Maternal Health Programs
Title V Maternal Health Programs
Iowa’s Maternal Health Programs work to make sure more babies can celebrate their first birthday (prevent infant mortality) and improve birth outcomes. This is done through family centered, community based services. IDPH Title V maternal health clinics provide preventive health services to Medicaid eligible and other low income women. Iowa supports 24 maternal health clinics that are monitored by the Bureau of Family Health (BFH) staff.
All of Iowa’s 99 counties have access to publicly funded maternal health services. Medical services provided by maternal health centers follow the standards of the American College of OB/GYN for ambulatory obstetric care. The BFH maintains a Title V funded contract with the University of Iowa, College of Medicine, Department of Obstetrics and Gynecology for consultation.
Clinics offer the following services to Iowa residents:
Ensure early and adequate prenatal care
- Assess health insurance needs and assist with Medicaid presumptive eligibility
- Provide care coordination to link pregnant women to a medical home, follow up on appointments and send appointment reminders.
- Transportation assistance
- Education on the importance of prenatal care
- Promote flu vaccines and Tdap vaccines and COVID 19 vaccines.
Early identification of risk factors or symptoms that need referral to health care providers.
- Health screening for depression, tobacco/substance abuse
- Breastfeeding education and support
- Signs of preterm labor
- Teach women to "Count the Kicks" Monitor your baby's movement Count the Kicks website
- Signs of high blood pressure and preeclampsia
- Social assessment and guidance provided by social worker or RN
- Oral health screening by and RN or RDH with assistance finding a Dentist
- Postpartum assessment by and RN of Mom and baby done in the home, or clinic.
Promote healthy lifestyle choices
- Avoiding alcohol, tobacco substance abuse
- Choosing healthy foods and staying active during pregnancy
- Reducing stress
- Encouraging seat belt use
- Preventing shaken baby syndrome
- Ensuring a safe sleep environment for infants
- Waiting for labor and avoiding elective delivery prior to 39 weeks
- Enrolling in Text4baby and Count the Kicks.
- Promotinge healthy birth spacing and reducing unintended pregnancies
- Preventing domestic and sexual violence and coercion
Among women of reproductive age, approximately 1 out of 10 women suffer from depression within the past year. Screening has improved identification of women with depression; however fewer than half of depressed women receive any treatment. Numerous barriers such as fear, stigma, lack of understanding of the significance of depression, lack of providers, language barriers, financial barriers or logistical barriers prevent women with depressive symptoms from obtaining treatment. Postpartum depression causes unnecessary suffering for the mother, and unfortunately can also have negative effects on the infant. Early identification, prevention and treatment can alleviate suffering for a new mother and decrease the potentially harmful impact on the infant.
In an Iowa-based randomized controlled trial, researchers at the University of Iowa illustrated the effectiveness of Listening Visits when delivered by U.S. home visitors. Listening Visits were associated with a statistically and clinically significant reduction in depression, improvement in life satisfaction, and were acceptable to the postpartum women. Based on the evidence the Iowa Department of Public Health implemented Listening Visits in Iowa’s Title V Maternal Health Program in 2014.
This innovative approach has the potential to fill the gap in mental health treatment services for low income women who are at high risk for depression. It is a maternal depression intervention that can be provided by public health nurses, case managers or social workers with little or no prior counseling experience, increasing access to care. Listening Visits are especially critical in rural Iowa where there is limited access to Mental Health professionals.
To request Listening Visit brochures, call the Healthy Families Line.
Maternal Mortality Review Committee (MMRC)
Maternal mortality continues to be an important focus in Iowa, and every maternal death is a tragedy. In 2019, Iowa began conducting Maternal Mortality Reviews on an annual basis. Prior to 2019, reviews were conducted every three years. Iowa’s Maternal Mortality Review Committee (MMRC) is a multi-disciplinary committee responsible for reviewing identified maternal deaths for the purpose of reducing morbidity and mortality. The Committee meets to determine if the pregnancy-associated death was pregnancy related or not, the cause of death (both primary and underlying causes), and whether the death was preventable. The Committee also looks for contributing factors and identifies opportunities for prevention after each case review.
