to participants’ questions on topics ranging from diet during pregnancy to immunizations for children.

Strong outcomes

In addition to preterm birth outcomes, the program supports women in making healthy choices for their families. Ninety-nine percent of members enrolled in Healthy Mom, Healthy Baby have cribs, Pack N’ Plays or baby nest boxes for safe sleeping. Sleeping in an adult’s bed is strongly linked to SIDS or accidental suffocation, leading causes of infant death.

All case managers are also certified lactation consultants, helping members learn about the benefits of breastfeeding and supporting their efforts. Dickerson is still breastfeeding her 3-month-old baby although she is back at work. In 2016, more than 81 percent of Healthy Mom, Healthy Baby participants breastfed their babies.

The program also empowers women to engage in family planning following their baby’s birth, with 78 percent of participants starting birth control after delivery.

Lasting connections

Once members give birth, care managers continue to provide support for two months postpartum. They help moms get babies immunized, answer questions, provide resources and are on call for support. Kroll often answered Dickerson’s questions about the baby’s health via text message. And during one visit, Kroll noticed that the baby was turning her head more to one side than to the other. “She’s getting physical therapy for that now,” said Dickerson.

Postpartum contact meant a lot to Dickerson. “My postpartum depression wasn’t as bad this time, but I still had it,” she said. “I felt comfortable asking questions and asking for help. Without my nurse I don’t know what state I would have been in.

“I just wish the program could go on longer,” she said. “My nurse helped me learn to be healthy for myself. I’m not as stressed, and it helps to have another person supporting me who is not a family member.”

Though the program is finite, connections often last. “We have moms who text updates and photos of their children to case managers as they grow,” said Herrera. “They are proud of what they’ve done as parents, and they want to share that with us.”