Adopt-A-Mom Program
Adopt-A-Mom Program
Section I: Summary
The Guilford County Coalition on Infant Mortality sponsors the Adopt-A-Mom Program, which coordinates prenatal care for low to medium-risk pregnant women who are Medicaid ineligible, and lack private health insurance to obtain prenatal care. Funds to support this program come from grants and donations exceeding $200,000 annually over the last three years. Over 80 volunteers work with the Coalition as a collaborative effort with currently five local participating obstetricians providing prenatal care at a flat fee of $400 per patient (paid for by the Coalition on Infant Mortality); the local Health Department employs 4 staff members to administer the program, providing office space, benefits, and salary; Wake Forest University School of Medicine, Spectrum Laboratory Network, and Labcorp provide lab analyses at a discount or at no cost to program participants. Duke Perinatal Consultants offer an array of procedures at a discount. Interpreters, doulas, and volunteers serve as mentors, and churches and civic organizations donate money and/or essential baby items.
Section II: Statement of purpose
In 1991, Guilford County had an infant mortality rate of 10.6 and ranked 50th out of 100 counties in infant deaths in North Carolina. In that same year, 56 babies died before their first birthday in Guilford County. Low birth weight is the single greatest cause of infant mortality, and a woman is three times more likely to have a low birth weight baby if she goes without prenatal care. In 1989, there were 148 no prenatal care deliveries in Guilford County.
Access to prenatal care in Guilford County was either through the private obstetrical community, or the Health Department who accepted medical eligible patients and those below 100% of poverty. An underserved population was those who were ineligible for Health Department Services, and did not have the financial resources for private care. Checklist for Community Needs Assessment
This program is designed to meet the needs of pregnant women who typically fall through the cracks, and who otherwise would not have medical care available to them. These women who are ineligible for Health Department Services and who do not have the resources to access private care. With the addition of the Adopt-A-Mom Program, prenatal care became accessible and available to every woman in Guilford County. Financial income was no longer a barrier for accessing care. Since the program started in 1991, no prenatal care deliveries in Guilford County have experienced a steady downward trend. As noted earlier, in 1989 Guilford County had 148 no prenatal care deliveries; in 1991 there were 124, and that number dropped to 59 in 2003. Preventing low birthweight through programs like this, that can be replicated anywhere, not only saves babies lives, but can save millions of dollars in health care costs. The national bill for preemies' hospitalizations is $13.6 billion a year. The average hospital stay costs $75,000, compared with $1300 for an uncomplicated birth. Aside from the cost to care for a child in the Neonatal Intensive Care Unit, ranging from $30,000 to several hundred thousand dollars, the cost to treat a child with severe disabilities (due primarily to prematurity) is higher for every year of their life. For every $1 spent prenatally, $3 is saved in medical costs alone in the first year of a child’s life. The value of this preventative investment is immeasurable when it comes to decreasing not only the financial burden brought on by infant mortality, but the heartache to families who suffer this demise.
The Adopt-A-Mom program is sponsored by the Guilford County Coalition on Infant Mortality. The Coalition was established by the Health Department to assist the community to recognize and help solve the problem of infant mortality. Checklist for Organizing The Health Department employs the Coalition Coordinator, the Adopt-A-Mom Program Coordinator and the Coalition Case Manager to oversee this community collaborative effort, which is comprised of volunteers representing many segments of the population. The Guilford County Coalition on Infant Mortality is a non-profit organization with its' own governing Board of Directors.
Private obstetricians have agreed to provide prenatal care for the Adopt-A-Mom women for a fee of $400.00, a significant reduction from the typical cost of $2,700.00. Any woman who has been denied Medicaid by an eligibility specialist and who can also show that they do not have private insurance to cover the cost of prenatal care will be considered for the program. Priority is given to women in their first or second trimester of pregnancy since one of the goals of the program is to get women into care early in their pregnancy.
Wake Forest University School of Medicine in Winston-Salem, North Carolina have agreed to perform medically necessary amniocentesis testing at no charge, and Duke Perinatal Consultants in Greensboro, North Carolina agreed to perform medically necessary services at a discount to women in the Adopt-A-Mom Program, and area labs reduce or waive routine lab tests for program participants.
Studies indicate that if a woman has a social support system throughout her pregnancy, the likelihood of a healthy outcome is much greater. An added feature of the program is the employment of five CHA's (Community Health Advocates) through a grant to reduce racial disparities in Infant Mortality. These workers are in the community educating citizens on the necessity of prenatal care, identifying pregnant women and getting them into care. Additionally, patients are referred to the program from the Health Department, Department of Social Services, private MD’s and by word of mouth. A majority of the patients served through this program are non-English speaking.
Section III: Outcomes
The Coalition on Infant Mortality has a volunteer statistician that compiles and disseminates a report that contains the following information most current information. As of October 2007, the Coalition's Adopt-A-Mom program has served 3,253 women in Guilford County and has involved seventeen OB-GYN practices (12 in Greensboro and 5 in High Point). At this point, 2,204 women (68%) have completed the program, 133 women (4%) were transferred to the High Risk Clinic, 214 women (7%) moved or transferred to private care, 61 women (2%) have become Medicaid eligible, and 295 women (9%) are current patients. In all, 8 women (<0.3%) were released from the program: one was released due to ineligibility; two were released after discovering they were not pregnant; and one patient delivered before her first appointment. A few women (108, 3%) have miscarried, and four have terminated (less than .3%).
