Fall/Winter 2006					North Carolina Perinatal Association
	A Coalition for Healthy Mothers/Healthy Babies

From the President: "Looking Back...Moving Forward "

As I look back over the past two years as President of the North Carolina Perinatal Association, I want to thank each of you for helping move us forward in our commitment to improving the health of mothers, babies and families in North Carolina. Each of you does this on a daily basis when you work in perinatal health and I applaud your dedication.

I am excited to report we had 270 registrants for the 2006 NC/SC Perinatal Partnership Conference and 108 of these were from NC with 72 new/renewing memberships at the time of registration alone! The Annual Business Luncheon and meeting were well attended and the agenda was full. Membership voted to not purchase the Capital Guides in the future but to explore a link from the newsletter to the information on the web. We are currently working on this so watch for this new feature. Mark your calendar now for the 14th Annual Perinatal Partnership Conference at the Sheraton Greensboro Hotel at the Four Seasons - Joseph S. Koury Convention Center in Greensboro, NC. Planning has already begun and the dates are October 20-23, 2007.

A special thank you to Frieda Norris who has tackled the challenge of merging membership databases. She has made great strides in this endeavor and it is an ongoing process at the moment. Much appreciation to Betsy Bryant and membership committee volunteers from Cleveland Regional Medical Center for all the hours making packets to send out to our new and renewing members.I encourage members to contact the committee chairs or myself and we will be happy to answer questions or discuss ways you can participate and become more actively involved in the organization. As a reminder, membership renewal is due with your conference registration or by November 1st to maintain active status with the association.

Thank you to Diane Yelverton for coordinating the NCPA newsletter online. We hope you use this to keep up to date on association activities and news. Currently a new edition of the newsletter is posted twice a year so look for a new version in May and November. The May 2007 newsletter will have information on the Ann Wolfe Scholarship Nomination forms for the 2007 NC/SC Perinatal Conference as well as requests for nominations for the Perinatal Awards for 2007 and requests for nominations for new/renewing board members for the following term. We appreciate the continued partnership and support of the NC Healthy Start Foundation in allowing us to have our newsletter as a link on their website. The direct link is: http://www.nchealthystart.org/ncpa/index.htm.
 
This past year NCPA continued it’s partnership with the March of Dimes for Legislative Day with an overwhelming response. Thanks to all the members of both organizations and our many other partner organizations and groups who took time to participate in this important advocacy event. A special thanks to Pam Spivey and Anna Bess Brown for their planning and coordination efforts to make this such a success this year.

My special thanks to each of the members of the board, the committee chairs, and the officers for their countless hours of assistance and support. There are not enough words to convey my heartfelt thanks. 

Thank you for the opportunity to serve as your President of NCPA. It has been an honor and a privilege. I look forward to continuing to serve on the Board of Directors. I have known Martha Schaub-Bordeaux for many years and know that as President she will lead this Association with dedication and ‘heart" as she truly has a passion for improving the outcomes of mothers and babies in our state.

Mildred E. Carraway, RN, BSN
President, North Carolina Perinatal Association

Phone: 252-744-3088
Email: carrawaym@ecu.edu

Women's Health in Africa

When I close my eyes to sleep, it is not unusual for my mind to remind me of my recent encounter with women's health in Africa. The images are strong and so powerful that I find myself still moved by scenes filled with beauty, courage, strength and weakness...on a backdrop of pain and human suffering. The digital pictures we took fill two albums. They reveal the darkness and light of all that is to be experienced by one from America's bounty suddenly transplanted among the images of poverty's grip on this continent. How often I had turned away or turned off these scenes that are so permanently engraved now. In the comfort of my home, a button could protect my spirit from the confrontation of these women's plight as it so starkly contrasts with my more sophisticated cares. That is not possible for me after my three weeks in Uganda, Africa. I returned to my world of prosperity with new eyes and as an advocate of the women I encountered. They wrung out my heart in such a way that I bear the fingerprints as if it were literally done to my physical being. I am forever changed.

I am a woman of Christian faith and I have been lured to participate in short term mission trips every time the money and opportunity have come together. My daughter Rebekah instigated the trip as she anticipated graduation from nursing school. So along with her sister Jennifer, we realized the first miracle had occurred, when we found we could all arrange our schedules to be away for three weeks!! We experienced our life changing trip in July of 2006.

