MCH exam 2

When were infant mortality rates at their highest? Why?

When were infant mortality rates at their highest? Why?

• Early 1900s/ 20th century particularly around 1915

• Poor healthcare, inadequate nutrition, and lack of sanitation.

What were some public health strategies used to combat this?

• Improved hygiene and sanitation

• Milk stations : improved nutrition

• Health education

What is Title V? What case led to its origin?

• A federal program established in 1935 to improve maternal and child health services, providing funding and support for state health programs.

• Shephard Towner Act

  • First federal legislation to provide funds specifically for maternal and child health services to reduce infant mortality and improve health outcomes.

What is Title X

• A federal program established in 1970 to provide access to family planning services and reproductive health care, ensuring that individuals can make informed choices about their reproductive health.

• Family planning program

Five factors that led to high infant mortality rates in the early 20th century.

• Poor housing conditions, sanitation, and hygiene 

• Malnutrition 

  • Food fortification to prevent neural disorders

• Economic factors 

• Unsafe home birth 

  • lack of access to healthcare

• High rate of premature births 

One factor that contributed to better living standards and improved infant health outcomes (not a public health/government program)

Economic growth

• Late 19th century _____________ led to significant increases in child labor

Industrialization/urbanization

What is the Children’s Bureau and its mission? What are examples of issues they address?

• The Children's Bureau is a federal agency established in 1912

• MISSION: address the most pressing social issues related to children and mothers/improving their welfare

• It addresses issues such as child abuse, neglect, adoption, and child poverty

In infant mortality studies, what was one of the greatest links they found between which families experienced the greatest rates of low infant health?

• Link between father’s income and infant health

Factors associated with declines in maternal mortality

• Medical advancements

  • Antibiotics

  • Blood transfusions

• Public health measures

  • Pre and post-natal care

  • Public health campaigns 

• Social factors

  • Women's education

  • Economic growth

  • Women's suffrage and rights

What is the Sheppard Towner Act?

• The Sheppard Towner Act of 1912 was the first legislation providing funds for maternal and infant health programs

• Aimed to improve healthcare access through initiatives like health clinics, visiting nurses, and midwife training

Currier stated, “Evolution of ___________ is not completely resolved infant disease but did accelerate the declining rates of milk born infectious disease”

Milk pasteurization

Other factors that contributed to a reduction in infant disease

• Education

  • Basic hygiene

  • Milk station

  • Bureau of Child Hygiene (taught older siblings about hygiene)

Three factors that influence infant deaths

• Urbanization

• Shift to urban lifestyles

• Greater reliance on scientific evidence

What is pregnancy-related mortality?

• Deaths during pregnancy and up to one year postpartum that are related to pregnancy

  • Hemorrhage

  • Eclampsia

What is pregnancy-associated mortality?

• Deaths during and up to one year postpartum

  • Murder

  • Car Accident

Why is it important to track the rates of maternal mortality?

• Important to track to formulate interventions

  • Tailor issue to a certain community

  • Inform programs/policies

  • To make sure we are addressing the right concerns

What group of women are most likely to suffer from high maternal mortality rates?

• Women 30-34

• Black women are disproportionately at risk of maternal mortality

  • 3 black women die per one white woman giving birth (pregnancy-related)

  • 1.5 Black women die per one white woman (nonpregnancy related)

When do the majority of pregnancy related deaths occur?-

During or within 42 days

Four types of pregnancy-related care

1. Preconception care

   • Patient factors

     1. Age

     2. Education

     3. Poverty

     4. Health status

2. Antenatal care

3. Delivery and hospital care

   • Provider factors

     1. Knowledge

     2. Experience

     3. Implicit bias

     4. Cultural competence

4. Postpartum

An example of a community barrier and a systemic factor

Community: poverty

Systemic: access to quality care

Five sections of support for reducing maternal mortality

• Systems

• Clinical quality improvement

• Social support

• Policy

• Public health research and communication

Two initiatives set forth by Merk for Mothers

• addressing pregnancy-related complications

  • domestic violence

  • depression

  • cardiovascular disease

• helping clinicians better manage hypertension, hemorrhage, and other OB emergencies

Two interventions that Dr. Clark implemented to halve his hospital’s rate of MM

• triggered automatic and rapid antihypertensive therapy when patients exceeded specific blood pressure thresholds

• prompted an emergency chest x-ray to look for pulmonary edema when a woman reported shortness of breath

One material implementation that hospitals can introduce when it comes to maternal hemorrhage

• Obstetric hemorrhage bundle

  • requires hospitals to have emergency carts containing drugs and equipment needed to immediately respond to a mother who is hemorrhaging.

