Texas Healthy Babies offers a variety of resources and planning tools that you can share with your patients during their pregnancies. Together, these documents make up a toolkit to encourage open lines of communication, patient-centered goal setting and can support behavior change over time. The Birth Plan, Prenatal Provider Poster and My Health Priorities Patient Worksheet complement each other and send a message to patients that their provider is open to their questions.
Encourage your patients to sign up for text4baby while they’re sitting in front of you. By texting BABY or BEBE to 511411, this free text message service will send scientifically vetted messages timed to the patient’s pregnancy twice a week. That means all of the education you can’t fit into the short time you have with your patient, will still get to her throughout her pregnancy — in the easily digestible text message format.
From the provider perspective, the tools help optimize patient education during the limited time you have in the clinical encounter. All of these tools are not designed to be implemented in one visit. They initiate an ongoing discussion about patient goals that changes with the patient’s circumstances and development.
The Someday Starts Now Birth Plan offers a convenient way to ensure your patients’ wishes are clearly stated regarding labor, birth and recovery. The Birth Plan offers anticipatory guidance about some of the options parents have during childbirth. It also allows patients to become more informed participants in their care over the course of their prenatal visits.
The plan is designed to be reviewed and completed over time. Both partners should share their preferences with each other, as well as their provider, so that when it comes time for delivery, expectations are clear.
This tool also offers clinicians the opportunity to explain what options exist if an emergency arises, so that patients can be prepared and make informed decisions.
The Prenatal Provider Poster can be placed in your waiting room or in exam rooms to prompt open discussion about factors that may impact labor, delivery and the post-partum period. It sends the message to your patients that you are open to their questions, aware of their potential concerns and have the information they seek.
The My Health Priorities Worksheet gives your patients a useful “checklist” of topics to discuss during their prenatal visits, from their medical histories to the importance of breastfeeding and taking their baby to full term.
get your patients prepared for breastfeeding during the prenatal period.
Research shows that those women who plan for breastfeeding and are supported by their partners and providers have a better chance of success than those who are only prompted to breastfeed at the hospital after birth. Support your breastfeeding patients by downloading the Healthcare Provider’s Guide to Breastfeeding smartphone app from the iTunes or Google Play stores.
the last weeks of pregnancy count.
Babies born late preterm and early term are knows as the great imposters. They often look healthy at birth and may be mistaken for older babies by their APGAR scores. But many times, they decompensate quickly in terms of thermoregulation, glycemic control and often require significant care in the Neonatal Intensive Care Unit.
Providers have an opportunity to change practice in their facilities and communities by promoting the elimination of elective delivery prior to 39 weeks. There are many toolkits available that providers can use to implement practice change within their facilities.
For additional resources on the elimination of elective delivery prior to 39 weeks, scroll to the bottom of the page.
Early entry into prenatal care.
Only about 60 percent of Texas women enter prenatal care before the end of their first trimester. Late entry into prenatal care is linked to low birth weight, smoking during pregnancy and other poor outcomes. Providers have the opportunity to engage women — particularly women not planning pregnancy — in early prenatal care by conveying its importance during the preconception period.
They can also encourage seamless entry into on-time prenatal care, educate their administrative staff about the importance of scheduling women early in their pregnancies and work to accommodate patients’ schedules to assure entry into care.
Women with previous preterm birth
The greatest risk factor in preterm birth is a history of preterm birth. Identifying these women early and administering 17-alphahydroxyprogesterone caproate (17P) in appropriate candidates can avert subsequent prematurity. 17P is reimbursable through Medicaid and is available through compounding pharmacies and as a commercial product, Makena®. Candidates for 17P must meet the following criteria:
- Singleton pregnancy
- Previous spontaneous preterm delivery (<37 weeks gestation) of a single baby
The North Carolina 17P initiative is a statewide quality improvement initiative aimed to increase the use of 17P. The website provides guidance about the use and indications of 17P. Please note the that the information about billing is specific to North Carolina.
Learn more about the appropriate administration of 17P, as well as how to identify candidates, with this PowerPoint slide show from the DSHS Grand Rounds Program by Dr. George Saade of the University of Texas Medical Branch at Galveston.
Antenatal Corticosteroids
Antenatal Glucocorticoids are steroids that hasten lung maturation in fetuses with threatened preterm delivery. These steroids have been a recommended treatment modality to reduce the incidence and severity of respiratory distress syndrome and mortality in neonates for thirty years.