The average age of the women being served is 25.7 with the youngest being 13 and the oldest 48. Most of the women are in their twenties (63%), with 23% in their thirties or forties, with only 14 % being adolescents. Half of the women in the program are married (51%); few are separated, divorced or widowed (2%), and the rest are single (47%). The racial/ethnic backgrounds are varied with the largest group being Hispanic (73%), followed by fewer numbers of Black (15%) and White (4%) women, and even smaller groups of Asian, Arabic, and South American Indian women (8% combined). Only 28% speak English; the rest of the women speak Spanish (65%) or another language (7%). The proportion of Hispanic clients has been increasing over the 15 years of the program, from 25% during the first three years to 76% for the year.
Over the 16 years of the program, over half of the women (53%) have chosen to participate in the mentoring phase of the program. During 2003 and 2004, there was an increase in the percentage of women opting for a mentor with 76% and 70%, respectively, choosing to participate in mentoring; So far this year, the percentage is down (55%) and closer to the overall rate for 2005, but increased to 71% in 2006. Community volunteers provide mentoring services, such as transportation for doctor visits, friendship, baby showers, language interpretation, etc. Church groups and civic organizations also support this mentoring component.
Full pregnancy and delivery information is available for the women who have completed the program. Partial information is available on women currently in the program, women transferred to the High Risk Clinic, and women who have moved.
For half of the women (44%), this pregnancy is their first child. The rest of the women have from one to nine other children. One of the women has two other children but this is the first pregnancy for which she has received any prenatal care. About equal numbers of the women entered prenatal came during their first (40%) or second (50%) trimester, with 10% entering during their third trimester. The range for the beginning of prenatal care was from 4 to 40 weeks gestation, with the average being 16.5 weeks.
The women who completed the program made from 1 to 26 prenatal visits, averaging 10 visits per patient. [NOTE: The number of prenatal visits completed is affected by the time of entry into prenatal care]. If we define adequate prenatal care as beginning before the third trimester, and consisting of at least 10 prenatal visits, 60% of the Adopt-A-Mom women received adequate care. There is one remarkable statistic: almost 60% of these women have NOT missed a single prenatal appointment! Over 74% never missed an appointment or only one appointment.
While 135 women experienced pregnancy complications which resulted in referral to the High Risk Clinic, 25% of the women remaining in the program experienced less severe complications. Among problems experienced by patients were pregnancy-induced hypertension, gestational diabetes, twins, premature rupture of membranes, HELLP syndrome, intrauterine growth retardation, bleeding, incompetent cervix, nausea/vomiting, shortness of breath, polyhydramnios, edema, eclampsia and preterm labor.
Now for good news! Among the women who have completed the program (and for whom we have complete birth information), there are 1,028 healthy girls and 1,170 healthy boys, including six sets of twins. Birth weights (excluding the twins) ranged from 300 to 5425 grams (.7 to almost 12 pounds). Only 77 babies (3.5%) weighed below 2500 grams (5.5 pounds), with six being the twins (it is much more common for twins to be born premature). Only 7 infants (<1%) weighed less than 1500 grams.
Almost 90% of the infants were full-term (born between 38-42 weeks gestation). Nine percent were born between 34 and 37 weeks, with 14 infants (<1%) being born prior to 34 weeks. Two infants were post-mature (born at 43 weeks). Infant problems included prematurity (the twins), small for gestational age, and chorioamnionitis.
The overwhelming majority of the deliveries were vaginal (83%), with few C-sections (17%). Over 85% were uncomplicated. The few complications included meconium staining, amnioinitis, prolapsed cord, maternal fever, fetal tachycardia, failure to progress, cephalopelvie disproportion, non-reassuring fetal heart rate, shoulder or other breech presentation, arrested descent/labor, prolonged second stage, and the cord around baby's neek/shoulders.
There is almost as good news among the women who were transferred to the High Risk Clinic. One woman lost her twins and another woman had a stillbirth at 29 weeks. Among the other women, there were 42 boys and 31 girls delivered, including two sets of twins. Twenty-two infants (32%) were born prior to 38 weeks but only ten (14%) weighed less than 2500 grams.
We have compared data for the Adopt-A-Mom clients with the most recently available national and state data. The Adopt-A-Mom data includes women who completed the program and women who were referred to the High Risk clinic (to make our sample more comparable to the state and national samples which include all women). The AAM program does not compare favorably with the nation or state on the initiation of prenatal care. Nationally and statewide in 2004, 84% of women entered prenatal care in their first trimester; only 38% of the AAM patients did so. AAM had three to four times as many women entering prenatal care late: the US rate for late or no prenatal care was 3.6%; for North Carolina, it was 2.9%; and for AAM clients, the rate was 13.3%.
