Healthy Babies Are Worth the Wait
By Ruth Ann Shepherd, M.D., FAAP
Director, Division of Adult & Child Health Improvement, Kentucky Department of Public Health
Healthy Babies are Worth the Wait® (HBWW) is a collaboration of March of Dimes and Johnson & Johnson. It was implemented as a pilot project with the Kentucky Department for Public Health in 2007 to address the rising rates of preterm birth. Kentucky was chosen for the project due to a high rate of preterm births, modifiable risk factors and strong collaboration among state perinatal leaders. The goal was to prevent "preventable" preterm birth using a community based, real-world, ecological design, by bundling interventions and implementing as many interventions known to reduce prematurity as possible. Kentucky had identified that their rising rate of preterm birth was due to late preterm infants, and this coincided with the national attention to late preterm.
The HBWW demonstration project targeted three communities in Kentucky over a three-year period (2006- 2009). HBWW brought together implementation teams of health department and hospital perinatal leaders and staff in Ashland (Kings Daughters Hospital), Madisonville (Trover Medical Center) and Lexington (University of Kentucky Medical Center). These teams worked together on local systems of care to provide consistent messaging, increase referrals to support programs (smoking cessation, home visiting, Centering Pregnancy, substance abuse, etc.) and bring the most recent research on prematurity prevention to providers, which included the increased risks of late preterm infants. The late preterm brain development became a primary message for providers, patients and the public. This informed reducing elective deliveries less than 39 weeks, and the public engagement was important in reducing the pressure on obstetricians to schedule early elective deliveries. Although data for the study period is not finalized, preliminary results indicate that Kentucky saw a drop in preterm singleton births of 9.4 percent and a drop in late preterm singleton births of 10.1 percent.
With the success of the pilot, March of Dimes continued the program, and has now rolled out HBWW in Kentucky to a total of eight sites. The decline in preterm birth has continued in the original intervention sites, and the year after HBWW was implemented in the comparison sites, they also have begun to decrease their preterm birth rates. The success of HBWW in Kentucky has generated great interest, including the new formation of collaborative sites in New Jersey and Texas. An implementation manual for HBWW, the HBWW Community Toolkit for Prematurity Prevention and the late preterm "Brain Card" adapted from the project are available at the March of Dimes prematurity resource center. For more information, contact Katrina Thompson.
*Adapted from the March of Dimes, KY Chapter website.
Innovative Practices in Prematurity Prevention and Preconception Health
Compiled by Kate Howe
Program Manager, Child Health, AMCHP
This issue of Pulse contains several examples of how states are addressing prematurity and preconception health. Given limited resources and time, sharing these practices and lessons learned is important as states not only want to maximize existing knowledge, but also learn how the evidence is being used to lead to positive behavioral change and healthier outcomes in populations. The AMCHP Best Practices Program and Innovation Station database aims to foster that knowledge exchange by reviewing and cataloguing programs that have a strong design based on theoretical foundations and proven models, and that incorporate rigorous evaluation and continuous quality improvement to ensure the program is using that evidence-base to best meet health goals. The Innovation Station database contains successfully reviewed MCH practices that range from new, emerging practices with solid design and evaluation plan to promising practices with strong evaluation data to demonstrate effectiveness to best practices that have been peer reviewed, extensively evaluated and replicated. Below are just a few examples of
Innovation Station programs that address prematurity and preconception health:
- Baby Blossoms Collaborative Preconception Health Program – Now and Beyond, Nebraska (Emerging Practice): This collaborative created a toolkit for health providers to address maternal health & prematurity and delivered provider trainings on how to apply preconception wellness to brief intervention concepts and techniques.
- Healthy Women, Healthy Futures, Oklahoma (Promising Practice): Offered at early childhood education centers , this program aims to improve the physical, emotional, social, dental and vision health of at-risk women living in poverty before they become pregnant again, thereby minimizing their risk of future premature birth or infant death.
- Mississippi Interpregnancy Care Project, Mississippi (Emerging Practice): Pilot programs in two communities – one urban, one rural – among women who delivered a very low birth weight infant that aim to improve overall health status and optimize child spacing, and reduce subsequent poor pregnancy outcomes.
- Partners in Pregnancy, Virginia (Promising Practice): Aims to improve adverse pregnancy outcomes by decreasing days in the NICU.
- PASOs (Perinatal Awareness for Successful Outcomes), South Carolina (Promising Practice): This program provides free, comprehensive prenatal classes, community health outreach and individual interventions to Latino families.
- Power Your Life Preconception Campaign, Utah (Emerging Practice): A social marketing campaign to raise awareness of preconception health and increase consumption of folic acid.
- Prenatal Plus Program, Colorado (Promising Practice): A program to improve birth outcomes by reducing the number of low birth weight infants born to Medicaid-eligible pregnant women.
- Women Together for Health, Arizona (Emerging Practice): A free, community-based program that addresses modifiable lifestyle behaviors to improve the health of women and their families, including healthy weight, physical activity, proper nutrition, stress management and tobacco use in women of childbearing age.
- Women’s Health, Now & Beyond Pregnancy, Wisconsin (Emerging Practice): Promotes folic acid consumption and healthy spacing of pregnancies.
For more information about these programs and other successfully reviewed MCH practices, visit Innovation Station or the AMCHP Best Practices homepage. If you have questions or know of a program that should be included in our database, please contact Kate Howe.