NICHQ Family Stories
Coordinated Systems Are Key to Addressing Rising Preterm Birth Rates
Captured by NICHQ’s Exploring State-Level Strategies to Improve Maternal Health and Birth Outcomes Initiative
Preterm birth is a leading cause of infant mortality and morbidity in the U.S. And troublingly, recent data show that U.S. preterm birth rates have risen for the fourth consecutive year. Improvement starts by identifying what programs and policies do successfully support mothers, understanding what makes them successful, and then using those lessons to prompt systems change in states across the country.
Sovannah, a mother of three in Kansas, is an advocate for systems-level change. During her third pregnancy, she connected with a network of supports that she says completely changed her family’s experience. Here, she shares a story that sheds light on the powerful potential of coordinated systems — for reducing preterm births and for strengthening families.
Sovannah did everything she could to have a healthy third pregnancy. She went walking regularly, maintained a healthy diet, and attended recommended prenatal classes. Then, in her second trimester, things suddenly changed: she experienced maternal hypertension (high blood pressure), a potentially dangerous complication of pregnancy that can lead to heart disease and organ damage in mothers and preterm birth and low birthweight for babies. Hypertensive disorders are one of the leading causes of maternal mortality in the world. Sovannah was also diagnosed with cholestasis, a serious liver condition that occurs in late pregnancy and causes bile build up, which can cause stillbirth.
Sovannah and her husband were now facing a high-risk pregnancy, and they were doing it without a network of family supports. They had moved from Missouri to Pittsburg, Kan., less than two years before. In those two years, Sovannah had lost her mother and her uncle. Sovannah’s sister was still an important support but she lived back in Missouri. “We had just gone through this rough patch where we lost so many supports,” she recalled. “In Pittsburg, me and my husband have each other—that’s it, when it comes to family.”
Recognizing that she needed more support, Sovannah turned to her local Kansas Perinatal Community Collaboratives (KPCC) Becoming a Mom group for prenatal education, a program from the March of Dimes Foundation. KPCC hosts a comprehensive program that provides group prenatal classes to women eligible for Medicaid while fostering a sense of community and connectivity among the families it serves. Importantly, Becoming a Mom is housed in the same location as the local WIC clinic (Women Infants and Children Nutrition Program) and the city’s Baby and Me Tobacco Free Program, an evidence-based smoking cessation program, creating an accessible one-stop shop for prenatal and postpartum care.
During Sovannah’s pregnancy and after delivery, these public programs became her family’s support network. “We didn’t have a real support system [at first] … but then we had this community. When I went to my classes, they would talk with me afterwards, asking, ‘Is there anything else we can get for you? Is there anything else you need?’ Our support system became whichever programs we invited in.”
When Sovannah needed a ride to an appointment, someone from her Baby and Me Tobacco Free Program would pick her up. If she couldn’t access essential baby furniture and products, someone from her Becoming a Mom class worked with her to make sure she got the items she needed. Sovannah and her husband were ready to do whatever their family required, but they didn’t have to go through it alone. Instead, they felt enfolded in a community that cared deeply about their family’s well-being.
At 37-weeks into her pregnancy, Sovannah’s son, Kyssaic, was born—a bit early term, but healthy. “He was perfect,” Sovannah said. “He was a little small, but everything was there. All 10 toes and 10 fingers, and two beautiful blue eyes. Just everything.”
How a Coordinated System Creates a Web of Community-based Supports
Sovannah and her husband were now parents of three young children. Both worked full-time jobs, and Sovannah was breastfeeding—a full-time job in itself. Again, because of Kansas’s public health programs, Sovannah’s family had the community support they needed. When her second child, Kimmary, became lactose intolerant, Sovannah worked closely with her WIC counselor to find a solution that worked for them after she stopped breastfeeding. Her family also connected with programs in their community they previously weren’t aware of, including childcare and early childhood programs.
“Once we were part of one program, we’d get joined into another one, and then another one. And now there’s this giant web of support that we didn’t realize we had in the beginning. And it keeps getting bigger and bigger,” Sovannah said. “I didn’t have this when I was growing up. For me to be able to give my kids something that I didn’t have, that makes it all the better.”
Why a Personal Approach is a Powerful Approach
Sovannah’s story illustrates the incredible power of a coordinated system that connects moms and families to needed health and social services. But it’s not only the network of support that gives the system power, it’s how the network’s personalized, compassionate approach builds community.
Sovannah described how she could visit her WIC counselor any time to discuss her concerns. She could bring her children with her to all her appointments and classes, and all the staff knew their names. When Sovannah would see a counselor from one of her programs in the grocery store, they’d stop and chat. She regularly received text messages from the WIC and clinic staff, just checking in on her and her family.
“They’d ask me like a friend would—not all clinical and strictly in the office,” she said. “And every time I got a text, I wanted to cry because I felt like someone actually cared.”
This personalized approach inspired genuine connection and trust—the ingredients needed to create community. And when Sovannah experienced postpartum depression, it was that trust in her community which kept her from staying isolated in her pain.
“My health clinic and the WIC clinic were fully aware of [my depression] … I wasn’t just keeping it all inside, but felt like I could freely and comfortably tell them I was having a hard time coping,” Sovannah said.
“And when you’re having such a hard time with postpartum depression, just that little bit of ‘How are you?’ can mean the world.”
Shift Approaches to Center Care on Mothers
When Sovannah looks back on her three pregnancies, she said that what made her son’s birth so special was that it centered on her. In the past, Sovannah felt like she didn’t have a say in her experience. But because of strong relationships with her health and social service providers in Kansas, Sovannah’s voice was always heard.
“Focus more on mothers. Focus on us. These are our bodies. This is what we have to go through. It’s our birthing experience.”
Navigating Well-Child Visits and Vaccinations during COVID-19
Well-child visits and recommended vaccinations are essential, ensuring children stay healthy and are protected from preventable diseases and illnesses such as measles, whooping cough, and seasonal flu. But, as the COVID-19 pandemic persists, data shows that fewer childhood vaccinations have been given and many children have fallen behind on their scheduled appointments. Healthcare professionals should utilize the following strategies to work with parents and caregivers to get their children caught up on missed appointments and recommended vaccinations.
Exploring a Nonbinary Approach to Health
NICHQ is not abandoning the traditional use of the terms “mother” and “maternal.” We are embracing the inclusive language of “birthing person/people” across our work. A move toward inclusive language does not force us to stop using language that so many people identify with; at its core, inclusion is about creating more space for one another. We are taking care to expand the use of these terms in our communications, on our website, in our resources, and eventually, in all our projects.
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Olivia Giordano, MPH, Project Manager shares how her work with NICHQ’s Supporting Healthy Start Performance Project (SHSPP) is supporting 101 Healthy Start community sites to harness lessons learned, implement innovative approaches to improvement, and ultimately start to close the disparity gap in maternal and child health.