The no prenatal care deliveries in Guilford County dropped from 110 in 1989 (5,289 births) to 65 in 2006 (6,119 births). Also, note that the increase in the number of births offsets the number of no prenatal care deliveries. Thus, resulting in 99% of births in Guilford County had the benefit of prenatal care. The outcomes of the Adopt-A-Moms as noted in the preceding paragraphs reflect improved birth weights in comparison with the no prenatal care patients. (See chart below.)
To stay abreast of the Adopt-A-Mom Program’s progress an updated interim report will be posted every 3 months on the Guilford County Coalition on Infant Mortality’s website: http://www.co.guilford.nc.us/publichealth/divisions/?page_id=11
Funding is critical for continued support of the Adopt-A-Mom Program. 340 women came through the program 7/01/04 – 6/30/05 at a cost of $136,000.00. That was a 30% increase from the year prior, and 450 are expected to enroll in the program 7/01/04 – 6/30/05. $180,000.00 will be needed to pay the physicians for next year Adopt-A-Mom sponsorships. The $400 per patient fee that the Coalition pays to the participating physicians has remained constant since the program started, despite the ever escalating costs of medical care. The $70,000.00 from the Monroe E. Trout Premier Cares Award would sponsor 175 patients at $400.00 each. This program can easily be replicated and implemented. (See attached for charts and graphs.)
Barriers to Prenatal Care
2003 N. C. Pregnancy Risk Assessment Monitoring System
(PRAMS)
- The objective of prenatal care is to monitor and improve the health of the pregnant mother and her baby.
- Getting early and regular prenatal care is crucial because it allows the health care provider the chance to find problems early so they can be treated as soon as possible. According to the Centers for Disease Control and Prevention, nearly one-third of American women who give birth every year will have some kind of pregnancy-related complication. Those who do not get adequate prenatal care run the risk that such complications will go undetected or will not be identified soon enough. This can lead to potentially serious consequences for both the mother and her baby.
- During prenatal visits, the health care provider teaches the woman about pregnancy, monitors any medical conditions she may have, tests for health problems with the mother and baby, and refers the woman to needed services such as a support group, childbirth class, or the WIC program.
- The percentage of women who reported that their first prenatal care visit occurred during the first trimester has remained relatively stable from a low of 74.8 percent in .1997 to a high of 80.8 percent in 2001.
- This is still below the Healthy People 2010 target of 90 percent of women beginning prenatal care during the first trimester.
Percentage of women reporting a barrier to prenatal care, by race/ethnicity: N.C., PRAMS, 2003 |
- Overall, 18.4 percent of mothers reported a barrier to obtaining prenatal care, - African American mothers (28.4%) were significantly more likely to report a barrier than white mothers (15.3%). Hispanic mothers were also more likely to report barriers to obtaining prenatal care (20.5%), compared to whites. |
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White |
African American |
Other |
Hispanic |
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Birth Characteristics:
Live Births, No Prenatal Care Deliveries, Infant Deaths,
County Infant Mortality Rate and Five Year Rates,
NC Infant Mortality Rate
Guilford County, NC
1988-2003
Year |
# Live Births |
# No PNC Deliveries |
# Infant Deaths |
Cty IM Rate |
Cty 5 Year Rates |
NC IM Rate |
1988 |
4914 |
84 |
66 |
13.4 |
||
1989 |
5289 |
110 |
68 |
12.9 |
||
1990 |
5195 |
93 |
54 |
10.4 |
||
1991 |
5276 |
80 |
56 |
10.6 |
||
1992 |
5194 |
81 |
56 |
10.8 |
88-92 11.6 |
9.9 |
1993 |
5110 |
68 |
47 |
9.2 |
89-93 10.8 |
10.6 |
1994 |
5053 |
58 |
47 |
9.3 |
90-94 10.1 |
10.1 |
1995 |
5171 |
48 |
53 |
10.2 |
91-95 10.02 |
9.2 |
1996 |
5229 |
52 |
60 |
11.3 |
92-96 10.2 |
9.2 |
1997 |
5310 |
47 |
53 |
10 |
93-97 10.4 |
9.2 |
1998 |
5607 |
51 |
47 |
8.4 |
94-98 9.84 |
9.3 |
1999 |
5724 |
43 |
54 |
9.4 |
95-99 9.86 |
9.1 |
2000 |
6095 |
54 |
44 |
7.2 |
96-00 9.26 |
8.6 |
2001 |
5918 |
51 |
55 |
9.3 |
97-01 8.82 |
8.5 |
2002 |
5831 |
55 |
55 |
9.4 |
98-02 8.74 |
8.2 |
2003 |
5885 |
59 |
46 |
7.8 |
99-03 8.6 |
8.2 |
2004 |
5,861 |
83 |
60 |
10.2 |
00-04 8.8 |
8.8 |
2005 |
6,000 |
81 |
57 |
9.5 |
01-05 9.3 |
8.8 |
2006 |
6,119 |
65 |
65 |
10.6 |
02-06 9.5 |
8.1 |
Contact information
For more information, contact:
Quinstar Coleman
Guilford County Coalition on Infant Mortality
North Carolina
Phone: 336-641-6775
cpurdum@co.guilford.nc.us