Susan Rodriguez, the chairwoman of Healthy Me Healthy Babies and a program manager for the Center for Rural Community Health at the UT Health Sciences Center at Tyler speaks at the April coalition meeting. The Healthy Me Healthy Babies Coalition is a collaborative of organizations, community members and agencies working together to help every baby make it to their first birthday. (Sarah A. Miller/Tyler Morning Telegraph)

When Dr. Paul McGaha read the 2015 Healthy Texas Babies Databook reporting Smith County as having one of the highest infant mortality rates in the state — and high numbers of women not receiving first trimester maternal health care — he asked himself, “How do we teach our moms to take care of themselves so they can teach their children to take care of themselves and change the trajectory of families for generations to come?”

McGaha is an associate professor and chairman of the Department of Community Health at the School of Community and Rural Health at The University of Texas Health Science Center at Tyler.

He knows that social determinants of health, the conditions of daily life such as where someone lives, what kind of job they have, their education, their economic status, social norms and political policies play a role in maternal and infant health problems in East Texas.

“Is your ZIP code a better predictor of your health than your genetic code?” he asks, “Yes, in most circumstances, it is. We’re trying to mine down deeper into how we can improve those social determinants of health. Education is probably the biggest factor related to one’s health status. The higher the level of education, the healthier that person is.”

McGaha sees a future of separate health care systems — nonprofit organizations and individuals working together to achieve a common goal of improving birth outcomes and women’s health in East Texas.

“We knew we needed to do something about those high infant mortality rates here,” McGaha said. “I think state decision-makers knew we needed to do something too, especially among African American mothers who have a higher infant mortality rate. It’s twice as high as the general population rate in most areas, not just Tyler.”

Out of these talks it was decided to bring two national programs to Tyler under The University of Texas Health Science Center at Tyler — Parents as Teachers, a home visiting program that teaches moms and dads parenting skills and Nurse-Family Partnership, an income-based program for first-time expectant moms who are matched with a registered nurse for support through the child’s second birthday. The center also partners with Tyler’s three colleges for a peer preconception program.

In addition, leaders at The University of Texas Health Science Center at Tyler were approached by colleagues in Austin through Health and Family Services to start a program specific to those high infant mortality rates especially among African Americans, called the Healthy Families Program. Smith County and Hildalgo County were invested in to develop programs specifically to look at systems of care and how they can be improved to allow women to feel more welcomed into those systems of care. The programs encourage pregnant women to seek prenatal care earlier and to make the system more friendly and inviting to women. Out of these discussions came the idea to bring the national Centering Pregnancy program to Tyler.

McGaha is seeing first-hand what a partnership like this across health care systems looks like with the Centering Pregnancy program that started in December. It’s a partnership between UT Health East Texas and Tyler Family Circle of Care that is funded by the Health and Human Services Commission in Austin. Centering Pregnancy is a different approach to prenatal care that focuses on group learning in a group setting.

“I think moving forward for community issues, you’re going to see more thinking outside of the box type stuff,” he said.

Centering Pregnancy

When Bianca Billops, 25, of Tyler, went to deliver her fifth child — a daughter named Peyton — Billops felt empowered, educated and confident about her birth plan because she was enrolled in Centering Pregnancy at Tyler Family Circle of Care.

Billops, who has anemia, was prepared for the possibility that she would need a blood transfusion because she had been tracking her health and knew she had low iron. She was able to communicate with her doctor and have paperwork filled out in case she needed it, and she did. She received two blood transfusions after delivery.

“I learned that my health during the pregnancy is important for my baby,” she said.

Peyton is now 3 weeks old and Billops has completed the Centering Pregnancy program.

“You get a lot more information out of the Centering Pregnancy group sessions than you do at an office visit,” Billops said.

Each cohort of women attend 10 two-hour sessions together. They have two facilitators, one doctor or nurse-practitioner and a medical assistant that works with them. At Centering Pregnancy, mothers are screened for depression and anxiety at every appointment. There’s a counselor and a social worker on staff who can get moms plugged into counseling or to other resources such as the Andrew’s Center or a psychiatrist.

At the start of each session the women sign in, check their own blood pressure, record their own weight and see the doctor for a belly check and urine test if needed.

They place beads in cups to vote whether they are feeling good or bad about topics like relationships, stress, transportation, exercise or sleep.

The topics and activities for each session are written out on the wall.

While the doctors facilitate the sessions, the group members lead the conversations. Each cohort of women can relate to each other because they are grouped by similar gestational age.

“We are able to rely on other people within the discussion so it empowers the women and it amplifies their voices,” said Dr. Josephine Huffman, OB-GYN at Tyler Family Circle of Care. “I am loving it because I get to know people so much more than with a traditional prenatal appointment.”

Family Circle of Care is a federally qualified health center. They take all patients, including those on Medicaid and patients who have no insurance.

“Our goal is for there to not be barriers to care,” Huffman said.

Nurse-Family Partnership

Nurse Amy Bozeman and new mother Markya Batee, 20, exchange infants at Batee’s Tyler apartment. Batee is handed a large baby doll with a clear skull with a model brain that jiggles inside when baby is bounced, thrown or swung. Bozeman gently holds Batee’s daughter, 3-week-old Zhaiva Phillips.

As a client of Nurse-Family Partnership, Batee is learning about shaken baby syndrome at today’s home visit.

Nurse-Family Partnership, a service of The University of Texas Health Science Center at Tyler, is a national program that is designed to educate expectant women and families. Through this program, women who are first-time mothers are paired with a nurse who makes home visits.

When the nurses visit expectant moms, they make assessments on the mom’s health, teach her to check her own blood pressure, and educate her on the danger signs of pregnancy.

