1. 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

2. Improving postpartum access to care (IPAC)

3. 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

4. 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

5. 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 worldwide. These girls are twice as likely to die compared to women aged Girls younger than 15 years are five times more likely to die.
Recommendation is to wait months between pregnancies and to delay pregnancy until after 18 years of age
Healthy timing and spacing of pregnancy (HTSP)

6. 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

7. 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%

8. 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)

9. 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

10. 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

12. 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

13. 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. 

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

15. 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

16. Thank you!!!!
If anyone has questions please or call me at OR