I‘m a problem solver as far as health care goes,” says Dr. Michael Clark, one of three physicians at River Rose OBGYN in Athens, Ohio. “It’s my job to keep mom and baby healthy and get them delivered—you might say that I am responsible for delivering the package. As a health educator through the Community Health Program, Mary McPherson’s job is to provide information to expectant mothers so when mom gets the package that baby has the best opportunity to reach its potential as it grows. That’s our whole goal. It’s not just about delivering babies, it’s delivering babies that reach their potential. There’s no way that we as physicians can give the type of support and knowledge that Mary provides to the patient. The only means we have to try and improve our patients’ awareness of their own health is to have someone sit and talk to them and that’s just what Mary does in her role as a perinatal educator. She does an outstanding job and she has an important impact on the baby’s, the mother’s, and often, the family’s well being. Mary is an invaluable member of our team.”

Pam Born, office manager for River Rose, remarks that with the socioeconomic situation most of their patients face, it takes a team, a community, to care for the patients they serve. “Our practice sees patients that are 75% high risk for pre-term births due to lifestyle, environment and medical risks. Our team approach, including partnering with the perinatal education program, has helped us reduce our prematurity rate—in fact; our practice has the lowest rate in the State of Ohio.” Although there are many patients for whom interaction with Mary has been life altering, Pam picks one particular story to share. “We had a patient who was experiencing frequent black outs and unusual weight loss. The doctors were running a series of tests and working to isolate the cause of her symptoms with no luck. Through Mary’s intervention and the patient’s trust in her, she was able to find out that the patient was eating only one slice of bread each day. That’s all the food she had in her house. The patient was afraid to tell the doctors for fear that social services would take her baby away. Mary was able to get the patient enrolled in programs that would provide food and other types of services for her and her unborn child. The rest of the pregnancy went well and the baby was born full term and healthy.”

Dr. Jane Broecker also believes that the perinatal program has played a huge part in the drop in pre-term labor rates. “Through Mary’s intervention we are able to keep better track of the patients at risk. If they don’t have transportation to make their office appointments, Mary finds a way to get them here. She helps keep patients aware of when they should seek care—she’s really thorough and in-depth when talking to the patient about the signs of pre-term labor and what to expect with pain management issues, parenting issues, breast feeding, post-delivery birth control—patients often confide vital information to her that they don’t tell the physicians. Mary may not be giving shots or doing exams, but the health care services she provides are critical in keeping the mothers and their unborn babies healthy.” (Interview Excerpts)

member of the Ohio University College of Osteopathic Medicine’s Community Health Program (CHP), the perinatal services/baby steps program is partially funded by the Ohio Department of Health through the Athens County CFHS program. This program provides support, education and prenatal care coverage for underinsured or uninsured women in Athens County. Case management for at-risk pregnant women is also provided on referral from their health care provider. All clients are educated about pregnancy, delivery post-partum issues and baby care. Education is one of the critical tasks for the perinatal educator, especially given the population served and the health issues, such as diabetes, depression, or the effects of smoking which are common to the Appalachian region (Denham, Meyer, Toborg, & Mande, 2004). In addition to the pregnancy-related information, the perinatal educator also offers smoking cessation tips and information about healthy lifestyle habits including proper nutrition and exercise. Additionally, during the interaction, patients are provided with brochures and other written materials to help with information retention and comprehension (including materials in foreign languages).

Every day more than 1,300 babies in the United States are born prematurely and, as a result, may spend weeks or months in the neonatal intensive care unit and face increased risk of death and serious medical complications (March of Dimes, 2007). The physicians and staff at RiverRose, which partner with the CHP, understand the importance the CHP perinatal services program plays in helping to reduce the percentage of pre-term births in Athens County. In a March 21, 2007, letter written to the president of the O’Bleness Health System, Dr. Clark shares a compilation of statistics from the Ohio Department of Health which demonstrate the positive impact prenatal healthcare providers have had in Athens County. According to these statistics, the pre-term birth rate in Athens County decreased by greater than 1% from 2000 to 2004 (11.7 % in 2000; 10.6% in 2004). This reduction is even more striking considering the March of Dimes’ (2007) report that between 1981 and 2003 the national percent of premature delivery increased almost 31 percent (9.4 to 12.3 percent). According to Dr. Clark, this 1% rate reduction means 6 pre-term births were prevented, the life expectancy for each child was improved, and $1,200,000 in healthcare dollars was saved.

In addition to providing health care education, the perinatal program also provides other services to their patients. When encountering teenage pregnancy, Mary often refers the young women to counselors at their school who are involved in the GRADS (Graduation, Reality and Dual-role Skills) program. The GRADS program works with the teenagers to help them stay in high school and earn their diplomas. Mary also makes patients aware of social services provided in Athens County such as the WIC Program, Healthy Start, and Help Me Grow. With Athens County being the poorest county in Ohio with an individual poverty rate of 27.4% (Job and Family Services, 2006), Mary understands the urgency of getting her patients enrolled in the services they need to maintain a healthy pregnancy or to provide the means for caring for the baby after birth. The assistance that these services make in the lives of people is best illustrated with a story by one of Mary’s former patients and her husband.

We didn’t know about Mary and the perinatal education services until we were in RiverRose. This was our first baby and my wife, Maya¹, didn’t speak very much English. We didn’t know very much about having a baby and we didn’t know how we could make the payments for the doctor and hospital bills. One of the nurses asked if we would be willing to talk to Mary, the perinatal educator. Maya interrupts Seth¹ and says, “Mary always came with books and papers and she would say—in ten weeks this is going to happen, I’ll show you what happens inside your body and outside. She always brings, like baby dolls, to show me how to breast feed and how to care for the baby. She brought papers in Spanish to help me understand. She even learned some Spanish words so she could explain in my language.” Seth nods his head and adds, “Yeah, it was very visual. The interaction was visual and real and tranquil and all those things that made you feel comfortable. Mary is no average Joe off the street. She is a nurse herself, a nurse and a mom, and her son was born premature so she really understands. When I asked Seth to explain exactly how the perinatal program helped he and Maya in addition to the educational and health component, he responded that the program helped propel them and get them moving in the right direction financially. “By getting us enrolled in the right programs, we were able to do and provide in other ways for our family so we didn’t have to worry about being in the hole right from the get go. We didn’t have to worry if we should pay the doctor bill or if we should buy food. The WIC program not only provided assistance with buying food, they also reinforced what Mary taught us about breast feeding techniques and nutritional advice. I don’t see WIC and Help Me Grow as a program for poor people; I see them as assistance for people that are assisting themselves. These programs provide people with a tool that lets you do more. We have our own business now and are starting to do well. That would never have happened without the help of Mary and the perinatal services program. We’re thankful every day for what we have and what we can continue to do.”

[1] Pseudonyms are used for patients throughout this story to protect patients’ privacy.

Written by:  Karen Deardorff, School of Communication Studies, Ohio University, Athens, Ohio. May 18, 2007.

References

Athens County Department of Job and Family Services (2006, November). Athens County, Ohio: An in-

depth look at the issues of poverty. Athens, OH.

Clark, M.J. (2007). Letter to O’Bleness Health System, RiverRose Obstetrics & Gynecology. Athens, OH.

Denham, S. A., Meyers, M. G., Toborg, M. A., & Mande, M. J. (2004) Providing Health Education to

 Appalachia Populations. Holistic Nursing Practice, 18(6), 293-301.

March of Dimes (2007). Premature birth: What we know and what we don’t. Retrieved May 15, 2007,

from http://www.marchofdimes.com.