Sunday, July 14, 2024

Health care: Women and children, complete care

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North Carolina health care providers are improving the lives of women and children by addressing ailments and issues that will affect them later.


Catawba Valley Medical Center in Hickory cares for patients from five surrounding counties. “As the region’s largest not-for-profit community hospital, our mission is to improve the overall health of our communities,” says Michelle Lusk, vice president and chief nursing officer. “We have built strong relationships with the people, businesses and communities in our region.”

Lusk says about 2,000 babies are born each year at CVMC, and it handles about 130 neonatal transports and 400 patients in its newborn intensive care unit. Their moms need care, too — before, during and after they give birth. “Rising rates of hypertension, hemorrhage and blood clots are the primary reasons mothers die during pregnancy, delivery or postpartum,” she says. “Other factors include the lack of education, money and resources to make healthy lifestyle decisions.” The National Center for Health Statistics reported North Carolina’s infant mortality rate was 6.8 per 1,000 live births in 2019, compared to 5.6 for the United States. In 2018, North Carolina’s maternal mortality rate was 10.9 per 100,000 live births, compared to 17.4 for the United States.

Health disparities and infant and maternal mortality issues are front and center in today’s health care landscape. In response, health care systems are adding services for women and children, because when individuals thrive so do their communities. “We know healthy women are more likely to have healthy pregnancies, give birth to healthy babies and grow up to be part of healthier families and communities,” says Kelly Kimple, chief of the Women’s and Children’s Health Section at the N.C. Department of Health and Human Services. “Our work is to promote healthy and thriving children in stable, nurturing families, schools and communities, and to support the whole child and family health.”

The COVID-19 pandemic complicated all health initiatives. It caused serious illnesses, deaths and long-term effects. The simple fear of contracting the disease, for example, kept people from seeking care for illness not related to COVID, scheduling wellness exams
and finding mental health support. “During COVID, we saw a decrease in routine well-child check-ups and prenatal visits,” Kimple says. “The pandemic’s economic impact has negatively affected health, stress levels, mental illness and substance abuse disorders, and we’re seeing the rates of suicide increasing, particularly among our youth.”

Many of those issues are being addressed as the pandemic slows. At CarolinaEast Medical Center’s Women and Children’s Pavilion in New Bern, for example, lactation support services are returning to in-person after being sequestered in virtual sessions. The hallmark of the four-year-old Pavilion is its 16-bed mother-baby unit, which has five full labor-and-delivery rooms. “Every improvement and change we have made has been patient focused,” says Shawn Klabo, CarolinaEast clinical nurse manager. “It’s all about keeping moms and babies together as much as possible, and all newborn care is done at the mothers’ bedside, where they can ask questions as nurses weigh their babies and administer tests.”

Klabo believes the sky’s the limit for future offerings at CarolinaEast Health System. “We are constantly evolving and improving care for moms and babies, and it’s a constant change,” she says. “We’re always learning and always growing, and we are just a part of different statewide initiatives to improve care and make North Carolina the best place to have a baby.”

CVMC is expanding its labor-and-delivery team to include a doula program. A doula is a professional labor assistant who provides physical and emotional support to mothers and their partners during pregnancy, childbirth and the postpartum period. “Doula programs have been shown to improve outcomes,” Lusk says. “We are also working with the state of North Carolina to align maternity patients to their best outcomes, whether their pregnancies are healthy, low risk or high risk.”

Health care professionals and administrators use a holistic approach at Moses H. Cone Memorial Hospital in Greensboro. “Our women’s and children’s services extend beyond our beautiful building,” says Sue Pedaline, the hospital’s chief nursing officer and vice president of Cone Health’s Maternal-Child Service. “The Women’s and Children’s Center is a full-service women’s health facility, where we offer services across a woman’s entire lifespan.” About 6,000 babies are born each year at the Center, which offers obstetric services, gynecology, nutrition and mental health services, and post-partum support. It has a food pantry, too. “Food insecurity and lack of access to proper nutrition is one of the things we’ve identified as a barrier to health care,” she says.