I invite you to walk with me through some of the realities faced by women in Uganda, Africa through our snapshots of the trip. Uganda is a prominent African country with the infamous reputation of being the place where the HIV AIDS virus was first identified in 1982. The Rakai district where this took place along the shores of beautiful Lake Victoria (the source of the Nile River), still reports greater than 40,000 orphans to AIDS despite millions of dollars in American and other money that has poured into the country.

Our first picture of women's health in Africa came on our second day in Uganda. We walked through the "shanty" type housing, played with the naked and scantily dressed children between our visits in homes of the Zana community near the capitol city of Campala. This was by no means, the poorest of places in Africa. If anything, it could represent the middle class (those with a roof over their head, with ability to get food and water...even some electricity every other day). We visited the home of a woman who is considered elderly in Uganda. She is around fifty years of age (life expectancy is 50), and the sole provider of a family of women and children. Outside her one room home, a row of eight small children with four young women are eating. Inside, this woman sits on the floor with her beading projects and proudly allows us to peek at the newest baby which is only a few days old. There are no men visible in this home or this neighborhood. The youngest boy child we saw was around 7 years old. On our first clinic day, this matriarch was one that was triaged to be checked by me. Her complaints were of "missed periods, irregular cramping, and headaches". After her physical assessment revealed no obvious problems and her reports and details of various aches and pains, we gave her intense education in the use of Tylenol for herself and her family. She cried tears of joy and thanked me profusely. She was one of the churched women, so I hoped she wasn't just thinking the touch of the "mzungu" (white person) cured her! She was a joy and I found her state of menopause was actually refreshing!! She had already defied the odds of life expectancy to be bothered by hormonal changes that unite women across all cultures! I admire the strength and perseverance that keeps her going each day. She is not a quitter and she is respected in her culture.

A far more typical picture of women's health in Africa was revealed when we actually set up our medical clinics in three different locations. In the Zana community, where we actually operated out of the church's medical clinic for two days, we had crowds of 500-600 people consisting predominantly of women with children each day. Women brought their babies and their friend's children to take advantage of this rare opportunity for free healthcare made available in their community. Refugees from the Congo and the Sudan had also made their way to the clinic. Initially this caused great tension in the crowds as they pressed to be first and the desperation of women concerned for their babies made it emotionally challenging for our team. Rebekah, as our triage nurse, made constant trips into the crowd, to find the fevered, most distressed children. Malaria's extreme ravage on the bodies of women and children became the imprint of women's health that day. Suffering born of a disease that could be prevented with nets and spray defined the role of women as strong caregivers for the burden of sickness ignored and debated by the politicians. They are on the sidelines, watching the disease take lives and permanently damage their babies. They are advocates and seek help when it is available. The average African, expects to have malaria at least once per year. Every pregnant woman I checked, either currently had malaria or reported having had malaria in the immediate pregnancy. We were thankful for a lab test that confirmed the presence of malaria in the pregnant women we saw. We used the country's protocols for treatment.

I did in Uganda, what I do here. Teach, teach and teach again the essentials for health promotion! A few of the women brought a prenatal record which looked much like an immunization record, proving they had been treated for HIV or malaria. These women knew their last menstrual period and due dates. Most of the churched women were educated and could speak English. Those who had no formal education and could not speak English seemed to understand English very well. I was surprised when they laughed at my suggestion that they drink 6-8 glasses of water each day. Most of them reported only drinking 1-2 cups of tea. They do not have clean drinking water available and I could easily palpate the fetal position of their babies. It appeared they had an oligohydramnios type state. The fetal heartbeats roared loudly to assure us of the stamina of the unborn child in less than perfect conditions. Without the fluid and nutrition they need, women bring babies into the world often doomed by HIV and vulnerable to vitamin deficiencies that rob them of their eyesight and strength to fight malaria and other illnesses. I was shocked when we visited the hospital and saw how they wrap their newborns from head to toe.(I mean completely covered heads!) The loud message I wanted to shout after seeing the ward of mattresses and tiny cribs was "Stay Home to have your babies!" A placenta pit outside the window of the ward, just magnified the primitive state of obstetrical care. This completed a picture of the affects of inadequate healthcare for women in Africa.

