Through a partnership between the state Health Department and the state Division of Medicaid, Healthy Moms, Healthy Babies program places registered nurse case managers in the homes of pregnant mothers undergoing high-risk pregnancies.
Since launching, it has expanded to 23 full-time nurses and 17 part-time nurses providing services to about 640 patients around the state.
State Health Officer Dr. Daniel Edney said the program is “plugging the gap” by bringing resources to small rural communities that aren’t there.
“With limited resources for mothers and babies, a lot of our efforts are going to be directed to our highest impacted areas to help the folks in the most desperate need the fastest,” Edney said.
The way resources are distributed across the state – sparsely in rural and remote areas but plentiful in certain others – means the program must take a targeted approach.
“We can not look at Mississippi as one organism. We are really six different regions when it comes to public health in terms of populations, demographics, resources available and challenges,” Edney explained. “I have to have different strategies for different areas. The one-size fits all strategy won’t work.”
Dr. Justin Turner, chief medical officer at the state Health Department, witnessed personally how important access to quality health care for mothers is.
Turner’s wife made 30 total visits to five different hospitals or emergency rooms during her last two pregnancies.
Seven of those visits came during her pregnancy five years ago, and the remainder of the visits came during their second pregnancy in August 2022. During her last pregnancy, she experienced “uncharacteristic pain” around month five, requiring her to be supervised by her family 24 hours a day until she gave birth.
The pain would spiral out of control resulting in psychogenic nonepileptic seizures (PNES), previously known as pseudoseizures – emotional and stress-related episodes similar to epileptic seizures but not of neurological origin.
As the number of trips increased, Turner said he had a tough time reassuring his family and himself.
“I was thinking, 'how do I continue to do what I’m supposed to do as the chief medical officer and help assist the state as a whole, when I can’t even help my wife at home?'” Turner told Mississippi Today.
For Black women in Mississippi, the pregnancy-related mortality rate increased from 51.9 to 65.1 deaths per 100,000 live births, quadruple the rate of white women (16.2). With this data in mind, fears of the worst outcome flooded both Turner and his wife’s minds.
“It was natural for me to think that my wife was going to be another statistic,” Turner explained. “She would ask me things like, ‘Baby, am I going to die?’”
The pregnancy remained a challenge until the day that she delivered their child by cesarean section. Every day prior to her being pregnant was “a day of misery,” Turner said. After delivery, his wife never experienced another pseudoseizure episode.
Turner said fortunately for his wife, she had a husband who is a doctor, an OB-GYN, support from family and friends, and a great health care team.
However, he couldn't help but think of how many mothers in Mississippi lack support. Turner said the Healthy Moms, Healthy Babies program aims to add emotional support for mothers who may be in need of it.
“For a lot of women, they benefit from the nurturing and feeling like someone is listening,” Turner continued. “The more people that’s on their team, the better it helps them to endure the process of pregnancy itself.”
As services are being provided to participants, Turner said the health department, stakeholders, policy makers and community members must collaborate to improve outcomes for mothers and their babies.
“We need to find common ground in the areas that we can improve and make sure that we are providing our moms and babies a decent chance at having a healthy pregnancy and coming into this world,” Turner said.
As a Medicaid-reimbursed program, Healthy Moms, Healthy Babies allows mothers to receive monthly targeted case management, health education, and assessments by nurses, social workers and nutritionists at no direct cost to them.
For moms with Medicaid, the services are reimbursed. Edney said the program works with uninsured moms to help them enroll in Medicaid or, if they are not eligible, will provide the services for free.
The Mississippi State Health Department declined Mississippi Today's request to interview a mother who has participated in the program.
After making contact with a mom in need, the nurse consults with the mother’s doctor, who shares why she may be considered high-risk. Common high-risk conditions include preterm labor, diabetes, multiple pregnancy losses and starting prenatal care late.
The nurse then works to mitigate her symptoms by going to the mother's home and pairing her with a multidisciplinary team of resources, such as social workers and nutritionists.
The team of health care workers educate her on the importance of prenatal care, diet plans and how to limit her chances of becoming high-risk in the future. Edney said the program is “working aggressively” to support affected Medicaid moms.
“In our last reporting from the maternal mortality review committee, 87% of deaths were Medicaid moms, and out of all of our maternal deaths, 80% were preventable,” Edney told Mississippi Today. “That is unacceptable.”
