From the President:
Greetings!

I hope all of you had a wonderful Holiday Season. This newsletter heralds a New Year and new opportunities for those of us committed to caring for patients within the perinatal/neonatal health area. As NCPA enters its 22nd year, our goal remains the same - to improve the perinatal healthcare of North Carolina families. The agenda has not changed dramatically, finding focus in Advocacy and Education. We seek collaboration with groups sharing our goals in these areas, primarily through Advocacy and Education. Along the way, we hope to nurture new leaders within our ranks.

With respect to Advocacy: we continue to have an NCPA member on the NC Child Fatality Task Force (CFTF), in order to speak to issues surrounding perinatal mortality; we continue to work closely with the March of Dimes, in order to remind legislators of the needs of the smallest citizens and their families. Again, the NCPA will join forces to support Perinatal Legislative Day, a time for connecting individually with legislators through conversations, apple pie and simple reminders. Date and information for this fun day will be provided.

With respect to Education: we continue to join with the South Carolina Perinatal Association, to offer a yearly conference for nurses, physicians, social workers, dieticians and other health care professionals interested in improving the outcomes of mothers and infants. Our 2007 conference was held in Greensboro, North Carolina. You will find more news on the conference within this newsletter.

It is critical for the future of the NCPA that we continue to gain new members. We need different perspectives that you and your colleagues bring from your day to day professional activities. Please stop for a moment and consider what you or others you know might bring in new insight and future leadership to the NCPA. Did you make any New Year resolutions? Was one of them or could one of them be to become more actively involved in the Association. If you are interested, please do not hesitate to contact any one of the Board Members. Board meetings are open to all members of the Association.

I look forward to a fantastic year and send my well wishes to each of you as we continue toward our personal, professional and association goals.

Martha Schaub-Bordeaux, MSN, PNP
President, North Carolina Perinatal Association

Phone: 919-681-6029
Email: [email protected]

Learning in Mexico: The Work of a Traditional Midwife
submitted by Tara Owens Shuler, M.Ed.,LCCE, FACCE
Duke AHEC PRogram

In September of 2007, 34 North Carolina health leaders set out on a week-long immersion trip to Mexico City and Puebla to learn about health care delivery and training in Mexico. The immersion trip was coordinated by The Center for International Understanding. The Center provide teams of health leaders, who represent various health agencies across North Carolina, with an opportunity to gain a better understanding of the cultural and medical landscape in the native communities of the Mexicans we serve here in North Carolina. As a member of the Duke University Medical Center team, I was interested in learning more about the prenatal health care system.

One of the most memorable experiences of the trip was the interview and discussion with a traditional midwife in a rural Mexican city, Chalpultepec. The midwife discussed how traditional medicine is practiced in conjunction with modern training. This traditional midwife received "hands-on" practice and then took a midwifery course offered by the State Health Department. With this training, she was accredited to continue practicing as a midwife. In rural Mexico, the traditional midwives begin to work with women early in their pregnancies. If she detects any complications, she is required to refer the mother to a clinic to receive care by a physician.

As the midwife shared information, there were some similarities with prenatal care and practices we promote in North Carolina. Similarities included:

• Women supporting women in birth, i.e. doula support
• Breastfeeding promotion as the best option for baby
• Promotion of folic acid
• No drinking or smoking during pregnancy

Some interesting beliefs or practices I learned were:

• A warm bath after birth with rue, chamomile and eucalyptus will tighten the uterus
• To encourage the letdown of breast milk, midwives grind sesame seeds and filter off the foam and place the foam on the mother's
  breast and back
• Girdles are encouraged after birth to assist the body in returning to its pre-pregnancy shape and to keep organs in place

This immersion experience gave me a better understanding of the cultural and medical landscape of the Mexicans we serve here in North Carolina. The staff with the Center for International Understanding did a superb job in planning and directing the team of NC health professionals while in Mexico. This trip is one of my most memorable international experiences.

For more information about the Center for International Understanding, visit http://ciu.northcarolina.edu.

The North Carolina and South Carolina Perinatal Associations, along with South Carolina's MidCarolina AHEC, hosted the 14th Annual PerinatalPartnership Conference, "Perinatal Excellence: A Season of Change" at the Sheraton Hotel at Four Seasons in Greensboro,October 21-23, 2007. The Planning Committee was delighted to see all the new and returning faces to the Conference. Final evaluations showed the overallsuccess with the total attendance approximately 206.

The conference started with three Preconference Workshops: Keeping Birth Normal, Developmental Care of the Premature Infant, Postpartum Home Management: Maternal and Infant Assessment and Safety. I think all who attended these workshops were well pleased.

