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A Comprehensive Approach to Fourth-Trimester Care Aims to Overcome Newborn Health Disparities


Care in the fourth-trimester, when the birth has taken place and the mother and baby return home, is crucial for the well-being of the mother or the birthing person, Takiyah Durham, MBA, explains in an interview.

The First Steps and Beyond initiative, a collaboration of Highmark Health and Allegheny Health Network (AHN), targets health disparities related to the alarming death rates among Black babies. In this interview, the director of First Steps and Beyond at Enterprise Equitable Health Institute, Takiyah Durham, MBA, and senior vice president and chief diversity officer of Highmark Health/AHN, Margaret Larkins-Pettigrew, MD, professor and academic chair of obstetrics and gynecology at Drexel University College of Medicine, discuss the program’s vast amount of community partnerships that help facilitate its objective of ensuring the health of every baby and their mother.


Are there any key partnerships or collaborations that support the First Steps and Beyond program?

Margaret Larkins-Pettigrew, MD: I think this is important to elaborate on because the fourth prong of this 4-pronged initiative is postpartum care and what happens to mom in that last that whole year—so after she has a baby. And this is really where many of our partners come together and do a lot of things for moms. So, Takiyah, you're going to elaborate on some of that. We have over 40 organizations working with us.

Takiyah Durham, MBA: Absolutely. So we have over 40 organizations. In terms of that fourth-trimester support, I think that is where moms go home and sometimes we miss the mark. And that is one of the most important pieces of the birthing experience. You want to make sure you get that well visit, you want to make sure we're taking care of your mental health. Most importantly, you want to make sure we're closing that loop.

We have partnered with our community-based organizations to ensure at that fourth-trimester phase that moms are getting connected to a provider, they're getting connected to the resources they need; some of our moms may need transportation, they may need financial support, they may need mental health care. I know a lot of our moms after they've given birth, they may suffer from baby blues, they may need therapy support.

We also, on our resource card, give them a checklist to say, "Have you checked in with yourself. Do you do your self-care? Do you need mental health support? Do you need additional resources?" One of the most important aspects is making sure mom is okay. If the mother or birthing person isn't okay, the family dynamic could potentially suffer. So we stress the importance of partnering with our CBOs [community-based organizations] and our health care partners to ensure that we take care of that birthing person in that fourth trimester. We make it very easy for the mom to have access to care.

Dr. Larkins-Pettigrew referred to the social determinants of health. We partner with our health care system. There's a program called the Social Care Network where our CBOs are incentivized to make sure that we close the loop on any resources that a mom may need to ensure that they're following up—if a mom needed food, did the mom get the food? Because when mom brings baby home, you're worried about the baby, you're worried about getting everything done in a home, and you're not so much worried about yourself.

We take it one step further to say “Mom, we're going to follow up with you to ensure that you’re okay,” and even when mom goes in for the well check for the baby, we're making it easier to partner with our health care systems to say, “Okay, mom, you're going in, but let's also take care of you.”

So the good news is that when moms goes in with the babies, we also have providers that will check in on mom as well. There's also another application where in a provider's office, the provider could connect mom with resources. It's called Find Health through the HIE [health information exchange] system. So we're finding every avenue to ensure that moms are connected with resources in that fourth-trimester phase, because that is one of the most important phases as well, to close that loop.

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