Amanda Wilde (Host): This is the Obstetrics Podcast from OB Hospitalist Group. Today, we're joined by two leaders working to improve maternal health outcomes across Mississippi. Dr. Norman Connell is a Market Medical Director with OBHG. He focuses on expanding access to high-quality obstetric care, particularly in underserved communities. We're also joined by Dr. Daniel Edney, State Health Officer and the Executive Director of the Mississippi State Department of Health. Dr. Edney brings a statewide public health perspective on improving outcomes for mothers and babies. Dr. Edney, Dr. Connell, thank you so much for being here and lending your expertise to this important conversation.

Norman Connell, MD: Thank you. Glad to be here.

Daniel Edney, MD, FACP, FASAM: Thank you.

Host: Dr. Edney, I'll start with you. How are maternal health deserts currently showing up across Mississippi, and what impact are you seeing on mothers and babies?

Daniel Edney, MD, FACP, FASAM: Yeah. And that's extremely important question. As a small rural state, you can imagine that we have significant deserts. But I try to reframe what a desert is. And so in Mississippi, we define a desert from a public health perspective as an area of the state that is more than forty minutes away from obstetrical care.

Of course, we have multiple counties. I think we have 52 counties with either no obstetrician or birthing hospital, but that doesn't mean it's a desert. It may be a county that's, you know, 30 minutes away from care. And, you know, we have counties with very low populations where it would make no sense to have an obstetrician or a birthing hospital.

But still, those difficult-to-access counties cover a significant amount of the land mass of our state. We actually have heat maps showing it. And when I'm talking to elected officials and stakeholders, I show just the width of these difficult-to-access areas and then, you know, look at strategies of how to close those in. We're not going to close those in by putting obstetricians, you know, in Issaquena County that has a thousand people in it. But we can close that access gap by perinatal care, let's say, to Issaquena County in a more meaningful fashion than we do today through telehealth support and mobile clinics and outreach. So, we're looking at how to cool off those deserts in ways that make sense with the workforce and the resources that we have.

Host: Dr. Connell, OB Hospitalist Group has been working to expand access to care through programs like Maternal Health Access Solutions. Can you share how that model is helping address gaps in care, particularly in underserved communities?

Norman Connell, MD: There are a lot of places in Mississippi that doesn't make sense to have an obstetrician. But there are pockets within these deserts, where we do have basic maternity care and a limited number of providers. We're seeing some attrition of those providers at some of these hospitals. And it's difficult to recruit new providers to reinforce the troops as we say. And maternal health access solutions is a solution that OBHG has provided for some of these communities where we provide the clinical support for maternity care through board-certified OB-GYNs to come and work in these hospitals.

The model that we set up is that our clinicians will usually have a core team of three that split up the 24/7 coverage, clinic call, delivery, gynecologic care. They, you know, work a schedule that's usually five days on, 10 days off. We've had success with that model bringing clinicians to a community that has struggled to recruit physicians in the traditional sense.

there's a popular phrase in medicine, you know, burnout. not popular in a good way. But, you know, we have a physician workforce in a lot of our rural communities that's aging, and then a lot of those physicians are overworked. To help keep that provider practicing, extending their practice career in a meaningful way to both them and their patients, you know, that's another way that Maternal Health Access Solutions can help bridge the gap and help put out some of those fires, if you will, as Dr. Edney mentioned.

Daniel Edney, MD, FACP, FASAM: And the gap is really what's important, what makes sense to close those gaps, you know, is not putting, you know, providers out there full time, but connecting our pregnant moms, who a large number are high risk in our rural counties, with the expertise of physicians like in Dr. Connell's group, and doing as much as we can through telehealth or remote clinics in between the ability to get them physically in front of their obstetrician.

So, one thing we're doing at the health department, all of these low population counties that are classified as deserts, they don't have clinics, they don't have FQHCs even, but what they do have is the health department. And we had pulled out of perinatal care and public health about fifteen years ago because of Medicaid doing a better job closing that access gap, OBs being able to handle it better in the private sector, our FQHC partners. But what we see now, we just have gaps that are baked in with our current system.

So, what we're looking at doing is plugging that gap by getting our arms around that high-risk pregnant mom, connecting them with an OB, making sure we do everything that OB wants us to do, and have her packaged nicely for her first OB visit, which may be early second trimester, but we've done a lot in that first trimester.

We've made sure, you know, she needs to be on aspirin, she gets on aspirin, you know, get her on her prenatal vitamins, obviously, do her full risk assessment. Whatever the OB wants us to do. But it helps with the capacity issues that we're dealing with in workforce. So, those are some of the ways we're looking at closing the gap.

Norman Connell, MD: We don't want to step on the toes of whatever entities are also pursuing those ventures.

We just want to be helpful in filling the gaps and, and working with our stakeholders, you know, who work directly with us at OBHG. I'm very happy to be in a state where it doesn't matter which team we're on, we all know each other. And, you know, that ought to make things easy to coordinate so that we fill these gaps efficiently. And you know, I always think Dr. Edney's heard me say this, I'm not, I'm not here to be a PR person for OBHG even though I'm on this podcast. I'm just very grateful to work for a company that wants to step up to the plate and help solve some of these problems. It helps to have more than one entity trying to address these things. So, very happy to be a part of that with OBHG

Daniel Edney, MD, FACP, FASAM: our birthing hospitals are excellent. Our labor delivery units are excellent. Our nurseries and NICUs are excellent. But it's the gaps that are causing the problems. So, you know, it's not because we have bad hospitals, bad doctors, bad nurses, but we have a bad system that we're all working really hard to improve the system so that our high-risk moms and babies are receiving the right level of care where they need to in the hands of the great healthcare professionals like Dr. Connell and his colleagues. So, the system is what, you know, is sick and that we're treating.