Iowa Maternal Quality Care Collaborative (IMQCC)
The Iowa Maternal Quality Care Collaborative (IMQCC) is a multi-disciplinary task force that serves as the principal oversight body responsible for improving communication and collaboration among groups addressing obstetrical care in Iowa. The IMQCC engages a broad, diverse group of stakeholders, and includes traditional providers of obstetrical care such as Obstetrician-Gynecologists, Maternal Fetal Medicine specialists, Family Physicians, Certified Nurse Midwives, and women’s health nurses as well as Anesthesiologists and Nurse Anesthetists, rural General Surgeons, providers of mental health care and substance use disorder treatments, and allied health professionals. The Collaborative also engages patient stakeholders in the form of labor and postpartum doulas and representatives of various advocacy groups in Iowa.
Iowa AIM Program
The Alliance for Innovation on Maternal Health (AIM) is a national data-driven quality-improvement initiative led by the American College of Obstetricians & Gynecologists (ACOG) in collaboration with other key stakeholders for maternal health and funded by HRSA. AIM works to reduce preventable maternal morbidity and mortality through partnerships with state and community based teams. AIM promotes high-quality obstetrical care through the implementation of evidence-based safety bundles that address key drivers of maternal mortality and severe morbidity in the US. Iowa joined the AIM program in 2020 and began an improvement collaborative for Safe Reduction of Primary Cesarean Births in spring of 2021.
Maternal Health Innovation Grant
Iowa was awarded $10,361,110 over five years from the Health Resource Services Administration (HRSA) to execute innovative strategies to address maternal health. IDPH has partnered with the University of Iowa to implement the following strategies:
- Develop an Iowa Maternal Quality Care Collaborative (IMQCC). The IMQCC will bring together experts and stakeholders in maternal health across the state to implement policies and protocols to ensure high quality maternal health care. As part of the work of the IMQCC, the state of Iowa will submit an application to join the Alliance for Innovation on Maternal Health (AIM). AIM is a national alliance to ensure safe maternal care and to reduce mortality and morbidity through implementation of evidence-based patient safety bundles. More information can be found at https://safehealthcareforeverywoman.org
- Improve state-level maternal health data and surveillance. IDPH/University of Iowa will identify strategies to collect state-level maternal health data, and will work to improve data collection for severe maternal morbidity and mortality data by validating existing data sources and improving data collection processes.
- Implement initiatives to address workforce shortages for obstetrical care, including adding a rural track OB fellowship, a family medicine OB track, and assessing the capacity and need for a Certified Nurse Midwife program in Iowa.
- Expand existing telemedicine initiatives to increase access to Maternal Fetal Medicine Specialists and mental health professionals.
- Address health disparities in maternal health outcomes and access to care.
Iowa's Title V Doula Project
Supporting the health and well-being of all mothers, children, and families is the goal of Title V Maternal and Child Health (MCH) Service Block Grant. Access to high-quality and equitable health services is one way to support MCH’s goal. IDPH recognizes disparities in maternal health outcomes among African American and Black-identifying individuals in Iowa and we also seek to reduce these inequalities by expanding and modifying Iowa’s MCH Service Delivery System (the Delivery System). An identified enhancement to the Delivery System includes developing a community-based service for pregnant people that provides effective interactions between the expectant mother and their OBGYN within this demographic.
To answer the need identified for the Delivery System, Iowa’s Title V Doula Project (Doula Project) was created. A doula is a trained, non-medical professional that will provide continuous emotional and physical support to the mother before, during, and after childbirth. The doula will live in the same area as the pregnant person and will facilitate the best possible birth experience for the mother and child. The CDC Preventive Health and Health Services Block Grant and Mid-Iowa Health Foundation are providing funding support for the Doula Project model run--launching in the fall of 2021--in Black Hawk, Dubuque, Polk, and Scott counties.
For more information, check out this resource!
Links of interest