Grants to focus on improving maternal, child outcomes in Nebraska

The Nebraska Perinatal Quality Improvement Collaborative has been awarded a five-year, $1.375 million grant from the Centers for Disease Control and Prevention to improve maternal and neonatal outcomes. The group was founded in 2015 to improve the quality of care for mothers and babies in Nebraska.

Separately, Elizabeth Mollard, an assistant professor in the University of Nebraska Medical Center College of Nursing’s Lincoln division, received a $304,641 grant from the National Institutes of Health that will fund an 18-month study exploring ways to improve maternal wellness and reduce health disparities among Black women.

Morbidity and mortality rates among new mothers in the United States are increasing, said Dr. Ann Anderson Berry, the collaborative’s neonatal medical director and executive director of the Child Health Research Institute, a collaboration between UNMC and Children’s Hospital & Medical Center. In addition, Nebraska’s neonatal mortality is higher than the national average — and rising.

A number of recent government studies indicate that many of the poor outcomes in the perinatal period, broadly defined as one year before to 18 to 24 months after the birth of a child, are worse among Black and Native American women.

Anderson Berry said disparities in outcomes are not driven by race but by social determinants of health, such as access to care, quality of care and communication with the health care team.

Studies in other states indicate that doula services are associated with improved outcomes for moms and babies, she said. The CDC grant will support the integration of culturally matched doula support for women with high-risk pregnancies. Doulas are trained professionals who support pregnant people through pregnancy and after delivery.

“That’s really the focus, is to get high-risk pregnancies doula support so we see better pregnancy outcomes,” said Anderson Berry, the principal investigator for the grant. The collaborative previously launched a statewide initiative to roll out a series of protocols intended to help health care providers quickly recognize and address conditions that can put mothers at risk of death or injury.

Currently, she said, the group is working with I Be Black Girl, a Omaha-based support organization for Black mothers and women, and the Omaha Black Doula Association.

But the collaborative plans a rollout that will include Native American, rural and other minority groups. The group is in preliminary talks with officials at Twelve Clans Unity Hospital in Winnebago, Nebraska, which is operated by the Winnebago Tribe.

Over the last seven years, Anderson Berry said, health officials have seen a steady decline in neonatal outcomes — namely, premature birth and low birth weight — among Indigenous people, according to data from the March of Dimes.

That’s worrisome, she said, because those outcomes once were on par with those of White people. In rural areas, women may live a long way from health facilities.

“We want the program to serve statewide high-risk pregnancies,” Anderson Berry said. “We see urban and rural access to care discrepancies that impact outcomes. This won’t solve those issues, but can provide another layer of support.”

She stressed that the culturally matched support is essential to the work. “This will be community-engaged work throughout the process.”

The money, Anderson Berry said, won’t directly fund doula services but instead will be used to create infrastructure to train doulas and to teach hospital officials and health care providers the importance of accepting them.

In addition to the CDC grant, United HealthCare of Nebraska has made a one-year grant of $100,000 to supplement the work on culturally matched doula support. Doulas are not covered by Medicaid or Medicare, and only some private insurance covers the services.

I Be Black Girl also recently launched the Ndu Doula Access Fund, which provides Black pregnant people awards of up to $2,000 a person for doula support.

Mollard’s project, by comparison, is a randomly controlled trial that will examine a program called Protective Assets Reinforced with Integrated Care and Technology, or PARITY. It is intended to empower women to take control of their health care.

Mollard, who has a doctoral degree, said those strengths include things such as self-efficacy and resilience that women already are using to overcome disparities. The idea is to maximize and leverage them.

Participants in the PARITY intervention will be assigned a community-based Black doula to offer support, emphasize their strengths and promote care adherence and healthy behaviors such as sleep, nutrition and movement. They also will receive 12 weeks of tailored wellness, strengths and health care adherence messaging via a mobile technology program. The mobile technology also allows participants to communicate with a virtual doula. A control group will receive standard, information-only care.

Mollard, who is a certified nurse midwife, said the inspiration for the grant application came from the grassroots work of Black birth workers in Omaha and Lincoln. The idea really came into focus late one night while she was working with Anabelle Elya, a doula and co-investigator on the grant, to support a woman through labor and birth.

Traditionally, Black birth workers were a big part of a Black woman’s birth experience. That changed when births began taking place in hospitals. “This is coming back to a solution,” Mollard said.

Results of the intervention will be measured through changes in blood pressure, gestational weight gain, cesarean rates and changes in wellness behaviors.