African women were often victims of superstition as evidenced by scars from community healers who would make slits in the offended body part and then insert herbs. Some of the women did believe a touch from a white person was healing, while just as many others were frightened and suspicious of the white people providing care. This imprint of fear, curiosity and desire to learn was also evident in the women we met in our school ministry. We taught the children to brush their teeth and left toothbrushes to replace their sugarcane! (Yes, their kids love sugar too!) As we completed the school sessions, women gathered for a question and answer time with the Maternity nurse(that was me). Their questions were about the welfare of their infants, breastfeeding and HIV. Again, they laughed at my suggestion that they find a friend or family member who was HIV negative to breastfeed their baby! Their laughter did not hide the pain in the eyes of the mothers who were HIV positive with a baby nursing while we spoke. Missing completely was the need to discuss bottle feeding. It is not an option and would kill more swiftly than the HIV virus. The women were still arriving when it was time to leave several hours later. Time is not rushed and pressured. Women gather for an event and stay unlimited by appointments. They bring their children with them so their work is also portable. I was overwhelmed by the lack of education that I met in Uganda. It is not that education is not received and desired, it is just not an expected luxury. It seemed fixable. Knowledge would bring empowerment in Africa as it has in the rest of the world. Truly this was a lasting picture of hope that drives me to go back.

In the Rakai district with its scars from a community completely bowed to the affects of AIDS, we set up 2 different clinics outside small hospitals. Much has been done for this area. Prenatal care, HIV treatments and immunizations for babies are free and advertised everywhere. From all that they have been through, the community strives to be the example of tried and true "evidence based" care of women and children with AIDS. They want to publish their reports and make money to rebuild their devastated towns. I saw community leadership by men and women here. There were men in the crowds awaiting care. Within these shadows of death, hope was shining through.

May I leave you with one last picture of a woman in Africa? A beautiful, well dressed woman presented to us with a vast array of complaints. She was dissatisfied with the doctor's orders for Tylenol for her pain. Indeed, her pain was much more than physical. I dared to ask her if I could pray for her and she quickly and sadly told me that she would not be able to ask God to forgive her sin. "I can never forgive those who have treated me so savagely" she said. Her story was of being torn from her parent's home and raped repeatedly as a child. She had learned to survive, but she was tormented by the physical abuse that being a woman in the Congo of Africa had imposed on her life. She spoke of the common practice of young girls allowing family members to cut off their breasts in an attempt to hide their female attributes from the expected attacks of soldiers and gangs of men. Her heart was filled with pain from the resentment and hatred of her attackers, and indeed this woman was depressed. Medication for depression was not a therapy we could offer her. She left with more than 2 months supply worth of Tylenol and vitamins. My heart broke for this woman but we had the opportunity to discuss the common symptoms of depression and the ways she could improve her condition. She eventually allowed a short prayer, we hugged and she walked away with her head up to face life as her reality presented. She was not at the quitting stage, indeed, she was a fighter and went back to the care of the children she was responsible for equipping for life. There it is again for me. A familiar picture of women I have seen all over the world. In Romania, Honduras and now Africa, I have seen the inner strength and ability women have in the face of adversity. I will never forget this woman. I pray for her often.

In the Old Testament of the Bible, a Jewish woman named Esther became a Queen in a foreign land. When her Jewish people were in jeopardy of being purged from the kingdom, her uncle compelled her to present their case to her husband the king. His words to her were: "Who knows but that you have been placed in this position but for such a time as this?" ( Frieda's translation). That is the question I come away with as I reflect on the condition of women's health in Africa. Those of us blessed with medical/nursing skills have been given the knowledge and benefits of living in a prosperous and free country. I believe God does indeed see the plight of those suffering in third world countries. Every time I have traveled to places like Honduras, Romania and now Africa, I have discovered there are those who came before me and there are many who will go after I return to my life. May I encourage you to seek out an adventure that matches your faith and desire to "give a cup of cold water and do unto the least of these"? If you can't go yourself, help someone who can!

If you would like a presentation about Women's health in Africa for your group or church, please contact me at 704-650-8142 or email frieda.norris@carolinashealthcare.org.  

Breastfeeding and Working

Gail Proper, PE, RCDD
Engineering Manager, Communication Technologies Office
North Carolina State University
President, Nursing Mothers of Raleigh (North Carolina)
www.nursingmothersofraleigh.org

Good news - you can work and breastfeed your child! However, you will need a few things in order to succeed - determination and flexibility from yourself, good communication with your employer and caregiver, support from your partner, family and friends, and a good breast pump.