For women who are at risk of preterm birth prior to 34 weeks, antenatal glucocorticoids should be administered from 24 to 34 weeks gestation. Indications for use include:
- Preterm labor/preterm rupture of the membranes
- Hypertensive diseases of pregnancy
- Blood group isoimmunization
- Placental abnormalities (Previa/Accreta)
- Other conditions: Twins, intrauterine growth restriction
Learn more about dosing recommendations and current research on antenatal steroids by visiting the March of Dimes Prematurity Prevention Resource Center. The California Perinatal Quality Care Collaborative has developed a toolkit specifically for the administration of antenatal steroids.
Fetal Alcohol Spectrum Disorders and Neonatal Abstinence Syndrome
Fetal Alcohol Spectrum Disorders (FASD) and Neonatal Abstinence Syndrome (NAS) are under-diagnosed conditions with great potential for long-term sequelae.
According to the American College of Obstetrics and Gynecologists, approximately one in 10 neonates are exposed to one or more mood-altering drugs during pregnancy. The number does not vary significantly by public or private insurance stats.
FASD is estimated to be most common in Texas among well-educated and well-resourced white women. Screening for FASD and NAS should take place during the first prenatal visit and referral to care should be followed up by the referring clinician.
Often, neonates who have been exposed to substances are under-diagnosed and may be discharged without complete recognition of their condition, putting them at risk for neglect and additional medical complications. ACOG has an overview and toolkit for the clinician in the diagnosis and management of FASD:
For additional information on FASD, as well as drinking and reproductive health, scroll to the bottom of the page.
Recognizing Perinatal Depression
Perinatal depression is most common in women who:
- Are younger than 20 years old
- Have had PPD or other mood disorders previously
- Have a family history of depression
- Are experiencing additional stressful events in their lives (death or illness of a loved one, financial problems, domestic abuse, personal health problems, drug use, etc.)
The Edinburgh Postnatal Depression Scale (EPDS) is a validated tool for assessment of PPD and is easy to administer. The questionnaire consists of 10 questions that the mother completes herself. Instructions for scoring are attached to the tools and a score of 10 or greater warrants further investigation. The tool is available for reproduction without permission as long as the authors’ names are included. A copy of EPDS can be downloaded here.
For additional resources and tools for perinatal depression, scroll to the bottom of the page.
Intimate partner violence
Intimate partner violence and domestic violence have been shown to escalate during pregnancy. The leading cause of death for pregnant women nationally is homicide — outpacing medical complications. It’s estimated that four to eight percent of women experience physical and non-physical abuse during their pregnancy.
According to ACOG, detection may be possible by discussing the increased stress pregnancy can place on a relationship. Asking how the patient and her partner resolve their differences followed by directly asking — in a caring and nonjudgmental manner — if the patient has been abused can also aide in detection.
The clinician should inquire about the safety of others in the household, keeping in mind that suspicion of abuse is reportable, even if it’s not proven. The clinician should also assist the woman in seeking services and making a plan for her own safety. Interrupting the cycle of violence is a battle worth fighting and the provider plays a vital role in assisting patients who present for reproductive health care services.
CHIP Perinatal Coverage
The Texas Children’s Health Insurance Program (CHIP) offers prenatal care for the unborn children of low-income women who don’t qualify for Medicaid coverage. Once born, the child will receive CHIP benefits for the duration of the 12-month coverage period.
Resources
The California Maternal Quality Care Collaborative (CMQCC) and the March of Dimes developed the Less Than 39 Weeks Toolkit, available through the March of Dimes Prematurity Prevention Resource Center.
These Healthy Texas Babies exam room posters help keep your patients informed and spur discussion of important health topics.
The First Trimester Checklist gives your patients a simple, step-by-step guide for ensuring they enjoy healthy pregnancies.
For additional resources and tools to support you in your assessment and treatment of perinatal depression, click here.
Get resources, information and other materials around Fetal Alcohol Spectrum Disorders from ACOG.
Get handouts, screening tools and other information from ACOG with Drinking and Reproductive Health: Toolkit for Clinicians.
ACOG has also developed a slide set: “Illicit Drug Abuse and Dependence in Women” to address the impact substance abuse has on a woman’s health.
Alcohol and Pregnancy: Myths and Facts explores the common misconceptions about “safe” levels of alcohol consumption during pregnancy and reinforces that drinking alcohol even in small amounts can have lifelong consequences for a child.
Interrupt the cycle with the guide: “Addressing Intimate Partner Violence, Reproductive and Sexual Coercion”, developed by ACOG and Futures Without Violence.
For CHIP training materials, a listing of CHIP perinatal plans by service area and important forms, visit the CHIP page on the Texas Health and Human Services Commission website.
