Healthy Start Coalition Annual Meeting

On Thursday, September 23, the Healthy Start Coalition of Sarasota County held their annual meeting. In attendance were many of our community's midwives, obstetricians, hospital staff, health department officials, leaders of health care organizations, families, educators, legislators and more.

Healthy Start Board of Directors co-chair Shara Abrams began the meeting by reminding guests of the uncertainty of the past year, with the Florida legislature coming dangerously close to eliminating all Healthy Start Coalitions. She also announced new Fetal and Infant Mortality Review (FIMR) Coordinator Beth Rubin. Jennifer Highland, Healthy Start Executive Director, then took the podium and gave an overview of Healthy Start (now in its twelfth year) and its services. She too spoke about the near-elimination in the legislature, as well as the downward shift in incoming young families to our community. Jennifer talked about some of the improvements made over the last year, despite the reduction in budget, including the addition of a Spanish speaking Certified Lactation Consultant to the care coordination team.

Jennifer went on to describe the Service Delivery Plan (SDP) 2010-2015, issued by Healthy Start this summer. I had the privilege of joining the Planning and Evaluation Committee of Healthy Start just in time to watch this incredibly thorough document's creation. The SDP identifies key risk factors and trends affecting pregnant woman and infants, and uses those to set forth an activity plan for the next five years. The statistics and research compiled to create these initiatives came from a variety of measures and sources, all referenced and double-checked, resulting in a comprehensive and thoughtful outline of steps. The SDP identified the following as the most affective negative trends in Sarasota County:

• smoking;
• substance abuse;
• obesity;
• maternal infections;
• unplanned pregnancies;
• high cesarean section delivery rate leading to unnecessary pre-term births;
• sub-optimal breastfeeding rates;
• and significant maternal and infant health disparities among African-Americans.

The SDP's plan of action outlines nine initiatives to execute during the next five years:

1. Implement "Right from the Start" and "text4baby" campaigns, both of which target pre/interconception, pregnancy, and infant health.
2. Promote uniform counseling messages and the "5 A's Approah" for women at risk of continuing tobacco use during pregnancy or between pregnancies.
3. Improve screening for drug abuse among pregnant women, and advocate for routine drug screening and treatment.
4. Provide education to the community and enhance Healthy Start services to reduce the hazards of obesity during pregnancy.
5. Improve public awareness of the risks of maternal infections during pregnancy and the importance of prevention and adherence to treatment protocols.
6. Offer updated family planning education to Healthy Start, MomCare and Healthy Families clients.
7. Improve public awareness of the dangers of elective C-sections prior to 39 weeks of gestation.
8. Improve breastfeeding rates among Healthy Start and Healthy Families clients by working along the continuum from pregnancy through the postpartum phase.
9. Increase and sustain education and support for preconception, interconception and pregnancy health for high risk African-American pregnant women.

After introducing two women who have been positively impacted by Healthy Start--one through taking advantage of its services, and one by recognizing high need and taking the path toward the field of obstetrics--Jennifer passed the microphone to Sarasota Mayor Kelly Kirschner, one of two keynote speakers for the morning.

Mayor Kirschner framed his message by sharing his personal journey with maternal and infant health--his oldest child, Bodhi, was born at 27 weeks gestation and spent three and a half months in intensive care. Kirschner's wife, Tracy, is a Certified Nurse Midwife who suffered a grand mal seizure as a result of sudden eclampsia during her pregnancy. After Bodhi's birth by emergency c-section, the couple watched by his side as Bodhi literally struggled for survival, using machines to help him breathe. Mayor Kirschner's message was clear: this was a necessary c-section, and the bill for Bodhi's care exceeds half a million dollars. His treatment, albeit appropriate and one for which the Kirschners are grateful, comes with repercussions today. The cesareans and resultant NICU admissions that are NOT necessary must be eliminated if we are to improve outcomes and healthcare costs.

Kirschner cited the recent Health News Florida article that connected high c-section rates and populations with high Hispanic percentages. Kirschner challenged some of these correlations, saying Florida has been home to Puerto Ricans, Brazilians, Chileans and others for decades, and that their presence here can't explain the sharp c-section increase. He focused instead on a hospital in Guadalajara, Mexico, that requires a second opinion, a documentation of reason, and monitoring and follow-up with the obstetrician when a c-section is suggested. Kirschner also reminded the Healthy Start members that while convenience, lack of VBAC access, fear of litigation, obesity and more are often called out as reasons for the high c-section rates, the highest increase is currently in women 25 and under--indicating that a lack of informed consent is perhaps the true culprit.

Mayor Kirschner summarized his message, inspired by Dr. Albert Bandura, by saying that a belief in self-efficacy is the foundation for change. We--mothers, fathers, families, policy makers, maternity care providers, hospitals, legislators, insurors--have to understand that to improve the practice of childbirth today, through a return to normalcy and appropriate care, is to reduce a high-cost impact tomorrow, both fiscally and physically.

Florida Representative Keith Fitzgerald was the second keynote speaker of the morning, and he continued Mayor Kirschner's sentiments with a plea to those present to get involved in their state government. He very honestly described the near-elimination of Healthy Start from a legislative perspective, which was enlightening to say the least: he said that the Coalitions were never intended to be eliminated, but rather cut in funding; however, proposing elimination allowed the Coalitions to rally, and allowed the State to then "save" the slice of the pie (albeit a smaller piece), making all parties look heroic. As these sorts of games continue to be played, it is more important year after year that consumers and advocates make their voices heard. Representative Fitzgerald adjourned with a strong message: It's up to YOU.

Jennifer Highland returned to the podium to present annual awards from Healthy Start for Volunteer of the Year (Liz Murphy), Business Partner of the Year (Sarasota Architectural Salvage), Community Partner of the Year (United Way 211), Family of the Year, the Mission Award (Shelley Rence), and the Lawton Chiles Award (Barbara White, Cyesis founder).

Jennifer then thanked outgoing Board of Directors members for their service, including six-year co-chair Jenna Norwood, who passed the "silver rattle" to incoming chair Shara Abrams. I am very honored to have been nominated and elected to the 2010-2011 Board of Directors for Healthy Start, along with many people whom I have respected in this community for years, and several new faces as well. Joining the board as honorary members are Representative Fitzgerald, Representative Ron Reagan, Ed Chiles, and outgoing director of Maternal Fetal Medicine at Sarasota Memorial Hospital, Dr. Washington Hill.

The mission of Healthy Start is to improve the health and well-being of pregnant women, infants and young children. I am privileged to join this group in this capacity, for I truly believe there is no organization in our community better poised to improve birth outcomes.