'Momnibus' bill aimed at lowering state's maternal-mortality rate, second highest in the nation, moves to the full House for a vote

By Melissa Patrick
Kentucky Health News

A bill aimed at decreasing the state's high maternal-mortality rate was approved by the House Health Services Committee Thursday and now awaits a vote in the full House. It's been dubbed the "Momnibus" bill.

The prime sponsor, Rep. Kim Moser, R-Taylor Mill, who chairs the committee, said House Bill 10 was the result of an informal House-Senate workgroup that dug into Kentucky's maternal-mortality data over the summer to try to understand why the state has the nation's second highest rate of death in the year following a childbirth in the nation, according to the Centers for Disease Control and Prevention.

Reps. Kim Moser and Nancy Tate
presented the "Momnibus" bill
to the House Health Services
Committee. (Photo by Melissa Patrick)

“It was a bipartisan, bicameral look at what’s wrong with our maternal health in Kentucky, why are our numbers so high and what can we do about it,” she later told reporters. “So this really addresses the priorities that we thought we could tackle.”

She told the committee that the bill addresses a number of contributors to the state's high maternal-death rate. 

"Initiatives that are included in this legislation will address the high rate of substance-use disorders, which are now the number one reason that Kentucky women die in the first year following childbirth; a lack of access to prenatal care, a lack of access to mental health treatment, a lack of education and this also provides a referral to service including treatment support and follow up care," she said.

Kentucky's maternal-mortality rate is 38.4 maternal deaths per 100,000 live births, according to CDC data gathered by the Kaiser Family Foundation. This number includes the deaths of women while pregnant or within 42 days of termination of pregnancy in 2018-21. During that time, Kentucky had 81 maternal deaths.

Rep. Nancy Tate, R-Brandenburg, a co-sponsor of the bill, said 89% of the deaths could be preventable and that 54% of the deaths are related to substance-use disorder. 

Moser agreed, telling reporters, " “I mean, if we’re talking about the maternal-mortality numbers that rival a third-world country, we have got to get serious about this."

What would the bill do? 

A key part of the bill would allow a special health-insurance enrollment period for pregnancy by allowing it to be designated as a "qualifying life event." Said another way, this would allow a woman without health insurance to sign up for coverage at any time after becoming pregnant.

“We discovered that pregnancy was not considered a qualifying life event for some insurance, and we just want to close that gap and make sure that moms can get the prenatal care that they need,” said Moser. "That's the period of time when we know that any chronic disease or any health issue is picked up and can more easily be dealt with." 

It also would establish the Kentucky maternal psychiatric access program, called the "Kentucky Lifeline for Moms." 

This program would establish a dedicated hotline to allow health-care providers to connect with a psychiatrist or a psychologist as a way to help address maternal mental health issues. It would be operated by the Cabinet for Health and Family Services and open weekdays from 8 a.m. to 5 p.m.

Moser said the state has a $750,000 grant to implement this program, but it is important to codify it to make sure it is long-lasting. 

"We know that mental health is an issue that is not being adequately addressed," she told reporters. 

The bill also calls on the cabinet to establish the Kentucky maternal and infant health collaborative. A committee substitute added two additional members to the collaborative, one from the cabinet's Department for Public Health and one from a local health department. 

Moser said this collaborative will oversee the psychiatric lifeline, will collect data, monitor the program and inform future policy needs. CHFS will also study doula certification, and whether or not this is a valuable service, said Moser. 

It also amends and expands the Health Access Nurturing Development Services (HANDS) program, a voluntary home-visitation program for new or expectant parents, to require it to provide lactation counseling, education about the importance of breastfeeding and to provide information about safe sleep for babies. It would also ensure that HANDS clients can participate via telehealth if needed. 

“Telehealth has become a really common-sense way to help address some of the health situations that we’re seeing," Moser told reporters. " If there are some needs that a mom has, we were looking for any way to help her." 

