GOSHEN COUNTY – According to data compiled by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH), rural women suffer pregnancy loss and complications at higher rates due to irregular, poor or inadequate prenatal care for various reasons. Goshen County Public Health (GCPH) is reintroducing its revised, revamped, evidence-based, in-home, mobile prenatal care program, called Wyoming Hand-in-Hand, to all Goshen County residents at no cost in partnership with the Wyoming Department of Health (WDH).

Goshen County Public Health registered nurses Manon Strong, Melissa Johnson and Cindy Wright, sat down with the Telegram to discuss what is new, updated and beneficial to expecting mothers in the county.

What the program, Wyoming Hand-in-Hand, offers is a specially trained nurse to do regular prenatal visits and care from the moment of pregnancy, or up to eight weeks postpartum, through when the child turns two  years old. This program is open to all expectant mothers in the county and is not income based nor income restricted.

Strong said, “The emphasis: the earlier a mother decides to utilize our services, the better, because together in the program we can do risk assessments, build trusting relationships and refer mothers directly to different sorts of specialists and available resources.”

One specialized area of concentration in which Strong, Johnson and Wright are certified in is lactation and breastfeeding.

“Mother’s used to be so terrified of SIDS (sudden infant death syndrome) – and constantly checking to see if their baby was on their backs or rolled into the sides of cribs,” Johnson explained. “But, health care – specifically prenatal care – has come a long way and we know more today than we ever did before, which is some of the education we provide to new mothers.”

Strong added, “But even experienced mothers are learning new things within our program for the same and similar reasons Melissa (Johnson) talked about and we really hope to help educate the mother’s in our county about new prenatal care – and the best, I think, part of our program is we can come to her home, she can come here or we can go any other place she might be more  comfortable at for her prenatal visits.”

Strong explained rural mothers are at higher risks due to a number of factors such as distance between them and health care providers, emergency rooms, hospitals and prenatal care in general, “and Goshen County is no exception to that with many of our more rural communities having to commute at least 30 minutes to even an hour to get into town here in Torrington for basic prenatal care.”

Wright added, “we felt, along with the (Wyoming) Department of Health, that we needed to better attend to our expecting mothers in our rural-most communities and here in Torrington to cut down on the prevalence of pregnancy loss and/or complications.” 

Together, the three women have more than 100 years of nursing experience, specifically in prenatal care and Johnson said their goal is to “get better, correct information and resources into the hands of expectant mothers and to identify, early, any possible pregnancy and/or birth and/or postpartum concern so that we can help guide mother’s to the resources and medical professionals who can help before tragedy happens.”

The program will offer a number of benefits, including specialized and individualized guidance as well as support for each mother and family during pregnancy, postpartum and until the child reaches the age of two during monthly visits initially and taper down to after the six weeks postpartum. During each visit, one of GCPH maternity nurses will perform a well-check of mother and baby, bring along educational materials as well as age appropriate supplies, resources and even toys. Some of the toys donated to the program are top quality and many are learning games, toys.

“We want our community to know this isn’t just a mom’s and babies only program – dads are more than welcome to participate in it also,” Strong added. “Dad’s play a vital role in pregnancy, birth and postpartum, which helps keep families safe and healthy.”

Studies from the NIH indicate that risk factors for pregnancy loss and complications reduce slightly if the father is actively involved from pregnancy through birth and the postpartum period.

“We also come alongside dad’s, dad’s-to-be, in addition to pregnant mothers, and walk alongside each of them during pregnancy, postpartum, birth and up to the baby’s second birthday so that they are informed about developmental milestones, what to expect and where to get help if needed,” Wright added.

“We also supply vital, expensive baby needs, like diapers and in some cases, formula,” Wright said.

The only requirement is that expecting moms must be a Wyoming resident and contact GCPH to schedule an appointment. GCPH can be reached at (307) 532-4069.

“More than 700 women die every year due to problems relating to pregnancy, delivery and postpartum complications, issues and/or concerns,” Strong said, citing data provided by the CDC.

The most common risk factor, and often difficult to diagnose and manage, relates to a number of pregnancy issues concerning high/increased blood pressure – such as hypertension, pre-eclampsia, eclampsia and toxemia.

“We want to ensure that mom’s don’t feel like they are alone in this journey, that they are healthy and happy – and really, that baby is healthy and happy,” Strong explained. “We do this by providing essential prenatal care, such as checking a woman’s heart rate and blood pressure due to our communities being very rural, so we can reduce risk factors and pregnancy, infant mortality rates.”

According to March of Dimes, a national pregnancy, infant loss nonprofit and research organization, roughly 10-15% of pregnancies end in misscarraige in the United States each year during the first trimester before gestational week 12. However, a significantly growing number of pregnancy losses are occurring in the late third trimester and even at birth, or shortly after birth due to a number of factors. Miscarriages occur up to 5% in pregnancies in the second trimester, between 13 and 19 weeks gestation and about 1% of pregnancies end in a miscarriage during the third trimester.

One significant issue is chromosomal abnormalities, especially for mothers who have not undergone genetic testing and/or have limited access to prenatal care, in addition to medical problems, such as blood pressure issues.