First and foremost, the one thing critical to your success of working and breastfeeding is a good breast pump. There are many makes and models, from"Buick to Cadillac". Evaluate your situation and see what you might need. I would suggest, at a minimum, that the pump be electric and have two flanges for efficiency. Past that, there are plenty of options. There are backpacks the pumps can go in with built in coolers, battery options, car adapter options, adjustable pressure and frequency. Check out what's available and see what will meet your needs and your budget. Go ahead and have a pump available as soon as you can if you think you will be pumping and working.

A few things to suggest before going back to work. Pump when you can and freeze this milk. Early on, a baby might only take one side at a feeding. If you pump the other side, you can build up some surplus. Often times your breasts are fullest in the morning, but pump when you can. You should pump after the baby has nursed. A neat trick for storing/freezing is to put breast milk in plastic ice cube trays. A cube is usually about an ounce. Cover the tray in the freezer to protect it. Once tray is full, the cubes can be transferred to freezer bags. Always label the bags with the date. You'll always want to use the oldest date when getting milk from the freezer. Later, you can freeze in larger quantities, when you know how much your baby is taking in one feeding. Place frozen milk toward the back of the freezer, as there is less variation in temperature than in the front. Building up at least some frozen supply will most likely give you peace of mind when going back to work.

Another important item to cover before going back to work is to introduce your baby to the bottle. Ideally this is done after nursing is well established to avoid nipple confusion on the baby's part. Sometimes it is helpful for someone other than "mommy" to feed with a bottle at first. Also, it is good to try this when the baby is not hungry. Put a small amount of breast milk in a bottle and let the baby try after a feeding. If a baby is particular, a few different bottle nipples may have to be tried before you find one that works for the baby.

Once you've selected a caregiver, it would be good to have a few practice runs before heading back to work. Take the baby for a morning or afternoon and run some errands. It will let everyone get adjusted. Once piece of advice I got from a friend was to start back to work in the middle of the week. It helped to not have such a long week with so much transition.

Ideally, while pregnant, you were able to scope out your work environment for policies or precedence's set before you. Your Human Resources folks may be of some help on this as far as company policies, etc. Ultimately, it is probably going to mean a good conversation with your supervisor about needs and expectations on both parts. This is the part where you can tell your supervisor that breastfed babies are more likely to be sick less often; therefore mommy will be at work more!

At work, it's ideal to have a quiet place, a room with door (and preferably a lock), chair and an electrical outlet to set up your "pumping station". This could be your office (if you have one), a vacant office, or a storage closet. Sometimes, you might have to be creative. Some workplaces even have rooms that are dedicated to pumping. Once you're in this space, it's helpful to have a picture of your baby to look at while pumping. Before pumping, it also might be helpful to massage your breast and surrounding areas to help stimulate a letdown. Then, pump for approximately 15 minutes, even if milk stops coming out before then. The pumping will stimulate breasts, sending the message that milk is needed. Remember that ideally, each pumping will be replacing a feeding. At first that might mean pumping 3 or 4 times while at work, but as the baby gets older, it may mean only 2 pumpings. I personally looked at the time spent pumping as all the smoke breaks I never took, so I didn't feel bad about it. I scheduled meetings around pumping and adjusted when I couldn't.

I have few friends that were able to multi-task while pumping. For instance, a doctor friend was able to pump, eat lunch, and dictate charts all at the same time. I was never so coordinated. I needed too many hands! I just took it as a chance to relax and think about my baby.

During the 9 months that I pumped and worked, I also had to travel a few times. Many hotels have rooms with small refrigerators.
I even made friends with the hotel restaurant manager so I could freeze the milk prior to coming home. I have pumped in restrooms and cars. Again, a little creativity and forethought is required. Don't be afraid to ask what is available. You might be surprised.

Good communication is a must with your caregiver. They can let you know how much your baby is eating and if it's changing due to growth spurts. You will need to communicate with your caregiver if you would like to nurse when you pick your baby up so that they will not have just given the baby a bottle or vice versa. I always sent one more bottle than I thought my baby needed. That way if there were appetite changes, the caregiver could have some milk to adjust with. I would send thawed frozen milk (oldest first) in on Monday. I would then send Monday's pumped milk on Tuesdays, Tuesday's on Wednesday, etc. through Friday. I would then put Friday's milk in the freezer and start over on Monday. It's likely there will be a decrease in milk production through the week. This could be due to stress, fatigue, and the fact that the pump will be less efficient than the baby. This is where the one ounce cubes can be added to fresh milk to make up the deficit. The caregiver is most likely subject to rules and regulations, so again good communication and coordination with them will make sure your baby gets what they need and what you want.