The amended version of the bill also included remote patient monitoring as a billable service for prenatal care and added in-home addiction treatment as a billable service. It also changed the phrase "pregnant individual" to "pregnant woman." 

Rep. Rachel Roarx, D-Louisville, asked Moser whether a person who identifies with a "gender marker of a different sex" would be excluded from this bill. Moser said the bill would "cover anyone who is carrying that pregnancy. . . . At this point in time, women are the only persons who can conceive and carry a pregnancy to term.”

The bill passed out of the Feb. 8 committee meeting on a vote of 15-0-2, with Reps. Josh Bray, R-Mount Vernon, and Felicia Rabourn, R-Pendleton, passing. Bray said he had questions about the "defrayal" cost to the state Department of Insurance and about a possible floor amendment. 

Earlier, Moser mentioned the possibility of a floor amendment to "really target who is able to provide this open enrollment." She also noted that she had not seen this bill marked as a "cost defrayal" to the state and that it "doesn't substantially raise the rates." The department's financial-impact statement estimates that the bill would increase premiums as much as $1.42 per member per month, or might not increase them at all.

Kentucky's breastfeeding rate is one of the lowest in the U.S.

Photo: Kybreastfeeding.com
(Click link for more information)

By Melissa Patrick
Kentucky Health News

The federal Centers for Disease Control and Prevention says breastfeeding is a key strategy to improve public health, and Kentucky ranks 48th among the states in the percentage of mothers who breastfeed.

Studies show that children who have been breastfed have less risk of respiratory infections, Sudden Infant Death Syndrome, Type 1 and Type 2 diabetes, obesity and asthma. Mothers who breastfeed have a decreased risk of  breast, ovarian and endometrial cancers and heart disease, all conditions that plague Kentucky.

"I don't think we have any pill, any vitamin, any thing that we can take that can reduce the risk of all these diseases just at once. Like, take this pill once a day and you will be able to decrease all these diseases. There is nothing like that," Ana Maria Linares, an associate professor at the University of Kentucky College of Nursing, said in a telephone interview. "But we can give that to our babies with exclusive breastfeeding."

The American Academy of Pediatrics recommends that infants be only breastfed for the first six months, with continued breastfeeding alongside complementary foods for at least one year.

"Breast milk is especially adapted to be easily absorbed by the baby gut . . . and produces a specific microorganism in the gut that (will) protect the infant," Linares said.

The CDC's 2016 Breastfeeding Report Card says Kentucky's breastfeeding rates are slowly improving, but remain very low.

The U.S. Department of Health and Human Services sets Healthy People goals in a plan to improve the nation's health.

Six months after giving birth, 35.3 percent of Kentucky mothers reported  breastfeeding their infants some of the time, with only Louisiana (31.2 percent) and Mississippi (23.9 percent) having lower rates. Only 19 percent of mothers in Kentucky breastfed exclusively after six months; that was much closer to the national figure of 22.3 percent.

Two-thirds of mothers in Kentucky said they tried breastfeeding at least once, indicating a willingness to do so and perhaps a lack of support to continue, the report said. Nationally, 81 percent of mothers tried breastfeeding at least once.

"We are getting there," said Linares, the UK professor whose research focuses on breastfeeding. "I am really positive about that  because more and more mothers are willing to breastfeed now, at least give it a try. And that is a lot to say because before they wouldn't even consider it."

Rates for Kentucky mothers who have breastfed their infant for six months has improved by almost 34 percent since the CDC started publishing these report cards in 2007, up from 26.4 percent. And improved 153 percent for Kentucky mothers who breastfed exclusively for six months, from 7.5 percent. Data from the 2007 report came from 2004.

Linares said Kentucky is working to teach health-care providers about the importance of breastfeeding and has increased its pre-natal education about breastfeeding. The state offers a peer-counseling program that puts mothers who have had a good breastfeeding experience in touch with new breastfeeding mothers.

