Taking Action to Reduce Maternal Mortality and Improve Postpartum Health

Community Health Centers are the primary and prenatal care providers for many people who are disproportionately affected by maternal health complications.

To improve health outcomes, NACHC, Maternal Mortality Review Committees (MMRCs), and Perinatal Quality Collaboratives (PQCs) around the country are learning how health centers are strengthening prenatal and postpartum care and coordination across the maternal health continuum. To reduce disparities in care and advance MMRC recommendations, health centers are also taking a deep dive into maternal health data from different sources for creative programming and partnerships that are improving the lives of pregnant persons and reducing preventable deaths.

Five Rivers Health Centers' Data-Driven CALM Program Drives Up Baby Birth Weights

"We are the second largest FQHC obstetrics practice in the state and are very focused on delivering high quality care and positive outcomes for our patients and their new babies," says Gina McFarlane-El, CEO, Five Rivers Health Centers, Dayton, OH. "But year over year, proportionally we had the worst low-birth weight rates among all 59 Ohio FQHCs. We knew we had to do something about it, so we became super data-focused to create some much-needed actions."

In February and March 2023, McFarlane-El pulled together a Brain Trust of certified nurse midwives (CNMs), care managers, nurses, quality managers, educators, and center managers to dive into the data. They found that people who delivered low-birth weight babies had one or more of the following risk factors: hypertension, tobacco use, marijuana use, depression or anxiety, and/or a sexually transmitted infection. They also found another trend. Babies with low birth weights that were not under the care of one of their CNMs tended to have a smaller abdominal circumference at their 20-week ultrasound.

"We knew that we could not do everything for everyone, and most of our patients were likely going to have one of the modifiable risk factors," explains Tori Tipton, a Five Rivers Health Centers' CNM. "So, we focused on prenatal patients with at least one of these risk factors whose babies' abdominal circumference was at least 40% below average at the 20-week ultrasound." Clients who fall into this very high-risk group are placed under the care of a CNM and enrolled into Compassionate and Loving Maternal Care (CALM), a new intensive wrap-around services program. In other words, keep calm and call the midwife.

The goal of CALM is to keep the patient calm. "We focus on their health and pregnancy, the health of their growing baby, and work to alleviate the stressors that can impact their health that includes, but also goes beyond, social determinants of health challenges," says Tipton.

The combination of CALM and midwifery care is working. In 2023, the health center's UDS data reported that an average of 10.8% of newborns had a low birth weight vs. 14.9% in 2015 or 12.8% in 2021. By February 2024, 11 new CALM babies were delivered, and none had a low birth weight.

Compassionate And Loving Maternal Care (CALM)

Program Components

• Clinical pharmacy consult
• Community health worker
• Dietician consult
• Marijuana Cessation Program for Pregnant Women (The Herb Cessation Program)
• Monthly massage therapy

• Social Drivers of Health (SDOH) interventions (e.g. transportation, food insecurity, intimate partner violence, social isolation)

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