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New York City Council Oversight Hearing: Prenatal Care in New York City Hospitals

Mitchell Katz, M.D., President and Chief Executive Officer
NYC HEALTH + HOSPITALS
Tuesday, January 21, 2020

Prenatal Care in New York City Hospitals

Good morning Chairperson Rivera and Members of the Committee on Hospitals. I am Dr. Machelle Allen, Senior Vice President and Chief Medical Officer at NYC Health + Hospitals (“Health + Hospitals”). I am joined by Dr. Wendy Wilcox, Chair of OB/GYN at Health + Hospital/Kings County and Clinical System Lead for Maternal Mortality Reduction and Women’s Health and Co-Chair the New York State Taskforce on Maternal Mortality and Disparate Racial Outcomes. On behalf of Health + Hospitals’ CEO, Dr. Mitchell Katz, thank you for the opportunity to testify before you to discuss prenatal care at Health + Hospitals.

As the largest public health care system in the United States, Health + Hospitals’ mission is to deliver high-quality health care services to all New Yorkers with compassion, dignity and respect, without exception. We serve over 1.1 million New Yorkers every year across the five boroughs and empower them to live their healthiest lives. The system is an anchor institution for the ever-changing communities it serves, providing hospital and trauma care, neighborhood health centers, skilled nursing facilities and community care, including care coordination and home care.

Improving maternal and infant health has been a central focus of the de Blasio administration and Health + Hospitals. In FY19, we had approximately 160,000 prenatal visits and over 15,000 babies were born. We are committed to providing and protecting the full spectrum of women’s health care; our doors remain open to all, and we will continue to support our patients in providing state-of-the-art and culturally competent care.

Addressing Pregnancy-related Morbidity and Mortality

Our 2019 community health needs assessment identified reducing the burden of life cycle-driven illness and health equity challenges as a priority health need. As such, we have implemented several initiatives to improve pregnancy and birth outcomes at Health + Hospitals. In 2018, in partnership with the Mayor’s Office and the New York City Department of Health and Mental Hygiene (DOHMH), we began implementing a comprehensive maternal care program with the focus of identifying and responding to pregnancy-related morbidity and mortality for women of color. In our maternal medical home, care coordinators and social workers provide care management and screening for depression, clinical conditions, trauma, social determinants of health and psychosocial conditions to patients predisposed to or at high risk for poor or adverse pregnancy outcomes. They help patients navigate their appointments and receive supportive services.

Our simulation-based program trains doctors, nurses and others on the delivery team to respond to the highest risk emergency situations – shoulder dystocia, hypertensive disorders in pregnancy, maternal hemorrhage, and cardiac arrest – in the labor and birthing suites. The simulation trainings are just the latest contribution of the public health system to address maternal health. We are the only health system in New York State identified by the American College of Obstetricians and Gynecologists to have every one of its facilities participating in the Safe Motherhood Initiative.

The interval pregnancy optimization program helps to improve maternal health by training providers to ask patients specifically about pregnancy intention. In this way, the health of the woman may be optimized before she becomes pregnant. And, our mother-baby coordinated visit program aims to increase adherence to the postpartum visit by having the patient scheduled with the baby’s visit.

Addressing implicit bias, which is the unconscious attitudes or stereotypes that can affect behaviors, decisions, and actions in the treatment of women of color who are pregnant is a priority at Health + Hospitals. As such, we provided training to our obstetrical leaders and other trainees from across the system on implicit bias through Re-Birth Equity Alliance. The trainings were launched in October and focused on improving equity in childbirth.

