Caitlin Whyte (Host): Welcome to UAMS Health Talk. I'm Caitlin White, your host. With me is Dr. Nirvana Manning, an OB-GYN from the University of Arkansas for Medical Sciences. Together, we'll discuss the Arkansas Center for Women and Infants' Health, and how we support the postpartum journey. Well, let's start with the basics today, doctor. What is the Arkansas Center for Women and Infants' Health Program and how did it get started?

Dr. Nirvana Manning: Well, we are so excited about this new center. So, the idea behind it really started a couple years ago when Senator Boozman approached us at UAMS and said, "Infant mortality is a problem in our state. Can you help us?" And I said, "Well, I am definitely not the expert on infant mortality, but I would argue that it starts with the mom and the family." And when mom and families aren't doing good, infants subsequently are not. And so, he said, "Well, give me a proposal on what you would do to change that." So, we were able to give him a proposal that subsequently ended in a federal earmark grant that developed the Arkansas Center for Women's and Infants' Health. And the idea behind this was really reaching out into all corners of our state and kind of standardizing what patients get.

Host: Beautiful. And talk to us about those three tiers within the program.

Dr. Nirvana Manning: So, the first one is really education. We wanted families in our state to get the same education no matter whom the provider was, where you were delivering, and what situation you were coming from, whether it was your first pregnancy or your tenth pregnancy. And so, we worked with a team of obstetricians as well as pediatricians, neonatologists to kind of standardize what do we think is important for moms and families to know when they leave the hospital? What are those early maternal warning signs that we think will be very impactful in those first weeks postpartum, as well as what is important to know about this infant that is brand new in your home, and what can you do to make it the safest environment for that child to thrive? And so, we standardize that. And the goal is to give it to each mom in our state immediately postpartum. With that, we also wanted to kind of create an extra something, and that is where the infant supply kits have come from.

Host: Yes. Please tell us more about the supply kits.

Dr. Nirvana Manning: The idea behind that is these first days and weeks are wrought with such excitement, such anxiety, such, you know, newness that if we can help give patients and families some of the essentials that they will need and prevent them from having to go buy and go, you know, figure out what to do, and they have that and can start to create what that home unit looks like, that will get them that much further ahead.

And so, in this supply kit are things like diapers and wipes as well as a sleep sack. There's things like vitamin D drops and a thermometer. There are hats and booties and wipes. And, you know, anything that we could think would wrap around this family in those first days and weeks, we wanted to give them kind of as a gift at that postpartum period and just kind of set them up for success going forward.

Host: Of course. And I'd love to also hear about these "I gave birth bracelets" that you give out. Can you tell us about those?

Dr. Nirvana Manning: Yeah. So, this is kind of that second tier. And the second tier is we know that women in the immediate postpartum are unique. And I like to tell a story that I'm a practicing obstetrician gynecologist. But if a routine gynecology patient were to come into my clinic, or if a patient presents in the emergency room with a blood pressure of 140/90 that is not pregnant or postpartum, that's really, I mean, fairly benign. If a patient presents postpartum with that same thing, that needs to be treated very differently and can have subsequent consequences if not treated differently.

And so, this "I gave birth" bracelet has been piloted in other areas of our country, and it's basically a visual reminder for not only the patients, but the families and EMS healthcare providers that this patient is uniquely postpartum. And with that comes a unique set of things that we need to watch out for very differently. One of the unique things with our bracelets is that on that bracelet is also a QR code. That QR code will lead to our website, which is myarkansasbirth.org. And with that is a plethora of information and resources. And everything from, you know, "I'm not breastfeeding well, what can I do?" to "My mood is not where I wanted it to be" to early maternal warning signs, "Is what I'm feeling normal and to be expected? Or is this something that I need to now go see a doctor for?" And the idea behind that is it's an easy one stop. So, patients as well as their families can scan that QR code and be able to get to that website seamlessly.

And so, hopefully, bridging some of those gaps such that if it's two o'clock in the morning and they have a burning question, they can go to this website and hopefully be able to navigate through the resources that they need in addition to having that visual reminder for them that, "Okay, these may be a little bit different in this early postpartum period, and I may need to take this a little bit more seriously."

Host: Absolutely. And on that note of additional resources, can you tell us more about the proactive postpartum call center?

Dr. Nirvana Manning: Yes. So, we really wanted to create a situation where the burden for asking for help was not left on the patient. You know, quite often we have call centers. We have them all over our state in various specialties, but patients have to call in. So, they have to first identify that something is wrong, and B, take the initiative to call.

And so, our idea with this is can we bridge that gap in a different way? Can we now proactively call them, and the aim is currently from seven to ten days postpartum. And we have a very predetermined list of questions. Everything from, you know, some healthcare questions to other social determinants of health to questions with regards to insurance coverage and whether they need help with the reapplication for Medicaid or other insurance providers. So, the idea is that we have now reached out to them. We are hopefully have created a trust, you know, in the early parts of the postpartum period. And now, we're kind of closing that loop. We have so many resources in our state that are going underutilized, or there's areas in our state that maybe don't have resources that we need to now advocate for. And the idea around this call center is kind of gathering this data, helping patients and families close that loop. But also, there's a whole piece of it of where do we not have the resources that we need and what do we need to advocate for? Whether it be at a legislative level, at a state or local level, or even on the federal level. What gaps do we need to bridge? And this will kind of give us that information along the way.

The data that we've gotten from this preliminary, and just so you know, we've piloted all of these programs now at UAMS, Because that's an environment I can control. Our next is five additional hospitals where we're going to reach out and the goal is by the end of this calendar year, to have all 33 delivering hospitals on all three tiers of this program. We had a summit recently, and it was a couple weeks ago, where we convened all 33 delivering hospitals or representatives from them at a round table. And it was the first kind of convening of these hospitals. We want to help support these hospitals in new and innovative ways. We want them to partner with us. But if they need certain elements differently, we want to kind of meet them in the middle and create what will work in their hospitals and in their areas.

Host: Thank you so much for the insightful conversation. That was OB-GYN, Dr. Nirvana Manning. For more information, go to myarkansasbirth.org. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is UAMS Health Talk. I'm Caitlin Whyte, and thank you for listening.