Key note speakers for the Conference were Dr. Kellie Flood-Shaffer, Associate Professor and Associate Chair of the Department of OB/GYN, Texas Tech University Health Sciences Center in Lubbock, TX and Dr. Angela Lamson, Associate Professor in Marriage and Family Therapy of the Department of Child Development and Family Relations, East Carolina University in Greenville, NC. Dr. Flood-Shaffer presented most enlightening information on the long-term effects of prolonged bed rest for high risk obstetrical patients. Much "food for thought" was raised with this presentation, in terms of maternal nutrition, muscle change and psychological effects. She discussed the development of alternative management plans. Dr. Lamson gave a powerful presentation on the biological, psychological, social and spiritual elements of perinatal/neonatal loss for families, as well as compassion fatigue experienced by providers. After these two presentations, many of us may be rethinking nursing interventions. Other topics at the conference included: domestic violence, illicit drugs/trends in the Carolinas, progesterone treatment for pretern labor, necrotizing enterocolitis, understanding reproductive biology and contraception, managing vaginal bleeding, retinopathy of prematurity, family centered care and centering as a method of prenatal care. We had a variety of very interesting regional perinatal research and model programs offered, both as posters and presentation. The conference concluded with Dr. Iwana Guess Ridgill and her uplifting talk, "Balancing Life with Humor and Motivation."

Participants visited over 37 commercial and educational exhibits. Sponsorship for the meeting was provided by: NC and SC chapters of the March of Dimes Birth Defects Foundation and Matria Healthcare. As always, the conference not only provided education, but an opportunity for interaction with other perinatal/neonatal providers to share ideas, have fun and renew commitments in seeking to provide the best healthcare to our patients and work towards a better tomorrow.

Planning is already underway for the 15th Annual Perinatal Partnership Conference. It will be held in Myrtle Beach at the Radison Resort, Kingston Plantation, September 28-30, 2008. We hope you will plan to be with us next year.

Reducing Recurring Preterm Birth - An Update on the North Carolina 17P Project
Submitted by Sarah Verbiest, MSW, MPH

The North Carolina 17P Project passed its first year milestone in September and continues to move forward towards its goal that all women in North Carolina who meet the clinical criteria for 17P will have access to this medication to reduce their risk of recurring preterm birth. Hundreds of women have received 17P since January 2007 thanks to the support of the General Assembly and the hard work of many health care providers around the state. A central focus for the project over the past few months has been informing providers about the availability of the medication for low income mothers and the protocol for its use. Another major focus has been on working with local clinic administrators on office protocol to insure smooth screening, ordering and reimbursement, and to support patient compliance with the treatment regimen.

There remain some challenges to full implementation of this project. The first lies in the widespread perception among providers and women that late preterm birth is not a serious problem. This may lead to discontinuation of the treatment prior to delivery or 36.6 weeks. This is problematic as stopping 17P early may increase the risk for an early delivery. There is an urgent need to increase awareness about the problem of preterm birth - regardless of gestational age. Another barrier is providers themselves who may be hesitant to implement 17P in their clinics due to reimbursement concerns, lack of knowledge about the medication, and worries about the amount of time it will take. Finally, more work needs to be done at the community level to educatie mothers of preterm infants about 17P, learn about the concerns low income minority women may have about the treatment, and support providers and mothers in completing weekly injections.

Information on the 17P Project web site (www.mombaby.org) continues to grow. New articles about 17P, billing information, presentations, pharmacy resources, community ideas and resources, and office protocol tips and tools are some of the items recently posted. Several groups around the state have begun to explore a variety of research questions about 17P. Their findings will be posted as they emerge. The project coordinator can also help connect leaders in different areas of the state interested in starting local 17P campaigns with others doing similar work. A Speakers Bureau for 17P is being developed and requests for presentations are now being accepted. Building on each other's knowledge is essential. The project welcomes ideas from providers, consumers and community members around the state. Everyone's help is needed if we are to fully realize the potential of this treatment to reduce recurring preterm birth in North Carolina.

Side Bar
As a reminder, all medications for low-income, uninsured patients as well as office stock vials must be ordered through the 17P project via the www.mombaby.org
web site. The password may be obtained by contacting Sarah Verbiest, the project coordinator, at (919) 843-7865 or [email protected]. Orders for Medicaid patients may be placed through the site. They may also be placed through local compounding pharmacies - be sure they have seen Medicaid billing requirements
on the web site. Patients with private insurance or Tricare will need to work with their provider to order the medication directly from the pharmacy. Be sure that the selected pharmacy has a contract wit the insurer to avoid delays in reimbursement.

