Interconception Education and

Counseling:Strategies from Florida

Presented by: Betsy Wood, BSN, MPH

Infant, Maternal & Reproductive Health Unit

Florida Department of Health

Florida 2005 Current Affairs

• 1st Trimester entry into prenatal care decreased from 85.8% in 2003 to 81.0% in 2004.

• Healthy Start Prenatal Risk Screening to identify high risk women increased from 59.73% in 2004 to 66.53% in 2005.

• Infant Mortality Rate increased from 7.0 in 2000 to 7.5 in 2003, then decreased to 7.0 per 1000 live births in 2004.

Florida’s Pregnancy Associated Mortality Review

(PAMR)

“A review of cases where death of a woman has occurred, from any cause, while she is pregnant or within one year of termination of pregnancy, regardless of duration and site of the pregnancy.”

CDC and ACOG definition of maternal mortality

PAMR 1999-2002

• 67.1% of women with pregnancy related deaths had a history of chronic disease or condition.

• Many had multiple chronic illnesses.

• Most common:– Obesity 11.8%

– Hypertension 11.2%

PAMR 1999-2002

Showed higher mortality rates for:– Black women, – Women >35 years old, – Overweight and obese women.

• Women who are obese have odds of pregnancy related mortality that are

2 to 5 times higher than the odds for women of normal weight.

2.47

1

1.99

2.99

4.715.12

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

Adjusted Odds Ratios for Pregnancy Related Death by Body Mass Index Category

Florida 1999 - 2002

Perinatal Periods of Risk Data

• Categorizes feto-infant mortality according to gestation at death and birth weight at delivery:

– Maternal Health & Prematurity– Maternal Care– Newborn Care– Infant Health

   

Maternal Health3.47

  

Maternal Care1.26

Newborn Care0.59

Infant Health

1.72

Infant Health

1845

   

Maternal Health4118

  

Maternal Care2478

Newborn Care1357

= 9798 Fetal-Infant Deaths

FloridaPPOR MAP1998-2002 Birth

Cohort

1,008,318 Fetal

Deaths and Live

Births

Fetal Infant Mortality Review

• 12 local FIMR projects covering 30 Florida counties.

• Statewide FIMR Trends– Need for pregnancy planning– Poor Nutrition– Need for early prenatal care– Need for health awareness related to

STD’s

Recommendation #8: Infuse and integrate components of preconception health into existing local public health

and related programs.

Florida’s Healthy Start Standards and Guidelines

Chapter 21: Healthy Start Services Interconceptional Education and Counseling

A collaborative initiative between Florida’s Department of Health and Local Healthy Start Coalitions

Healthy StartInterconceptional

Counseling and Education Topics

• Access to Care• Baby Spacing• Nutrition• Physical

Activity• Maternal

Infections

• Substance Abuse• Smoking• Mental Health Concerns• Environmental Risk Factors• Chronic Health Problems

http://www.doh.state.fl.us/family/mch/training/icc/icc.html

Key Implementation Components:

• Culturally Sensitive• Considerate of client’s

educational and literacy needs.• Inclusive of father, family,

and/or significant other.• Tailored to the clients needs

Interconception Education Target Audience

• Women with previous poor birth outcome

• Women with behavioral or environmental issues contributing to poor birth outcomes that have not been resolved during pregnancy regardless of birth outcome

Implementation

Coding

Services can be provided to a Healthy Start mother or on behalf of a Healthy Start Infant, and are coded in 15 minute increments.

Providers

Providers are trained and qualified professionals and paraprofessionals.

Opportunities for Interconception Education

• Family Planning• WIC• Federal Primary Care Clinics• Prenatal Care • STD and HIV Clinics and Care

Coordinators• Children’s Medical Services Clinics and

Care Coordinators• Pediatric Care• Child Care Facilities

Preconception Education Target Audience

• Women of childbearing age

• Families of women of childbearing age

• General public

Vitagrant Program

• Multivitamin settlement - $2 million• Partnership between March of

Dimes and Department of Health• MOD staff housed at DOH• Vitamin with folic acid distribution

expanded to include preconception education

Integration of Preconception Education and Counseling Services

• Technical Assistance Guidelines were developed for use by all 67 County Health Departments (CHD)

• Education can be provided in any CHD setting where women are accessing care

• Mostly used in family planning clinics

Other Opportunities for Preconception Education

• Primary Care Clinics

• School Health Programs

• STD and HIV Clinics

• Care Coordinator interactions

• Health Fairs

Next StepsChildren’s Medical Services:• provided preconceptional brochures,

resource lists, and information sheet to Early Steps for distribution at their statewide meeting

• will be providing a 1.5 hour inservice on interconceptional topics to CMS providers (therapists, MD's, mental health providers, case managers, etc) at their Bi-annual meeting in June, 2006.

• invited to join the March Healthy Start Interconceptional Education and Counseling webinar

Next StepsSchool Health • provided preconceptional brochures and link

to online training. • scheduled to provide a 30 in-service on the

School Health Meet Me Call on March 2, 2006

Doulas • will be providing a training for the local

Doula Program. • training both Birth and Postpartum doulas • focusing on ensuring providers are able to

reinforce education about interconceptional issues when interacting with their clients

Next StepsWIC and Breastfeeding support paraprofessionals • will be providing training with these groups. • provided a link to our online training • invited to join the March Healthy Start

Interconceptional Education and Counseling webinar

Community Colleges –• contacting community college and university health

centers to distribute preconceptional brochures• starting a "Sticker Campaign" that would involve

placing a sticker reminding women to take folic acid on all birth control pill packs dispensed from their pharmacies. (This is still in the planning stage.)

Questions?