Moses H Cone
Moses H. Cone Memorial Hospital is the largest medical center in Greensboro and the surrounding five counties.

Reversing unhealthy lifestyles’ impact on wellness is a focus at Iredell Health System in Statesville. “Crucial issues impacting the health of pregnant women and their babies in our communities are obesity, diabetes, tobacco, alcohol and substance abuse,” wrote The Birth Place Director Sharon Paul and 3 North Director Diane Hamby, leaders of IHS care for mothers and their babies, in an email. “Domestic violence and poverty also play roles in driving down good health, and social determinants impacting maternal health include … income and education levels, social support systems, physical environments and working conditions.”

IHS is responding to these concerns with myriad services, including out-patient laboratory and imaging. Iredell Women’s Health Center, for example, offers mammograms and bone density scans. And about 500 pregnant women as inpatients and hundreds more as outpatients use its personalized Pampered Pregnancy Program, which helps them prepare for childbirth and care for a newborn, each year.

FirstHealth of the Carolina’s Southern Pines Women’s Health Center recently experienced a baby boom. “In 2021, we had 2,324 deliveries, our highest yet,” says Beth Tabor, FirstHealth’s administrative director of women and children services. “We average anywhere from 185 to 215 deliveries a month,” she says. “We aim to offer a place where women feel comfortable and where they can have the birth experience they want.”

A partnership between FirstHealth and Pinehurst Surgical Clinic provides comprehensive care to women in Lee and surrounding counties. Services include prenatal care, annual gynecological services, surgical intervention, hormone treatment, treatment for
infertility, mammography and continence treatment, says Lissette Machin, an obstetrician and gynecologist at Pinehurst Surgical Clinic. “Our partner-ship has made making referrals to other specialties seamless for patients.”

Many families turn to specialty providers such as Charlotte Eye, Ear, Nose & Throat Associates. It provides comprehensive pediatric and adult wellness services, along with treatments for various ailments and medical conditions, at 18 locations in the Charlotte region. “These are essential services for women,” says Lee Wiley, an ophthalmologist at CEENTA’s Pineville and Steele Creek offices. “They have a longer life expectancy than men, so women are at a higher risk of age-related conditions such as macular degeneration, cataracts and glaucoma. Women also tend to have a higher risk of autoimmune disease, which can cause ocular inflammation and vision issues, too.”

CEENTA is welcoming back patients as the pandemic wanes. “COVID-19 resulted in delay of care for many treatable conditions, which resulted in preventable vision problems,” Wiley says. “Luckily, hesitancy to see doctors is beginning to decline and patients are returning for routine care.” 

Other providers are treating issues that are direct results of the pandemic. IHS providers, for example, say mental health needs among youth in its communities are growing. “We need to have more discussions regarding the mental health of our pediatric population, including more counselors, facilities that treat pediatric mental health, and more education on mental health in general,” Paul and Hamby wrote. In addition to isolation during the pandemic, they cited drug abuse, family stressors, social media and constant peer pressure as causes. 

Treating mental health issues often involves bringing help to the patients who need it. “During the pandemic, kids dealt with many stressors, and today we are working with school nurses, counselors and psychologists to continue helping meet their mental health needs,” says Kim Crickmore Osborne, vice president of James & Connie Maynard Children’s Hospital, women’s services, community health programs and nursing support at ECU
Health. It’s the new banner for Vidant Health and East Carolina University Brody School of Medicine, which recently signed a joint operating agreement.

But even with those efforts, access remains a concern. ECU Health serves 29 counties in eastern North Carolina. Most are rural and among the state’s most economically distressed, Crickmore Osborne says. “Some counties in our service area have only one health care provider, making it tough for those who need specialty services such as pediatrics and
OB/GYN,” she says. “Access to health care is a big problem, and the majority of our women and children are Medicaid patients.”

Private OB/GYN doctors in the community help extend the health care system’s reach. “We work closely with our nursing school, and we have a nurse practitioner program, a physician’s assistant program, a rural health residency, and we have case managers and other health care professionals who engage with the community,” Crickmore Osborne says.

— Teri Saylor is a freelance writer from Raleigh.




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