"The peer counselor program is one of the most important programs in the state," because it provides support for mothers not only to start breastfeeding, but to also maintain it, Linares said.

The state is also working to get hospitals certified as "Baby Friendly," which, among other requirements, allows the mother and baby to have "skin-to-skin" contact for at least two hours, with has been proven to prompt breastfeeding.

Kentucky has three such hospitals: Norton Women's and Kosair Children's Hospital in Louisville, St. Elizabeth Medical Center in Northern Kentucky, and University of Kentucky Hospital in Lexington.

Linaes said that Kentucky has work to do on its societal views of breastfeeding, because some mothers still feel that they don't have enough support to do it, especially in public places. Kentucky has had a law since 2006 that allows mothers to breastfeed anywhere.

"We need to have a law that protects mothers so that they can have maternity leave, to stay home for at least one month so that they can establish breastfeeding," Linares said, adding that six months would be preferable.

Linares said the U.S. is one of only three developed countries that doesn't offer paid maternity leave, which she said creates a situation which poses a question for mothers: "Should I work or should I breastfeed my baby?" She cited a study indicating if 90 percent of U.S. mothers were able to breastfeed exclusively for the first six months, it would save the country "billions of dollars" and "many lives."

Common beliefs about obesity and weight loss found to be myths

Think going to gym class drives weight loss, or that breastfeeding protects a child from obesity? Think again, because these are among seven popular myths about obesity myths, according to an international team of researchers.

The seven popular but largely inaccurate beliefs, which lead to poor policy decisions, inaccurate public-health recommendations and wasted resources, were identified by the team led by David Allison, associate dean for science in the School of Public Health at the University of Alabama at Birmingham.

Here are the seven myths:

• Myth 1: Small, sustained changes in how many calories we take in or burn will accumulate to produce large weight changes over the long term.
Fact: Small changes in calorie intake or expenditure do not accumulate indefinitely. Changes in body mass eventually cancel out the change in calorie intake or burning.

• Myth 2: Setting realistic goals in obesity treatment is important. Otherwise, patients become frustrated and lose less weight.
Fact: Some data suggest that people do better with more ambitious goals.

• Myth 3: Gradually losing weight is better than quickly losing pounds. Quick weight losses are more likely to be regained.
Fact: People who lose more weight rapidly are more likely to weigh less, even after several years.

• Myth 4: Patients who feel “ready” to lose weight are more likely to make the required lifestyle changes, do health-care professionals need to measure each patient’s diet readiness.
Fact: Among those who seek weight-loss treatment, evidence suggests that assessing readiness neither predicts weight loss nor helps to make it happen.

• Myth 5: Physical-education classes, in their current form, play an important role in reducing and preventing childhood obesity.
Fact: Physical education, as typically provided, does not appear to counter obesity.

• Myth 6: Breastfeeding protects children against future obesity.
Fact: Breastfeeding has many benefits for mother and child, but the data do not show that it protects against obesity.

• Myth 7: One episode of sex can burn up to 300 Kcals per person.
Fact: It may be closer to one-twentieth of that on average, and not much more than sitting on the couch.

The research team also defined six “presumptions" that are generally held to be true even though more studies are needed before conclusions can be drawn, such as the idea that regularly eating versus skipping breakfast contributes to weight loss. Studies show it has no effect.

The same goes for the idea that eating vegetables by itself brings about weight loss, or that snacking packs on the pounds. According to Allison and colleagues, these hypotheses have not been shown to be true, and some data suggest they may be false.

The researchers also identified nine research-proven facts about weight loss. For example, weight-loss programs for overweight children that involve parents and the child’s home achieve better results than programs that take place solely in schools or other settings.

Also, many studies show that while genetic factors play a large role in obesity, “Heritability is not destiny.” Realistic changes to lifestyle and environment can, on average, bring about as much weight loss as treatment with the most effective weight-loss drugs on the market. (Read more)