Host: And like you said, bridging the gap, supplementing efforts in places that are underserved, you have to be flexible and see what is needed. So, your thoughtful ways of looking at this will bring effective solutions, I think, to bridging this access gap. Where do you see the greatest opportunity for stronger collaboration between public health leaders and healthcare organizations to improve access and outcomes across Mississippi, Dr. Edney?

Daniel Edney, MD, FACP, FASAM: I can only be so proud of the collaboration that we have had and the cross partnerships between public health and the private sector. And that really grew out of a pandemic response that, I mean, we were forced to work together, public health and private sector medicine, get out of our silos and band together to fight the pandemic together. There's no way either one of us could have done it alone. And I've been determined post-pandemic to continue on that success, which is why the health department is excited to partner with our private sector partners, both among our obstetricians and our birthing hospitals, and that partnership is very effective.

as state health officer, I'm really, really pleased that everybody is trying to pull together to improve these outcomes. And we have made some significant success. You know, I don't really talk about maternal mortality like we did five years ago. It's maternal morbidity, because we don't have the number of women dying directly related to the pregnancy that we did ten, 15 years ago. But infant mortality has not budged a bit because we still have a large number of very unhealthy pregnancies that are generating a preterm birth of, you know, a low birth weight baby, many of whom don't survive.

so, looking at maternal morbidity, and it's where all of us are really leaning in, giving our moms access to early and high-quality prenatal care so we can identify, you know, that she's diabetic and hypertensive and obese and be working on those things as early in pregnancy as we can, identifying communicable diseases like syphilis or hepatitis, you know, early in pregnancy and dealing with that to protect the baby and the mom.

The partnerships have been, you know, so effective to allow us to fight our way upstream. And there's no way we can do it by ourselves at the health department. There's no way OBHG can do it by themselves. There's no way, anybody can do it by themselves. But all of us together, we absolutely can and will do it.

Norman Connell, MD: Together, we can get it done. And, you know, I kind of take it personally. I get tired of seeing us be last in maternity care, so many quality metrics. I will put a plug in. We're not last in a lot of things anymore, and that's because of the collective work of all of our providers in the state of Mississippi.

Daniel Edney, MD, FACP, FASAM: the landscape is totally different today than it was five years ago even, much less twenty years ago. It really is. I'm optimistic and encouraged. And, you know, when I see the innovation that's going on in the private sector, like, you know, groups like OBHG taking totally different approaches, that just shows me we have the ability to conquer this problem.

And part of my job for four years has been raising awareness of just how severe it is, because I had the exact same issues that Norm described. Being a physician in Mississippi, you know, I take it personally, you know, that we score so poorly in our health metrics. But as a father and grandfather, it's like, "Okay, I've had enough of this." We have talked about this long enough. We've studied it long enough. You know, we all have to pull together to do something about it, which is what everybody is doing. and I've also just had to fight against everybody being jaded that, well, we've always been this way. So, it's just our lot in life. We do have the highest rate of poverty in the country. We know that. But I'm 64 years old, and we were last in education my entire life, and we are not anymore.

The last ten years, we have been steadily moving up to now we're top ten in the country in education. And so, I have been preaching, if we did it in education, we can do it in health, and that means we can do it in maternal infant health specifically. And our goal is not just to get off the bottom, our goal is to get off the radar, to where the conversation about maternal infant health, everybody doesn't just immediately pivot to Mississippi. And that people stop saying, "Thank God for Mississippi," because otherwise we'd be last. You know, everybody knows public health world what we're doing here. We're taking it seriously. We're attacking it hard, making strategic investments, looking at innovation every way that we can, so that our moms and babies not only survive, but actually thrive.

Norman Connell, MD: I want to get off the radar. And to further qualify that, I want to be number one. I know that's a monstrous goal. And Dr. Edney understands, you know, the details of getting there means more than I do. I'm just competitive by nature. I just want to be number one.

Daniel Edney, MD, FACP, FASAM: And it's not that hard because, right now, we lose about 350 babies a year before their first birthday. And I would say 65% of those are preventable deaths. Now, we save 150 babies a year that we're currently not saving because of our current system. And we're below the US infant mortality rate. Below it, 150 babies. And we're determined to get there. So, you know, our goal is not to get up to a respectable 35th. Our goal is to get below the US average maternal infant mortality. And you cannot disconnect the two because, you know, half of our infant deaths are directly related to an unhealthy pregnancy.

And obviously, the maternal deaths are directly related to unhealthy pregnancies. So, t's the, two are tightly connected, and we have to study both, and we have to impact both.

Host: And as you say, tackle it from all these angles that you've mentioned, take the long view, and continue with the positive forward momentum you have with some of the programs you've already begun. Dr. Connell, Dr. Edney, thank you for showing how clinicians, hospitals, and public health leaders are working together to improve access and outcomes for mothers and babies across the state of Mississippi.

Daniel Edney, MD, FACP, FASAM: Oh, my pleasure.

Norman Connell, MD: Yeah. My pleasure as well. Very happy to do it.

Host: To learn more, visit www.obhg.com. Thank you for listening to the Obstetrics Podcast from the OB Hospitalist Group.