We are working hand-in-hand with DOHMH to provide training sessions in all of the acute care facilities in Health + Hospitals, as well the voluntary not-for-profit hospitals participating in the DOHMH Maternal Hospital Quality Improvement Network (MHQIN), which is a comprehensive strategy with 14 NYC maternity hospitals to address the root causes of persistent racial/ethnic disparities in maternal mortality and severe maternal morbidity with emphasis on the importance and the “how to” of setting up a quality improvement process in their departments. With DOHMH support, the eight H+H hospitals in the MHQIN are integrating reviews of all cases of pregnant and postpartum patients with severe hemorrhages and ICU admissions (severe maternal morbidity) into our quality assurance and improvement processes, and providing data to DOHMH to inform population-based strategies to address these conditions. MHQIN hospitals are also partnering with DOHMH to implement the NYC Standards for Respectful Care at birth, further training on implicit bias by Perception Institute, and training and practice changes to promote respectful patient-provider interactions.

Our Health + Hospitals/Community Care program ensures that pregnant women access the highest quality of care in a home setting, which includes antepartum assessment and instruction, breastfeeding teaching and support, high risk infant care, among others. Additionally, ten of our acute care facilities have earned the prestigious “Baby-Friendly” designation from the World Health Organization, in collaboration with the DOHMH NYC Breastfeeding Hospital Collaborative, for promoting the highest level of care for infants through breast feeding and promoting bonding between mother and baby.

Reducing Preterm Birth

As part of the New York City’s Birth Equity Initiative, Health + Hospitals partnered with DOHMH and the Centering Healthcare Institute to launch CenteringPregnancy, an evidence-based group prenatal program, at Health + Hospitals/Elmhurst Hospital. CenteringPregnancy has been shown to improve maternal and infant health outcomes including reducing preterm birth, which is the leading cause of infant death, and encourages greater patient engagement during the prenatal experience. The program features group pregnancy visits with a provider, networking with other pregnant women, group discussions, and prenatal wellness and education classes on nutrition, stress management, and breast feeding. All pregnant women are eligible to participate in the group care sessions and are asked to join during their initial prenatal visit unless their pregnancy shows sign of being or becoming very high-risk. The sessions begin at about 16-20 weeks gestation, and occur with the same frequency and routine pregnant care visits.

Maternal Depression

Pre-natal and postpartum patients seen at Health + Hospitals are screened for maternal depression, a commitment that was reinforced by the Maternal Depression Learning Collaborative started by ThriveNYC and run by the Greater New York Hospital Association and DOHMH. Mothers are screened in both the OB-GYN and Pediatric Clinics during well-baby visits. Those who are positive for possible depression are connected to counseling and if needed continuing mental health care. In 2019, maternal depression screening rates remained high for all prenatal and postpartum patients, and for new mothers presenting in pediatrics. The screening rates for prenatal, postpartum, and pediatric patients were approximately 95%, 96%, and 92%, respectively.

Midwifery and Doula Services

Midwifery services are offered throughout Health + Hospitals to improve patients’ experiences. Last year, Health + Hospitals/North Central Bronx opened its renovated and expanded midwifery unit. With an investment of $50,000 the unit’s clinical space has doubled from 2,300 square-feet to 4,800 square-feet. With all clinical services available on one floor, expectant patients can easily access obstetrics and gynecological services and the Labor and Birthing Suite. Patients will also be able to access the Maternal Fetal Unit for specialized ultrasounds. We are currently collaborating with DOHMH to assess our midwifery services, to highlight what’s working, and what areas need improvement.

Health + Hospitals accesses doula services through our relationship with community – based organizations. Health + Hospitals/Kings County refers patients to Brooklyn Perinatal Network and DOHMH’s By My Side Doula programs. Over the past three years, physicians, midwives, and nurses have held multiple meetings at Health + Hospitals/Kings County with the doula organizations to learn more about the services that doulas provide and to bond and form relationships with one another. Over the last three years, we have made many referrals for doula support for patients giving birth at Health + Hospitals/Kings County.

In conclusion, we would like to thank the Council for its support of Health + Hospitals in providing funding for state-of-the-art equipment to improve the care and outcomes for the women we serve, including Chairwoman Rivera and Councilmember Mark Treyger’s recent FY20 appropriation of $400,000 in capital funding for upgrades to critical OB/GYN ultrasound equipment at Health + Hospitals/Coney Island.

Thank you for the opportunity to testify today. We are happy to answer any questions.