During the 2021 TCHMB Annual Summit, conference attendees asked a number of questions that weren’t able to addressed in the time allotted. We reached out to the relevant panelists to obtain answers.
Dr. Wanda Barfield
WANDA BARFIELD, MD, MPH, RADM USPHS, is Director of the Division of Reproductive Health in CDC’s National Center for Chronic Disease Prevention. She was our keynote speaker.
Question: Where would you direct us to find safety information for the vaccination of pregnant and breastfeeding people?
Dr. Wanda Barfield: You can find CDC’s recommendations for vaccination of pregnant and breastfeeding people at this site and ACOG’s recommendations here.
Is there a tool or questionnaire that you recommend using in the ambulatory clinic setting to assess for trauma due to racism?
While I do not have specific recommendations for tools in ambulatory clinic settings, I would recommend looking at the Pregnancy Risk Assessment Monitoring System, or PRAMS, questionnaires. These questionnaires are used to gather data that are not available from other sources, including data on respectful care, experiences of racism, and emerging issues.
How can we be sure without a shadow of a doubt that the vaccine is safe for the unborn fetus? If the focus is lowering infant mortality would this not be a huge concern?
Limited data are available about the safety of COVID-19 vaccines for people who are pregnant. Based on how these vaccines work in the body, experts believe they are unlikely to pose a specific risk for people who are pregnant. However, there are currently limited data on the safety of COVID-19 vaccines in pregnant people.
We do know however, that COVID-19 poses increased risk to pregnant people and their babies:
Pregnant people with COVID-19 might have an increased risk of severe illness as compared to non-pregnant persons, and adverse pregnancy outcomes, such as preterm birth, are more common among people with COVID-19.
We also know that Hispanic and non-Hispanic black pregnant people appear to be disproportionately affected by COVID-19 infection during pregnancy.
CDC and the Food and Drug Administration (FDA) have safety monitoring systems in place to capture information about vaccination during pregnancy and will closely monitor reports. For more information please see Information about COVID-19 Vaccines for People who Are Pregnant or Breastfeeding and v-safe COVID-19 Vaccine Pregnancy Registry
I would like to know any insight you have into gaining further trust in some communities where disparities are seen in many health-related areas; any successful practices and experiences in community engagement activities beyond taking great care of individual patients?
I’d recommend this article with insights into how Perinatal Quality Collaborates can advance maternal fetal medicine, including engagement with community stakeholders: Advances in Maternal Fetal Medicine: Perinatal Quality Collaboratives Working Together to Improve Maternal Outcomes - PubMed (nih.gov)
At the institutional level (i.e. hospitals), specifically for parents giving birth, what exactly would assessing for trauma due to racism look like?
Several organizations have provided frameworks in this joint statement: Collective Actions to Address Racism. Since institutional racism is a structural issue, it is more about looking at the organizations (hospitals, healthcare systems) and undoing practices that are inherently racist. There is no pathognomonic sign or symptom to identify racial trauma; this is a process that providers need to understand and feel comfortable addressing.
Assessments for trauma due to racism should give parents the opportunity to tell you if they have any concerns with the quality of care they’ve received, including whether staff were respectful, whether they felt supported, if they experienced any complications, if they received information to stay connected to care, and if there are any other social determinants of health that might affect their needs for care (i.e. food insecurity, housing, employment, environment).
Dr. Sarah Wakefield
SARAH WAKEFIELD, MD, is chair of the Department of Psychiatry at Texas Tech University School of Medicine. She participated in the panel “Coordination of PMI for the Uninsured in Texas and Addressing Racial/Ethnic Disparities.” A video of the panel is online.
Question: What do you feel is the best way to address the early signs/symptoms of PPD in the hospital setting?
Dr. Wakefield: Screen everyone with EPDS, provide psychoeducation and resources (therapy, groups (PSI), emergency care (crisis line) in succinct handout, plan 1 week f/u for Mom even if SVD (not 6 weeks) for re-screening and discussion of starting a medication. If h/o PPD or PMDD, consider starting medication in hospital (within scope of FAM/OB attending, does not need a psych consult).
Do you have any suggestions to help with bridging the gap between psychiatry and mother/baby while in the hospital? At my facility, we have a hard time getting the mothers who need a psych consult to be seen before discharge.
For adequate access to psych, there really needs to be a full time psych attending dedicated to consults. There is no way to do this if it’s not paid by the hospital because consults pay so little. If this is not an option, there are on-demand telemedicine companies that hospitasl could contract with and pay by the visit.
We have difficulty getting provider buy in. Do your providers deliver at more than one facility? Specifically, what did you do to get them engaged? We need ideas.
It is the recommendation of every professional organization that any “deliverer” should care for mother’s mental health. MCPAP for Moms has great resources, algorithms, and power points that make this much easier to digest.
We screen in the NICU, but if we identify PPD, it is difficult to provide referrals, connect with providers and in a timely manner. What options do providers have?
I would make certain you are looping in PSI. There are NICU mom groups for support and clinicians listed on the website.
Can a provider "refer" a patient to mental/behavioral health? I was always told the patient has to call themselves?
Depends on the system.
Laura Kender, MSEd
Laura Kender, MSEd, is Chief of Early Childhood Services (ECS) for My Health My Resources (MHMR) of Tarrant County. She was one of the panelists on the session addressing Coordination of PMI for the Uninsured in Texas. A video of the panel is online.
Question: What is the best language to use when referring for post-partum depression resources?
Laura Kender: “Perinatal Mood and Anxiety Disorders” during pregnancy and within the first year after delivery seems to be all encompassing even when relating to fathers.
How are you funding your Family Connects Program and are you able to get to most births or are you focusing on one/few hospitals?
Family Connects North Texas is in the following hospitals: THR Arlington, HCA Arlington, THR Cleburne, Wise County Hospital District, and Lake Granbury Medical. Funding consists of DFPS Prevention and Early Intervention, DSHS Title V, philanthropy dollars, and MCO-Medicaid. We are funded to support births at the hospitals mentioned. We are currently planning to also bring in THR Presbyterian hospital Dallas and THR Harris Fort Worth this year.