Good support from your partner, family and friends is critical in your success of meeting your breastfeeding goals. Often times there are local support groups for breastfeeding mothers. I have been involved in a local group since my son was born 4 ½ years ago. They've been my best source of information, support, tips and tricks, mommy advice and a general cheerleading section. Sometimes when breastfeeding is difficult or obstacles come up, it's nice to have folks reminding you of the good things your are doing both for your baby and for you. If there's not a local group, don't be afraid to start one!

Hopefully this has given you some helpful information, insight and encouragement. With some determination, creativity and good support you can meet your breastfeeding goals!

This article was previously published by WorldWIT in Thinking Aloud, www.imninc.com/worldwit

North Carolina Takes Action to Save Babies

Prepared by Pam Spivey, NCPA Legislative Committee Chair

The state legislature enacted three bills that will fight the rising rate of premature birth in North Carolina.

The legislature passed a bill to provide education and treatment with 17P, a derivative of the hormone progesterone. When given to a woman who has had a previous preterm birth, 17P may prevent a second preterm birth. The legislation provides funding which will support education and increase access to 17P for low income and minority women and their health care providers. The legislature also funded the Perinatal Quality Collaborative, which will strengthen quality measurement and improve perinatal health outcomes. The Collaborative will identify strategies to improve access, foster appropriate resource use, and reduce unnecessary expenditures. The goal of these quality improvement initiatives is to reduce infant mortality and disease burden. Thirdly, in 2006 the legislative buildings became smoke free, enabling pregnant women and children to visit in a smoke-free environment. Research shows that smoking causes preterm birth.

If you would like to become involved in advocacy efforts to promote healthy moms and babies, contact Pamela Spivey, chair of the Advocacy Committee of NCPA, at 704-355-7207 or Pamela.Spivey@carolinashealthcare.orgIf you would like to join the Advocacy Network of the March of Dimes NC Chapter, contact Anna Bess Brown at
919-781-2481 or abrown@marchofdimes.com

The March of Dimes is a national voluntary health agency whose mission is to improve the health of babies by preventing birth defects, premature birth and infant mortality. Founded in 1938, the March of Dimes funds programs of research, community services, education, and advocacy to save babies and in 2003 launched a campaign to address the increasing rate of premature birth. For more information, visit the March of Dimes Web site at marchofdimes.com or its Spanish Web site at nacersano.org

Fish Oil and the Prevention of Preterm Birth

Preterm birth is a problem. 12.3% of all births in the USA in 2003 were preterm, and prematurity is linked to 50% of long-term neurologic disability in children. Diagnosing preterm labor is a problem because preterm contractions are common. In 80% of women with presumptive preterm labor, preterm delivery will not occur. Only 3% will deliver within 2 weeks of presentation. Despite vigorous efforts to treat preterm labor, the rate of preterm birth has actually increased in recent years (30% since 1981). Unsuccessful attempts at treating preterm labor include tocolytic drugs and antibiotic therapy.

Preventing preterm labor is the best idea. Unsuccessful attempts at preventing preterm labor have included: bed rest, home uterine monitoring, antibiotics, and cervical cerclage for cervical shortening. However, omega-3, fish oil, is under investigation for its role of preventing preterm labor. An association between increased omega-3 intake and increasing length of gestation has been observed in both observational studies and clinical trials. What might it work? A link between the inflammatory response and preterm birth has been established. While the presence of an inflammatory response is evident in many patients with preterm labor, an active infectious process is not apparent as most have negative amniotic fluid cultures. There is accumulating evidence from animal models that progestational agents (17P) prevent preterm birth by inhibition of the inflammatory response. In summary, preterm birth continues to be the major cause of perinatal morbidity and mortality. An inflammatory response appears to be central in the causal pathway, and omega-3 fatty acids have anti-inflammatory properties through alteration in the production of arachidonic acid.

A randomized trial of omega-3 fatty acid supplementation to prevent birth in pregnancies at high risk is being conducted by the NICHD Maternal-Fetal Medicine Units Network. However, supplementation should not be prescribed to prevent preterm birth outside of a clinical trial. Prevention of preterm labor is better than treatment; stay informed of progress in this study.

"Fish Oil and Prematurity", Gravidas at Risk 2005
Margaret A. Harper, M.D., M.S., Associate Professor
Wake Forest University School of Medicine

Re-printed with permission, Perinatal Post July 2006, Wake Forest University School of Medicine, OB/GYN, Perinatal Outreach.