March of Dimes lists a number of other risk factors, including mothers aged 35 and older, aging increases risk of miscarriages/loss; mothers who have had/experienced more than one misscarriage, pregnancy and/or infant loss; being exposed to harmful pollutants and chemicals; autoimmune disorders; hormonal problems and imbalances, such as polycystic ovary syndrome (POCS); pre-exisiting diabetes and pregnancy induced diabetes; thyroid medical diagnosis and problems; and smoking, drinking or illict drug use.
The nonprofit also lists that common pregnancy-induced blood pressure issues continue to plague women spontaneously, and emphasizes the need for mothers to continue regular prenatal care to identify issues before they become problematic and/or tragic.

The NIH states, “the deprivation of prenatal care can lead to premature pregnancy, intrauterine growth retardation, low weight at birth, and maternal and child mortality as a result of infections in the perinatal and postnatal periods.”

The agency also states that single women, or women with husbands who work extended lengths of time away from home, such as spouses who are deployed in the military, truck drivers or oil workers, tend to have higher prevalence of pregnancy, infant loss as well as maternal mortality rates. 

Both March of Dimes and the NIH state that about 1% of women nationwide forego any prenatal and postpartum care, with those pregnancies reporting roughly a 40% increase of pregnancy, infant or maternal mortality rates, with rates being significantly higher for rural women and women of color.

“We don’t want our mothers and families here in Goshen County to experience pregnancy, infant or maternal mortality – we want to reduce it as best as we can, and we believe our Hand-in-Hand program, through WDH is how we do it,” Strong explained. “And we do that through a lot of education, so the right information is in the mother’s hands – because, as we learned through the (COVID-19) pandemic, you can Google search and find a lot of bad information or misleading information regarding pregnancy loss.”

Wright added, “But not just that, we are connected to all the local providers and nearby hospitals so we can get mothers the referrals they may need if we have identified a potential risk and/or concern – some of these resources we have available, a lot of our expecting mothers don’t probably know exist.”

Johnson interjected and said, “There is a lot, I think, we can do to better educate our rural communities about the need for pregnancy, prenatal and postnatal care, as well as infant care through the age of two – however, I think the best thing we can do as small communities is to let mothers know they do not have to go through pregnancy alone and sort of ‘figure it out on their own’ sort of deal – we are here and we want to help mothers so they have healthy pregnancies and children.”

GCPH will provide mothers with books and pamphlets, including a speech pathology book with developmental milestone approaches to communicate with newborns and infants as they develop verbal skills – in addition to age-appropriate gifts to celebrate milestones and resources, like diapers, wipes and formula.

“Also, we want mother’s to know we are all certified lactation specialists,” Strong said. “Studies continue to show that when mothers have access to other women who have and support breastfeeding, they are more likely to be successful in breastfeeding. So, we work with mothers to teach them best breastfeeding approaches; what to expect with breastfeeding and breastmilk; how breastmilk changes with the growing; and developing baby and what to expect when changing the diaper of a breastfed child.”

Wright said, “we also teach daddy how to help and support mommy when and if she chooses to breastfeed because studies also show that if dad supports her, she is also more likely to be successful.”

Strong added, “yes, that’s correct, the single-most important factor in being able to breastfeed successfully is if a mother is connected with individuals who have breastfed, support breastfeeding and if daddy is supportive.”

“We work very closely with families to teach them everything they need to know about breastfeeding and what to expect,” Strong said.

The ladies explained that even if breastfeeding is not the mothers choice, they also provide a number of other nutrition supports in the program.

National pregnancy and infant loss remembrance day is Saturday, Oct. 15 this year, with the month of October being pregnancy and infant loss awareness month.

Former President Ronald Reagan declared October national pregnancy and infant loss awareness month in 1988 and since then has been a supporter in advocating for better prenatal care, postpartum care and rights for parents who have experienced losses. He pioneered reforms to help parents who have experienced pregnancy and stillbirth the right to bury their children, because of his work and organizations that support his work, mothers nationwide now have easier access to burial rights.

According to Star Legacy Foundation, a national infant loss awareness nonprofit which collects, archives and distributes data and research, 1-in-4 women will experience pregnancy, infant loss; 70 babies are stillborn every day in the U.S.; 1-in-160 pregnancies end in stillbirth every year; and 1-in-10 gynecologists will be so devastated with a patient’s stillbirth, they will consider changing careers.

Most stillbirths and pregnancy losses are preventable, reliable, timely and adequate prenatal and postnatal care according to both Star Legacy Foundation and March of Dimes. Many risk factors are identified through monthly testing and visits for non high risk pregnancies and weekly testing, visits for high risk pregnancies.

GCPH nurses will also help moms identify if they qualify for additional income-based and income-restricted programs such as Women Infant and Children (WIC), TNAF (food stamps) and/or Wyo Help.

“It’s important our families and mother’s know that we will work with their primary care physician – that we will never go against the doctors nor their orders but we provide the support they may need, when they need it and as they need it, free of charge, through this program as an extra resources because we want to reduce pregnancy loss for our rural communities,” Strong explained. “So if you feel something is wrong, or off, or if you are in pain – we want mothers to immediately call their doctors and the nearest emergency facility to them because we are not a replacement for doctors or equipped to handle emergency situations, we are merely an extra preventative measure to ensure moms and babies are healthy and safe.”

GCPH nurses said their motto is: “Don’t feel like you’re in this alone; let us walk with you in your parenting journey Hand-in-Hand.”

Hand-in-Hand is a WDH funded, maternal early childhood sustained home-visiting program aimed at reducing maternal, pregnancy and infant loss, for more information visit www.health.wyo.gov.