Douglas County’s Collaborative Pre-Natal Clinic Reduces Number of Low Birthrate Babies

Success is attributed to the clinic's ability to provide wrap around health and social services to its clients

February 3, 2012— Despite taking care of pregnant women who have some of the highest risk factors for giving birth to low-weight babies, the women seen at Douglas County’s Prenatal Clinic beat the odds – and had the lowest rate of giving birth to low-weight babies compared to the rest of Douglas County and the state.

Evaluating the results for the first time, Douglas County’s Health and Human Services Department found that 2.7 percent of women served by the clinic in 2009-2010 gave birth to babies with low birth weights. Overall, the rate in Douglas County during that year was 6.5 percent, compared to the state’s rate of 6 percent, and a national rate of 8 percent.

“The first year of the program has shown that there were good results,” said Peggy Madison, director of Douglas County’s Health and Human Services Department.

Babies born under 5 pounds, 8 ounces are considered to have a low birth-rate, and women of color are disproportionately likely to give birth to such babies, according to the Urban League of Portland, which found that African American infants are twice as likely as Caucasian infants to be born with low birth weight.

Also, in 2010, The March of Dimes gave Oregon a grade of “C” for having an immature birth rate of 10.1 per thousand, compared with a national average of 7.6 per thousand.

Babies born with a low birth weight face a variety of physical and mental health problems, including cerebral palsy, mental retardation, learning disabilities as they grow older, impaired vision and hearing and lung problems.

“They’re health issues that can stay with the child for the rest of their life,” Madison said. “They may catch up [to their peers] at some point in their life, but sometimes they don’t catch up.”

Nationally, preterm births cost society over $19 billion per year, although they only account for 8 percent of all infant admissions to a clinic or hospital. According to a study commissioned by the National Conference of State Legislatures in 2011, Medicaid programs paid for 40 percent of preterm births.

There are a variety of risk factors and behaviors associated with women giving birth to low-weight babies, and they include smoking, alcohol and drug abuse, and stress, anxiety, depression and other mental illnesses. Additionally, what are known as the “social determinants of health”—a person’s income, socio-economic status, access to transportation, and family health history—also impact a woman’s pregnancy.

The Prenatal Clinic, which provides services to women on the Oregon Health Plan along with women with low incomes, is run by Douglas County’s Public Health Department, and its services are provided by the county, the Douglas County Individual Practice Association (DCIPA), Mercy Medical Center, and obstetricians with Harvard Medical Park’s Integrated Women’s Health Care program.

Originally, the clinic was solely operated by the county and run with county general dollars. But three years ago the county cut funding, and DCIPA and the other organizations stepped up, contributing the financial resources and services to keep the Prenatal Clinic running.  

The clinic tracked 85 patients between July 2009 and June 2010. The majority of those women reported they had engaged in many of the risk factors associated with giving birth to low-weight babies. For instance, 37 women said they smoked, and 25 percent said they used marijuana, methamphetamines or abused prescription drugs while pregnant. Two thirds of the pregnancies were unplanned, and close to 70 percent of the women were not married.   

Additionally, the majority of women said they felt stressed about having enough money to pay their bills, had problems with family members or experienced one or more deaths in their family; were in abusive relationships or had work-related problems.

“The population served at the clinic is considered to be at very high risk for [low birth weight] deliveries,” the study found.

Madison attributed the program’s success to the collaboration and coordination with the various healthcare providers operating the clinic.

The clinic provides individualized case management, an in-depth assessment allowing providers to learn about a woman’s health history and factor in their how their life impacts their pregnancy. Each women is given a treatment plan, identifying the physical and mental healthcare they need, as well as substance abuse treatment and access to social services.

“The plan is based on service needs and instead of referring clients out to a variety of support services, those services come together to meet the client’s needs under a coordinated treatment plan,” according to the study.

“The extra case management and support goes beyond what they normally receive in a normal doctor’s practice,” Madison said.

The state is exploring ways to lower the rate of low-weight births and other negative birth outcomes among low-income and underserved women. Last year, the Legislature passed House Bill 3311, which directed the Oregon Health Authority to investigate how doulas—who provide emotional support and training to pregnant and post-partum women—and other community health workers could be integrated into the Oregon Health Plan and provide care and services to these women. The Oregon Health Authority is expected to report to the Legislature sometime this month about the bill’s implementation.

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