The National Summit on Preconception Health
Submitted by Sarah Verbiest, MSW, MPH

In October 2007, over five hundred individuals from across the country gathered in Oakland, California for the Second National Summit on Preconception Health. The Summit offered an outstanding array of plenary speakers, including North Carolina's own Merry-K Moos who gave one of the opening keynote addresses. The summit program included 45 breakout sessions with an average of three presenters per session. Additionally, three of the Center for Disease Control and Prevention's Preconception workgroups reported on their progress. The wealth of information and the enthusiasm of the participants made this a trult memorable event. Fortunately, all of the presentations and abstracts from the Summit are available free of charge online. To access this information, go to www.mombaby.org. Click on the pink preconception section and you'll find the link on the welcome page. In addition, to the powerpoint slides, the link includes the audio content for each session.

North Carolina was well represented at this event with one poster, four presentations, and ten participants. Two of North Carolina's abstracts received awards. It was clear to the NC team tha the work currently underway in the state towards developing a preconception action plan is cutting edge. Participants shared ideas and information they had generated from the Summit at a December meeting of the State Preconception Planning Team. Some of the major impressions included the following:

• the importance of taking the life course perspective,
• consideration of potential opportunities to partner with Medicaid,
• the role that underlying institutional rules and policies which may play in serving as barriers to women's health care,
• the opportunities available through partnership with the Baby Love Plus Program/National Healthy Start Foundation,
• the many opportunities for researchers and programs to add to the body of literature on preconception health,
• the importance of integrating this movement into existing public health programs.

A key message from the Summit was the urgent need to integrate issues around family planning and pregnancy intendedness nto the heart of the preconception campaign. Efforts will also need to be made to shift political focus away from a spotlight on the child to a floodlight on the entire family. Finally, there is tremendous interest and momentum nationally on preconception health. Other states are already looking to North Carolina's leadership on this initiative. To this end, it is hoped that others in the state will take some time to participate in the Summit online and then share their own insights with others as this exciting paradigm shift emerges.

New HIV Guidelines for Pregnancy

North Carolina laws have been revised to reflect the new CDC guidelines listed below, effective November 2007.

Every pregnant woman shall be offered HIV testing by her attending physician at her first parental visit and in the third trimester. The attending physician shall test the pregnant woman for HIV infection, unless the pregnant woman refuses to provide informed consent, pursuant GS 130A-148(h). If there is no record at labor and delivery of an HIV test result during the current pregnancy for the pregnant woman, the attending physician shall inform the pregnant woman that the test will be performed, explain reasons for testing, and the woman shall be tested for HIV without consent using a rapid HIV test unless it reasonably appears that the test cannot be performed without endangering the safety of the pregnant women or the person administering the test. If the pregnant woman cannot be tested, an existing specimen, if one exists that was collected within the last 24 hours, shall be tested using a rapid HIV test. The attending physician must provide the woman with the test results as soon as possible. However, labor and delivery providers who do not currently have the capacity to perform rapid HIV testing, shall not be required to use a rapid test until January 1, 2009.

If an infant is delivered by a woman with no record of the result of an HIV test conducted during the pregnancy and if the woman was not tested for HIV at delivery, the fact that the mother has not been tested creates a reasonable suspicion pursuant to GS 130A-148(h) exists that the newborn has HIV infection and the infant shall be tested for HIV. An infant born in the previous 12 hours shall be tested using a rapid HIV test shall be performed. However, providers who do not currently have the capacity to perform rapid HIV testing shall not be required to use a rapid HIV test until January 1, 2009.

Testing for HIV may be offered as a part of routine laboratory testing panels using a general consent which is obtained from the patient for the treatment and routine laboratory testing, so long as the patient is notified that they are being tested for HIV and given the opportunity to refuse.
HIV pretest counseling is not required. Post-test counseling for persons infected with HIV is required, must be individualized and shall include risk reduction guidelines, referrals for medical and psychosocial and control measures.

Confirmed AIDS and HIV infection is now reportable in 24 hours (was 7 days).

BESST Kit
Baby’s Easy Safe Sleep Training Kit

Contact:
Marta Pirzadeh
(919) 828-1819

Baby's Easy Safe Sleep Training (BESST) toolkit provides most everything you need to teach infant safe sleep strategies in your community.
Featuring a flipchart with 16 color illustrations, a thorough training guide, a sample agenda and more, BESST makes it easy to plan and conduct a one-on-one counseling session, a parent education class, a presentation or a training. Most importantly, the kit presents evidence-based, baby safe sleep practices in an easy-to-understand way to help parents, caregivers and health professionals promote infant sleep safety and reduce the risks of Sudden Infant Death Syndrome (SIDS).

The National Center for Cultural Competence at Georgetown University named BESST an effective and culturally sensitive project for reducing SIDS risks among minorities. To order this resource in English or Spanish, visit the North Carolina Healthy Start Foundation’s website at www.nchealthystart.org/BESST/flip_chart_info.htm