Silent lullabies: Fourth in a series on infant mortality.
Meghan Shutika says she found being a mother was very different when her second child arrived just over a year ago, compared with having her first child a dozen years earlier. Then she was a teenager, living with her mother. Now in charge and on her own, when she sought medical care for her second pregnancy she had some serious health issues that put her in a high-risk category.
She signed up to accept help from Healthy Start, a federally funded program that coordinates services for women with high-risk pregnancies. It’s especially designed for new mothers who had little or no prenatal care and for recently discharged infants born at low birth weight. Its home visiting program builds on public health, nutrition and social services offered to women within Pittsburgh and Allegheny County.
Healthy Start was brought to the Pittsburgh area in 1991 because of its relatively high infant death rates. Areas with poverty are particularly vulnerable to the risk factors of infant death, according to Vicki Sirockman, Healthy Start executive director.
The county 2008-12 infant mortality report found that Braddock, McKees Rocks and Mount Oliver were the municipalities with the highest overall infant death rates. In Pittsburgh the highest overall were in the neighborhoods of Homewood South, Northview Heights and Marshall-Shadeland. Gaps between black and white infant death rates were the widest in Penn Hills, Pittsburgh, McKees Rocks and Wilkinsburg.
Ms. Shutika, 30, who lives in North Fayette, said she appreciated Healthy Start’s help with finding resources to help her family when she had her daughter Kamryn in 2015. When she had her first child, Rylie, now 13, she relied on support from her mother.
“I don’t know what I’d do without Healthy Start,” Ms. Shutika said, adding that she welcomes home visits and advice from Healthy Start professionals.
In mid-February Kamryn was seriously working on standing alone and taking her first steps. As she celebrated the milestones, Ms. Shutika was helping Kamryn’s big sister in her activities as a competitive gymnast, and home-schooling Rylie as part of an effort to keep the teen’s Type 1 diabetes under control and help her focus on her classwork. Ms. Shutika is engaged to Joseph Roy, Kamryn’s father.
Healthy Start reports success since coming here, finding a 30 percent decline in the mortality rate in the Pittsburgh areas it serves, and a reduction of 40 percent among Healthy Start participants. A nurse and trained outreach staff work to encourage healthy lifestyles and link families to services and programs that fill their individual needs.
Healthy Start community health worker Tiffani Thompson visits Ms. Shutika’s home to stay up to date with the family’s progress and share insights, such as child development milestones, with the mom. Feeding herself, starting to talk and walk were all signs that Kamryn is developing well, Ms. Thompson said.
“Home visiting is a big part of my job,” said Ms. Thompson, who started with Healthy Start in July 2014. “It’s self-rewarding to help someone when they’re going through a tough situation. It can be empowering to them.” She also teaches Healthy Start Life Skills classes and self-esteem and healthy relationship workshops.
“It’s part of empowering women to make healthy decisions. At Healthy Start, I like the people. We do a lot of teamwork,” Ms. Thompson said. By visiting a woman in her home, “we can see the conditions she lives in, see what she is in need of. For example, in safe sleep, if we see the child doesn’t have a safe sleeping space, we can go in and help them. We work together and resolve the solution.”
Teamwork
A free volunteer program, Healthy Start is now focusing on three ways to reduce child deaths by promoting safe sleeping, breastfeeding and birth spacing.
Ms. Sirockman said 19 African-American babies died in Allegheny County between January and Halloween of 2015, due to sleeping situations. Pediatricians say the only safe sleep position for a baby under 1 is on the back, in a crib with no loose bedding.
“A lot of families are couch surfing. There’s no crib, there’s no Pack ’n Play. … It’s an easy fix, use the Pack ’n Play. Cribs for Kids gives us each Pack ’n Play at two-thirds the cost. We offer girls in high school the Pack ’n Play.” The portable play yards are purchased with donations. (For more on the nonprofit Cribs for Kids, call 1-888-721-CRIB or go to www.cribsfor- kids.org).
Breastfeeding support is a second focus because preterm babies have been known to benefit from breast milk. It appears to reduce their risk of infections, particularly from necrotizing enterocolitis, which causes the death of tissue in the intestine and can be life-threatening. It’s seen most often in premature or sick babies.
“Breast milk is a sampling of the mother’s immune system,” said Sarah Warner, epidemiologist and Healthy Start’s director of IT systems, in charge of the public health data analysis. “We’re encouraging breastfeeding.”
Popular lactation consultant Ngozi D. Tibbs works part time for Healthy Start, leading childbirth and breastfeeding classes and making home visits to moms having problems with nursing their babies. Also a childbirth and breastfeeding teacher at Magee-Womens Hospital of UPMC, Ms. Tibbs is co-founder of the nonprofit Pittsburgh Black Breastfeeding Circle, which promotes and supports breastfeeding among women of African descent.
There’s also a breastfeeding hotline supported with a grant from the Heinz Endowments to the county health department, which has extended support to Healthy Start. The phone help line can connect callers with a certified lactation consultant who can determine if a home visit is necessary. The Breastfeeding Help Line is 412-687-2243 on weekdays from 8 a.m. to 4:30 p.m. After hours help can be found from 4 to 10 p.m. weekdays and from 8 a.m. to 8 p.m. weekends and holidays at 412-247-1000.
Another Healthy Start strategy is to educate women about the importance of taking time before having an additional child.
“Having children too close together can predispose the mother to have preterm babies,” Ms. Sirockman said. Ms. Warner pointed out that it’s recommended that women have at least 18 months between births.
That means a birth control discussion, ideally at the doctor’s appointment six weeks after the first child is born.
“We’re learning that African-American mothers are not going [to that appointment],” Ms. Sirockman said. “At the Magee [Neighborhood Health] clinic, only half of the mothers are coming back. We’re trying to find door-to-door transportation for these mothers.” Medicaid will cover the mother six weeks after the birth, so that appointment is important for birth control coverage, she said.
‘Decades behind’
“Teen births have gone down,” Ms. Sirockman said. “What determines [the infant mortality rate] is how wealthy parents are; how economically secure they are. Infant mortality is a commentary on social inequality.” She serves on the county’s child death review team, which reviews each death. “We find that other factors are involved: jail, homelessness. There’s almost always something [to explain the death].”
Dannai Harriel participated as a young mother in Healthy Start and recommends it. She’s now program manager for the Allegheny County Health Department’s maternal and child health program,
“Healthy Start [can make a difference] earlier in pregnancy, particularly with a first pregnancy. Things happen in a community where people are actually not healthy,” she said, “In generations of families, we’re seeing stress, poverty and crime. We’re decades behind the problem in our community.”
To give communities an even chance, she said the county is partnering with federally qualified health care centers to support health efforts and doing home visit followups to help people build on their strengths.
“With that, plus [dealing with] blight and poverty, you begin to see a future discussion among men and women in Allegheny communities: How do we support communities that aren’t doing so well?”
Jill Daly: jdaly@post-gazette.com, 412-263-1596.
First Published: May 3, 2016, 4:00 a.m.