  • checklist on the cart describes how to recognize and manage hemorrhage

Most difficult factors to address

• Suicide, homicide, or drug overdoses

  • Most of those women hadn’t received mental health care, which can be very difficult for new mothers to access

• More than half the deliveries in the US are covered by Medicaid, which stops paying for pregnancy care six weeks postpartum

  • Problem: Mothers will bring their newborns for a well-baby visit, but many skip their postpartum 6-week visit where depression and other potentially life-threatening problems may be diagnosed

  • Solution: combining mother and baby visits at 2 weeks postpartum

• Community health workers and doulas, also need to be integrated into care systems to support at-risk women when their lives are at stake

• Eliminating the racial disparity gap in maternal deaths

Factors that have influenced the evolution of childbrith practices in the USir

• Cultural values about childbirth

  • Fear of childbirth

  • Trust in science and rationalism

  • Individualism

• Economic pressures to maximize the efficiency of hospitals and reduce spending

  • Hospitals birth in large maternity wards

  • Standardization of care

  • Technological advances

  • Insurance and Liability

• Social and Political Movements

  • Public health movement

  • Civil rights movement

  • Feminist movement

Two types of birth centers

• Hospital-based

• Free-standing

Some reasons as to why Black women have higher rates of C-sections

• Complex interplay of socioeconomic health care system and systemic factors such as

  • Healthcare system disparities

  • Socio-economic disparities

  • Pre-pregnancy disparities

  • Healthcare providers attitudes and bias

Three indications for C-section

• Umbilical cord prolapse

• Placenta previa

• Fetal misplacement

Give an example for risks associated with C-sections for the mother, baby, and future pregnancies

• Mother: infection

• Baby: altered immune development

• Future: higher rates of pre-term/still-born babies

What impact do doulas have on birth outcomes?

• More likely to attend childbirth preparation classes

• Initiate breastfeeding

• Less likely to use epidural/pain medication

• Less likely to experience postpartum mental health difficulties

What are the five indicators to measure breastfeeding?

• Ever breastfed

• Breastfeeding at 6 months

• Breastfeeding at 12 months

• Exclusive breastfeeding at 3 months

• Exclusive breastfeeding at 6 months

Two benefits of breastfeeding for children

• Immunity boost

• Decrease chances of SIDS

Two benefits of breastfeeding for mothers

• reduced risk of ovarian cancer

• reduced risk of type 2 diabetes

Socioecological model of barriers to breastfeeding

Why did people start to use formula instead of breastfeeding? What are some factors associated with exclusive formula feeding?

• Why

  • perception of inadequate milk supply

  • desire for sleep

  • plan to breast and bottle feed

• Factors

  • single martial status

  • birth mother in the US (more widely accepted)

  • c-sections

Baby Friendly Initiatives

1. Written breastfeeding policy

2. Train all medical staff on skills to implement policy

3. Inform all women of the benefits of breastfeeding

4. Help mother breastfeed within 30min of birth

5. Show mothers how to breastfeed

6. Do not give infants anything other than breast milk unless indicated

7. Practice rooming in

8. Encourage on-demand breastfeeding

9. No artificial treats

10. Foster establishment of breastfeeding support

Factors that may help mothers breastfeed longer

• Baby-friendly hospital initiatives

• Home visits

• Health care staff education

• Peer support with the WIC program

Unique barriers for Black women to meet breastfeeding intentions

• Black women are over-represented in the service sector where labor protections are weaker

• less access to lactation breaks

• less guidance on how to breastfeed

What is the Barrier Analysis Tool used by Tran?

• Rapid assessment tool that is used to identify determinants associated with a particular behavior

  • Strength: provided a framework for a range of questions based on behavior change theories

  • Limitation: data collected involved individuals who have most likely had some experience or knowledge of breastfeeding

Two key events that marked the history of child maltreatment recognition

• "The Battered Child Syndrome" Article

  • Starting in the 1970 every state required medical professionals to report children who showed possible signs of mistreatment

  • 1974 "Child Abuse Prevention & Treatment Act" was enacted to help individuals identify and report child abuse and to provide shelter and other protective services to victims

Types of child maltreatment

• Sexual abuse

• Physical abuse

• Emotional abuse

Examples of Austin’s risk and protective factors

What is the Protecting Our Students Act of 2023

• Prohibit corporal punishment in schools that receive federal funding

• Bill establishes enforcement provisions, including a private right of action for students subjected to corporal punishment

What groups of individuals are most at risk for experiencing abuse?

• children 0-3 yrs old

• children with disabilities

Spectrum of neglect

• Occasional inattention

• Chronic under-stimulation

• Severe neglect in the family context

• Severe neglect in institutional setting

Strategies to prevent child maltreatment (socioecological model)

• Evidence-based programs for preventing child maltreatment

• Nurse family partnership

  • First-time disadvantaged mothers received home visits from nurses

• Early/Head start

  • Family Services

  • Education services

  • Health services

  • Nutrition Services

  • Special needs services

• Triple P Positive Parenting Program

  • Multilevel system of family intervention

  • Aims to prevent severe emotional and behavioral disturbances in children

• Abusive head trauma education programs

• Enhanced pediatric care