Perinatal Quality improvement initiatives saint Anthony hospital Mothers and newborns affected by opioids (MNO) Improving postpartum access to care (IPAC) VTE Prevention Best practices cesarean section Perinatal Quality improvement initiatives saint Anthony hospital

Improving postpartum access to care (IPAC)

Improving care in the fourth trimester Physical Postpartum Recovery Incisional/Perineal pain Postpartum bleeding pattern Pelvic floor function with referral if desired Return to exercise, Healthy Weight maintenance Mood Assessment Validated screen for Postpartum Depression Substance Abuse Assess for resumption of pre-pregnancy substances including tobacco and marijuana Follow up on treatment plans for Opioid Use Disorder if applicable Infant feeding and care strategy Improving care in the fourth trimester

Improving care in the fourth trimester Breastfeeding support if needed, plans for returning to work or school Family Planning Counseling with LARC placement if desired Sleep Dysfunction/Fatigue Enroll support of family members if needed Prevention of recurrent pregnancy complications Discussion of possible 17α-hydroxyprogesterone caproate if previous preterm delivery or aspirin treatment with hypertensive disorders if applicable Cervical cancer screening or Immunizations as needed Routine health maintenance and chronic disease management Improving care in the fourth trimester

Healthy timing and spacing of pregnancy (HTSP) Women and families who make informed decisions about delaying, spacing, or limiting their pregnancies achieve the healthiest outcomes for the whole family. Research shows that HTSP helps save the lives of mothers and babies. Healthy mothers build healthy families. Pregnancy and childbirth-related complications are the leading cause of death in girls aged 15-19 worldwide. These girls are twice as likely to die compared to women aged 20-24. Girls younger than 15 years are five times more likely to die. Recommendation is to wait 18-24 months between pregnancies and to delay pregnancy until after 18 years of age Healthy timing and spacing of pregnancy (HTSP)

Consequences of Unplanned Pregnancies & Short Interpregnancy Intervals Poor pregnancy outcomes Delayed initiation of prenatal care Lower breastfeeding rates Intended Unintended Consequences of Short Inter-pregnancy Interval Higher risk of poor maternal and infant outcomes: preterm birth, low birthweight, preeclampsia 50% of IL births covered by Medicaid

Fertility awareness (Natural family planning) One option for pregnancy spacing A collection of methods using your body’s natural functioning to determine the days of the month you are most likely to get pregnant It combines the calendar/rhythm method, the basal body temperature method, and the cervical mucous method to prevent or promote pregnancy Perfect use with regular menstrual cycles can lead to effectiveness rates around 90%

Fertility awareness (Natural family planning) Advantages: No drugs or devices No cost No health risks or side effects Disadvantages: May not be as effective with lactation or irregular menstrual cycles Usual failure rates up to 25% High level of commitment needed, ability to abstain during fertile days Fertility awareness (Natural family planning)

Long-Acting Reversible Contraception (LARC) Important to give patients education regarding all of their options Beneficial for the treatment of multiple medical conditions Endometriosis Chronic pelvic pain Menorrhagia Dysmenorrhea Premenstrual Dysphoric Disorder

Support for LARC from ACOG, AAP, AAFP, AWHONN, CDC, CMS, ASTHO Why LARC? LARC is safe and cost effective LARC can be removed any time with restored fertility Women choose LARC and report high satisfaction with LARC Reduces adverse maternal and infant outcomes associated with unplanned pregnancy Support for LARC from ACOG, AAP, AAFP, AWHONN, CDC, CMS, ASTHO

Juno4me.org A non-profit organization Provides patients in Chicago with access to free LARC regardless of insurance status Provides free Lyft rides to appointments for insertion and removal Compassionate and effective access to care for all patients Website available in English and Spanish

Kai Tao For the last 15+ years she has been in practice as a certified nurse midwife while also working administrative jobs to improve the lives of families in Illinois. From payment reform in Medicaid to running ambulatory care centers across Illinois, Kai receives a lot of satisfaction knowing she can make macro level changes to impact the population she is most passionate about: moms, infants, children and adolescent. 

Admission to labor and delivery All patients should have counselling regarding their family planning preference postpartum documented in their prenatal records

Postpartum discharge All patients should be given the following prior to discharge: Appointment with provider within 1-2 weeks Education regarding healthy pregnancy spacing (HTSP) Education regarding Natural Family Planning (NFP) Education regarding LARC if desired Warning Signs Lactation Resources

Thank you!!!! If anyone has questions please email or call me at MBUCCIERO@sAHCHICAGO.ORG OR 847-707-1517