North Carolina Perinatal Association 2006 Awards

The Association presents “Baby Bootie” Awards each year to individuals and teams who have provided services to our citizens that further the mission of the Association of improving perinatal health for childbearing families throughout the state.

2006 “Baby Bootie” Business and Industry Award: 

This award is presented in recognition of the important role that business provides in efforts to improve the health status of North Carolina Mothers and babies. The 2006 Business Award goes to Wachovia Bank.

This award is presented in recognition of the important role that business provides in efforts to improve the health status of North Carolina mothers and babies. The 2006 Business and Industry Award this year goes to Wachovia Bank with special recognition to Ann Campbell, currently a Relationship Specialist in the Business Customer Service office on Weston Parkway in Cary.  In her previous role as Financial Specialist Officer, Mrs. Campbell assisted NCPA through transitions and went “above and beyond” in her role.  NCPA is appreciative of her kindness and assistance.  NCPA has banked with Wachovia throughout its 20+ year history and is grateful for their support of non-profit organizations.

2006 “Baby Bootie” Team Award:

This Award is presented in recognition of a regional or local team for their outstanding achievements in work to improve the health status of mothers and babies. The 2006 Team Award goes to “Cleveland Regional Medical Center”.   Cleveland Regional Medical Center Women’s and Children’s Services has the largest representation of NCPA members than any other agency in North Carolina.  For the past several years, these members have volunteered their time and materials to compile NCPA’s Annual Report and membership packets.  They have also supported their colleagues, who are board members, to fulfill duties of NCPA.  A special thanks goes to Wesley Barrett, in the CRMC print shop, for his contribution and support in compiling the Annual Report documents over the past few years.  The CRMC Women’s and Children’s Services division is led by Nancy Porter, RNC, BSN, MBA and the unity director is Myra Douglass, RNC, MSN/MHA.  Current NCPA board members from CRMC are Betsy Bryant of Cleveland County, representing lactation and perinatal nursing and Region III and Edith Earley of Rutherford County, representing hospital based perinatal nursing and Regions I and III.

2006 “Baby Bootie” Legislative Award:

As part of our advocacy efforts with the legislature we recognize outstanding Legislators each year who take leadership in sponsoring and supporting legislation and in funding and/or preserving funds that are used to improve the health of mothers and babies. The 2006 Legislative Award goes to Senator William Purcell representing Anson, Richmond, Scotland, and Stanly Counties. He is a retired Pediatrician and has been instrumental in educating other Legislators about important issues related to healthcare. This year Senator Purcell sponsored bills for funding efforts to reduce infant deaths/preterm births and funds for the development of a network of providers to focus on issues related to perinatal care. Senator Purcell is the Co-Chair of the Appropriations Committee on Health and Human Services, Co-Chair of the Committee on Health Care and serves on numerous other committees. We thank him today for his dedication to women, children, and families in North Carolina.

Ann F. Wolfe Award: 

The Ann F. Wolfe Award was created and first awarded in 2001 in recognition of Dr. Wolfe's guiding force in the health of mothers and children throughout her career. She gave many years of service to North Carolina women, children and their families. She was a member of the NC Perinatal Association Board at the time of her death in February 2002. In giving this award we look for those who have given likewise over many years of service.

This year’s recipient has dedicated the majority of her nursing career to improving the health and well being of mothers and babies in North Carolina. She received her nursing degree from the University of Colorado at Boulder and later pursued a Masters in Public Health from the University of North Carolina at Chapel Hill.

As the original member of the North Carolina Perinatal Outreach Education Program within the Department of Health and Human Services, Division of Maternal and Child Health, for Perinatal Region V, she has been a pioneer for change as she has advocated for women’s health care issues within our state. In her role as a POET, she has served as a mentor, educator and patient advocate throughout Perinatal Region V for over 22 years. Based at Coastal AHEC in Wilmington, she has worked to train numerous health care professionals not only in her region but throughout the state on a variety of perinatal topics.

One of the original members of the North Carolina Perinatal Association, she has spent countless volunteer hours in support of the organization. She is a past President of the Association, active on the Board of Directors throughout the years and has served faithfully on various committees. 

As a mother and grandmother, she has a personal as well as professional commitment to improving the health for women and children in North Carolina. This year’s award goes to Joanne Carl with gratitude and appreciation for her love, devotion and dedication to mothers and babies.