Michele Kulhanek’s Preferred Resources and Recommendations
Tuesday, April 21, 2020
By Lauren Hamilton
Over the past month, healthcare providers and hospital administrators across this country have taken daily stock of the ever evolving data models that predict the curve of the Covid-19 pandemic and have done their best to prepare and respond. In some states and cities, Covid-19 has now reached its predicted peak or surpassed it while others still await their area’s surge. But, everywhere, every medical professional is meeting a challenge unlike any they’ve faced before. In the midst of this challenge, maternal health care workers find themselves discovering what it means to support women giving birth during a deadly pandemic, while they, and the mothers they serve feel the most vulnerable they have ever felt. To help guide maternity healthcare workers as efficiently as possible, PQI has teamed up with Michele Kulhanek MSN, RNC-OB, C-EFM, Director of Safety and Quality, Maternal Infant Health at Washington State Hospital Association, to deliver a quick list of accessible resources. She includes resources specific to the disparities in Covid-19 cases in the African American community which many health experts say is likely due to deeply rooted economic and healthcare inequities.
Michele Kulhanek’s Preferred Resources and Recommendations:
· Centers for Disease Control & Prevention (CDC)
o Specifically, the CDC’s Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings, which originally was posted back in February and was recently revised on April 4th. The update provides clarification to the following:
§ The determination of whether or not to separate a mother with known or suspected COVID-19 and her infant should be made on a case-by-case basis using shared decision-making between the mother and the clinical team
§ Prioritized testing of pregnant women with suspected COVID-19 at admission or who develop symptoms of COVID-19 during admission
§ Considerations related to visitors and essential support persons to pregnant women who have known or suspected COVID-19 infection
§ Isolation of infants with suspected COVID-19 from other healthy infants
o CDC’s guidance on pregnancy and breastfeeding found here
· The World Health Organization (WHO) Q&A on COVID-19 in pregnancy, childbirth, and breastfeeding found here
· The American College of Obstetricians and Gynecologists (ACOG) website. I scan for any new tools, Q&As, or articles.
· The Society of Maternal Fetal Medicine (SMFM) website for updates and education -which are free until June 30, 2020.
· American Journal of Obstetrics and Gynecology (AJOG) Guidance and the latest COVID-19 articles can be accessed here at no charge during the pandemic.
· American Academy of Pediatrics (AAP) issued INITIAL GUIDANCE: Management of Infants Born to Mothers with COVID-19 on April 2nd, 2020.
· California Maternal Quality Care Collaborative (CMQCC) & California Perinatal Quality Care Collaborative (CPQCC) COVID-19 Resources for Maternal Infant Health https://caperinatalprograms.org/
o This website is a one-stop shopping experience, with the latest updates and recommendations from several organizations, data registries, sample resources for hospitals, webinars, as well as resources for caregivers and patients. There are some days where I don’t have enough time to hit every single website. On those days, I look at this one.
· Washington State Department of Health to keep a pulse on the current status of COVID 19 cases and deaths. I also look at demographics here, as WA is tracking and reporting COVID 19 data by race and ethnicity. I recommend checking your state’s Department of Health website to learn more about the number of positive cases in each county
- Minority Health Month (April)
- NICHQ has a social media toolkit. We are using this toolkit to raise awareness on our social media sites with the following:
- Black Maternal Health Week has just ended, but we must continue to elevate and amplify the voices and experiences of Black women’s birthing experiences and focus on eliminating racism, bias, and disparities in maternal care.
- COVID-19 brings to light more inequities for Black women, American Indian women, immigrants/non-English speaking, LGBTQ people, and other vulnerable populations. It is important to remember that disparities were present before the pandemic and will continue afterwards.
- Many of the above mentioned have low-wage, but essential jobs, such as in grocery stores, as caregivers, or in our health care systems. People may decide to go to work when they don’t feel well due to inability to take time off or fear of losing their jobs.
- Unemployment is rising and livelihoods of the lower income workers are in even more jeopardy than before the pandemic.
- Social determinants of health (lack of transportation, food scarcity, education, etc.) are exaggerated in a crisis such as COVID-19.
- Black women are also known to have more comorbidities than their white counterparts - diseases such as asthma, hypertension, and diabetes put them at greater risk of contracting the virus
- There is a mistrust due to profiling. (Black) Women who have historically been undervalued and unheard are now birthing without a support person or doula. Many who have different birthing and/or cultural beliefs, lived experiences and education from the people who are providing care for them.
- People may delay much needed care which means we may see an uptick in chronic illness severe maternal morbidities or mortalities.
- With social distancing, isolation, and stay home orders, intimate partner violence increases. If only one person is allowed to accompany a woman to the hospital for birth, it may likely be the person whom the woman is mistreated by (father of the baby) and not a supportive person like a doula, friend or family member. It is vital that health care providers are screening for safety at every interaction throughout pregnancy and postpartum.
- Pregnancy is often a time when more women have access to health care benefits. Consider if deferring or delaying services - like postpartum long lasting reversible contraception (LARC) may cause financial strain on the woman.
- Resources for reducing maternal mortality and increasing health equity (my go to resources to learn more)
- Reporting data by race and ethnicity, payer status, language
- States may not be required to collect data on race and ethnicity
- Collecting this data is crucial in understanding the effect of COVID-19 on ALL of our communities and developing solutions.
- Lastly, with every decision we make in health care, we must ask ourselves, How will this affect all of our population?