“We try to help moms to learn how to read their body,” Young said. “Because of the issues of preeclampsia and hypertension, each mom that we work with we give them a blood pressure cuff and teach them how to use it and track their blood pressure and take those readings into their doctors. We educate them on what’s normal and what’s not normal.”

The program also hosts special events throughout the year to bring their clients together. For Mother’s Day, they held a lunch event with speakers and vendors providing information on services such as pregnancy support groups and child nutrition.

Through a grant they were also able to host an infant CPR and choking class for their clients.

WIC Addresses Barriers to Access

At WIC in Smith County, the focus has been on evolving into the most mother-friendly program as possible by changing how services are delivered.

To lessen barriers to transportation and appointments, WIC has added a mobile van unit dubbed “WIC on the go” that travels to apartment complexes, housing developments and to clients’ homes.

The one-on-one home visit service is used to enroll women, infants and children to WIC services. The van allows nutrition education and breastfeeding education to be offered on site. They can also discuss insurance options and refer clients to programs such as the Children’s Defense Fund, which assists in helping moms and children have access to insurance coverage. WIC is a member of the Healthy Me Healthy Babies Coalition, a group of organizations that work together to promote positive maternal and infant health.

Between two offices in Tyler and a Lindale office, WIC sees over 7,200 women, infants and children.

A problem that WIC personnel discovered was that moms were not aware they could make a doctor’s appointment for prenatal care and have it reimbursed after applying for Medicaid. Moms were applying for Medicaid then waiting weeks or months before going to see a doctor unaware that Medicaid would cover three months of previous check-ups and prenatal appointments.

WIC refers clients to the Children’s Defense Fund, an outreach operation funded through a grant from the Episcopal Health Foundation in Smith, Cherokee, Rusk and San Augustine counties to connect pregnant moms to CHIP Perinatal coverage along with assisting families in applying for children’s health insurance Medicaid/CHIP. The organization works to identify children who do not have health insurance.

While WIC benefits such as food stamps are based on income, WIC has several educational programs that are open to everyone, although WIC is reassessing how it offers services to reduce the stigma of receiving benefits such as food assistance.

“Knowledge is powerful,” Smith said. “I hate for them not to come because of the stigma.”

One misconception is that WIC benefits are only for single moms, but grandparents and foster parents can also qualify for WIC benefits.

Families are screened for food insecurities and provided with information about local food pantries. Even if someone doesn’t qualify for benefits, they can still attend nutrition classes.

“We’re looking for all women to come and be a part in our nutrition programs,” said Tecora Smith, WIC program director. “Having healthy foods and knowing how to prepare those foods is important.”

WIC offers breastfeeding support, a class for dads to learn baby care techniques and a prenatal class for moms to create a birth plan.

Breastfeeding is encouraged, and WIC issues each mom a breast pump to keep.

“We’re trying to make sure mom has these systems in place where we have mother-friendly sites,” Smith said. “Mom returns to work wanting to breastfeed so we are working with businesses to help them write breastfeeding policies.”

Other changes include adding nontraditional hours, such as later appointments after 5 p.m. and getting feedback from clients about their services.

“Our families really don’t know about the services,” Smith said. “Smith County has so much to offer families, so why is our infant mortality rate so high and why are our moms dying? I know it’s a question we have to figure out. We are, but it’s taking time.”

More Information

Healthy Me Healthy Babies Coalition. Meets once a month on the third Monday from 11:30-1pm at the Tyler Area Chamber of Commerce Genecov Room.

https://www.facebook.com/HealthyMeHealthyBabiesCoalition/

WIC Locations:

First United Methodist Church, 409 E. Hubbard, Lindale (903-882-0483);

WIC Broadway, 815 N. Broadway Ave., Tyler (903) 592-7635;

WIC Tyler East Amherst, 225 E. Amherst Dr., Suite 800, Tyler (903) 533-1319.

WIC will offer its first Prenatal Birthing Classes for WIC families on Tuesday, September 10 from 6-8 p.m. at the Broadway WIC Clinic located at 815 N. Broadway, Tyler, Texas 75702. The prenatal class will be taught by Tammy Jiminez, RD, IBCLC and trained midwife. The class will have topics that help moms and dads prepare for the birthing experience, infant feeding options, skin to skin method after birth and the importance of nutrition during pregnancy.

Children’s Defense Fund: contact the Tyler WIC offices for more information

Nurse-Family Partnership

Centering Pregnancy at Tyler Family Circle of Care

Telephone: 903-535-9041

http://tfcc.tmfhs.info/

Parents as Teachers 

https://parentsasteachers.org/

Twitter: @TMT_Sarah

This is Part 5 of the six-part series “Empowering Women – Improving Birth Outcomes” which focuses on personal stories of maternal health and infant mortality in East Texas as well as resources to improve maternal health and birth outcomes.

Part 1: A Tyler woman’s account of losing a child due to preeclampsia

Part 2: A Bullard couple’s account of a misdiagnosed miscarriage

Part 3: How the Glory Babies grief support group is helping parents who have lost infants or babies in utero

Part 4: How doulas are helping women be intentional about their birth experiences

Part 5: How health care providers are implementing new programs to improve maternal outcomes

Part 6: How men are learning to be more involved in parenting starting from conception

Additional articles:

• March of Dimes March for Babies raises awareness of local organizations that help expectant mothers
• Counselor addresses the grief parents face after losing a child
• Texas report shows lack of prenatal care and health insurance as barriers to healthy mothers, babies
• Christus Mother Frances Hospitals focus on maternal and infant health with expanded NICU, TexasAIM and breastfeeding policies
• Expectant Heart Pregnancy Resource Center offers free doula care to clients and also offers doula training classes