Currently, 86% of the participating mothers are Medicaid beneficiaries.
Healthy Moms, Healthy Babies monitors not only high-risk mothers but also high-risk babies up to one year of age.
A baby is considered high risk if they are born prior to 37 weeks of gestation, weigh less than 5 pounds 8 ounces at birth, have genetic disorders, experience nutritional deficiencies, infections, or live in unsafe conditions among other factors as well.
The average age of infants enrolled in the program is less than one month old.
The goal of the program is to increase the infant's chances of survival, Edney said. Mississippi leads the nation in its rate of infant mortality.
“I know that if we continue doing what we are doing, nothing is going to change. So, if we all agree we have a problem, which I think everybody does, then this has got to change,” Edney stated. “I don’t have to convince anybody that being 50th in the nation for dead babies is a good thing, because it isn’t.”
The Health Department plans to expand the program so that more women and babies in rural communities have access to necessary care.
Around 35% of babies were born to women living in rural counties of the state, but only a quarter of maternity care providers practice there, according to the latest March of Dimes’ report.
Jillian Harper-Peavy, the state program director for Healthy Moms, Healthy Babies, said partnerships with different individuals and organizations are critical for the program to expand.
Those organizations include community health centers; hospitals; OB-GYN offices; pediatricians; managed care organizations; and other maternal and child health programs.
“We are prioritizing outreach and engagement of patients continually, as we do want to see the program serve more pregnant women and infants,” Harper-Peavy continued. “As additional patients are enrolled, we will continue to assess our staffing capacity and plan accordingly.”
However, financial constraints have hindered its expansion.
Earlier this year, Edney asked lawmakers to fund $9 million to hire nurses needed to fully staff county health departments and Healthy Moms, Healthy Babies. The request was denied.
Now, Edney said he is seeking to redirect the funding he has and cut back in every department possible to hire the 100 or so nurses he’s identified as potential job candidates.
“I’m trying to provide core public health services around this state with a battered workforce,” Edney explained. “I try to get people to understand that while everybody else may be over COVID-19, the health department is not. We were beaten to pieces, and we’re working hard to rebuild our workforce with the resources that we have.”
Susan Bates, nurse team lead in the northeastern region of the state, manages a team of nurses who serve patients in 11 counties, seven of which are maternal health deserts: Marshall, Benton, Tippah, Pontotoc, Prentiss, Tishomingo and Itawamba.
These counties have no hospitals or birthing centers that provide obstetric care, and no practicing OB-GYNs or certified nurse midwives.
Across the state, 51.2% of counties are defined as maternity care deserts, compared to 32.6% nationally.
Bates, who cares for an average of six to 10 mothers and babies each day, has encountered women experiencing preterm labor, preterm delivery, preeclampsia, anxiety and depression. She’s also cared for premature and low-birthweight babies.
With more than 26 years of nursing experience, Bates said she aims to make every patient feel respected, valued and heard. Her approach is to listen, understand and “not just focus on checking a box.”
“I feel that it is important to establish a relationship of trust between the mother and her doctors that way we can promote and foster communication. This allows us to provide a more comprehensive care and therefore improve our patients’ outcomes,” Bates continued. “So, when we meet our patients' needs, consistently and correctly, they develop trust in us as their caregiver.”
The Corinth native previously worked for the Mississippi State Health Department for 11 years as a public health nurse, promoting and protecting the health of populations using knowledge from nursing, social and public health science.
Bates, who is certified in pediatric advanced life support and neonatal advanced life support, said caring for high-risk mothers and babies requires a calm demeanor to help the family through what can be a scary time.
“If you look at the big picture, then it may seem overwhelming, but we can’t be stopped by that. We have to know that what we are doing makes a difference to each patient,” Bates explained. “One life at a time, we’re making a difference.”
Edney said that scoring poorly in maternal and infant mortality is a “heavy burden” that requires a “heavy lift” to flip the negative trend to a positive one.
“It’ll take years, but with the work that we’re going to do with the agency, I’m convinced that we will not only get off the bottom with infant mortality,” Edney stated, “we will get off the radar.”
Correction 8/9/2023: This story has been updated to reflect the correct number of hospital visits Turner's wife incurred over the span of two pregnancies.