Early care key to health for babies, nurses say
By Phyllis Moore
Published in News on September 24, 2007 2:04 PM
Infant mortality rates in Wayne County have dropped significantly in recent years, prompting the Health Department to focus on ways to maintain the trend.
Historically, the issue has been a problem for the county, Health Director James Roosen said. In the past two years, however, there has been a marked difference in the rate of babies dying before their first birthday -- in 2005, 25 baby deaths were reported, with only 12 reported in 2006, he said.
It's a complex issue, Roosen said.
"There's a lot of components to ensuring a healthy birth," he said. "It's not just getting prenatal care. It starts when a girl is in kindergarten, in terms of understanding her health. If these young girls in the fifth and sixth grades are directed in the right way, everything that we're doing in every agency will have an impact on infant mortality."
Health Department services are accessed by an estimated 40 percent of women who deliver babies in Wayne County, said Evelyn Coley, director of nursing. But it has to be a combined effort, both inside and outside of the Health Department, she noted.
In-house, not only are there nurses in place to provide prenatal care and education, but also social workers who link the women to such services as transportation, food and housing.
"We also do post-partum home visits. Prenatal nurses do those to make sure the environment is safe and they have the support, supplies that they need," Ms. Coley said.
"A lot of these visits may be the only contact from an individual that understands and cares about their needs," Roosen said.
There are other players working toward the same goal, though, he noted.
"A lot of agencies in Wayne County try to tackle the issue -- Department of Social Services, ob/gyns, WAGES First Steps, Smart Start, pediatric practices," he said. "It's not one agency that's going to make a difference. We have got to look at the entire system in Wayne County."
Challenges abound, health officials say -- from abuse and neglect, to stresses caused by drug and alcohol use. It's important to reach females in time.
Debbie Wyatt, program manager for the maternity care program, also known as "Baby Love," and her staff of social workers have a steady caseload of maternity clients.
With five maternity care coordinators on staff, they currently have 300 patients on the rolls.
Each social worker has an average caseload of 60 to 70 women, which the state requires them to contact at least monthly, Ms. Wyatt said.
Lack of transportation is the biggest obstacle for many, followed by housing and child care.
"Some are working but don't make enough to pay for day care," said Linda Thompson, a maternity care coordinator.
Substance abuse and mental health, especially depression, are also concerns, Ms. Wyatt said, prompting efforts to find resources and make referrals.
But there are success stories.
Tina Williams, a maternity care coordinator, recalls a 23-year-old client with a history of drugs who had been pregnant four times and had her first three children taken by social services because of positive drug screening at the time of delivery. Ms. Williams began working with the woman during her fourth pregnancy.
"She was extremely concerned about her baby being taken as her other children had been," she said. "During her pregnancy, she did not use drugs or drink alcohol and had negative drug screenings that she voluntarily submitted to."
In addition to complying with all she was asked to do, the woman sought help from Wayne Pregnancy Care Center, Ms. Williams said, which enhanced her parenting skills and provided items for when the baby arrived.
"At the time of her delivery in November, she tested negative for drugs and was able to take this child home without social services' involvement," she said. "I feel that being a part of the Baby Love program made the difference. ... She received the needed support to make life changes and to have a positive outcome for her pregnancy."
Sometimes it's as simple as building relationships and letting the women know someone cares about them. Providing counseling and education, as well as encouragement, can go a long way.
"We try to empower them to have the tools to live life," Ms. Wyatt said.
The public can also be part of the solution.
"We take for granted sometimes that everyone doesn't always have someone in their life," said Julie Sutton, maternity care coordinator.
With teens especially, helping them reach goals can be about talking with them and pointing them in the right direction, she said.
Having a stigma attached to coming to the Health Department sometimes slows down the process.
"I think the community needs to be able to empathize with our clients," said Ms. Thompson. "Most people, as statistics go, are only a paycheck away from being where our clients are.
"Be more sensitive. We have clients that are motivated to do and be anything they want to be. They just need somebody to believe in them."
The maternity department has redesigned its clinic to accommodate more patients and streamline the process.
Instead of having to book appointments weeks in advance, patients can now schedule a slot the same week or even the next day, said Wanda Westbrook, program manager.
Her staff -- two nurse practitioners, six registered nurses, one part-time nurse and one LPN -- are responsible for dividing up the more than 600 patients who typically utilize the services. The bulk of their duties center around sharing information.
"About 75 percent of the first appointment is education," Ms. Westbrook said.
"When they reach 24 to 28 weeks, we discuss pre-term labor symptoms, signs and symptoms to report; information on newborn care, car seat safety, shots, well-baby checkups and a choice of doctors who will take newborns."
Before imparting wisdom, though, it's important to get a sense of who the patient is.
Debbie Snyder, a nurse practitioner, said she also asks at the outset how the woman feels about the pregnancy and about the home environment.
"It gives them a time to ask questions," she said. "I ask about their dreams, get a good feel about how they emotionally are handling their pregnancy."
Building rapport with the expectant mother is vital to their sense of safety and trust, and in turn eases some of the stress that accompanies a pregnancy.
"We want them here and we want them to feel relaxed and know that we'll take care of them so that they'll feel confident in coming in," Ms. Westbrook said. "I think there's a stigma to care at the Health Department, but I know that they get excellent care here."
One of the biggest challenges centers around breaking cycles that already exist.
"They come in fearful a lot of times with information that's not true or correct, so that's another teaching opportunity," Ms. Snyder said. "Or when you see kids having kids, all we can do is the best that we can to give them information and give them support, to try to be their friend as well as their provider. And certainly to include their mother when they come with them, so that time is not wasted when someone else is included."