Kentucky maternal health roundtable explores ways to improve Kentucky maternal health; two stories from Kentucky Lantern

Centers for Disease Control and Prevention photo

The Kentucky Lantern offers two stories this week about maternal health in Kentucky, both by Sarah Ladd. One is about a roundtable held in Louisville that was moderated by Carole Johnson, the administrator of the Health Resources and Services Administration for the Biden administration. The other is a Kentucky Lantern Q&A with her. 

The roundtable discussion touched on several topics, including the Health Access Nurturing Developmental Services program, more commonly known as HANDS; praise for Rep. Kim Moser's, R-Taylor Mill, "Momnibus" bill that passed during the 2024 legislative session; and the need for a comprehensive approach toward improving the state's maternal mortality rates, including addressing social determinants of health, which includes things like transportation and housing, and the role that substance-use plays in such deaths.

Kentucky's maternal mortality rates are dismal, according to Ladd's reports. And, they are worse for women of color than white women. 

"The 2023 March of Dimes report showed the state once again had high maternal mortality, which was worse for Black Kentuckians. The state has a maternal mortality rate of 38.4 deaths per 100,000 live births, higher than the national rate of 23.5 deaths per 100,000 live births," Ladd reports.

She adds, "A 2023 state report on maternal mortality also showed substance-use disorder contributed to nearly 60% of all maternal deaths. Most maternal deaths in Kentucky — 88% — are preventable, a report from the Cabinet for Health and Family Services said." 

The links to the stories are below. 

https://kentuckylantern.com/2024/08/09/a-kentucky-lantern-q-a-with-federal-health-

https://kentuckylantern.com/2024/08/08/roundtable-explores-ways-to-improve-kentucky-maternal-health/

New state health laws are in effect; one to regulate herbal drug kratom is in limbo due to lack of funding, Beshear says

Kentucky Capitol (Wikipedia photo)

By Melissa Patrick
Kentucky Health News

A number of new state health laws took effect July 15, ranging from measures on maternal health to improved access to a commonly used allergy medication.

The General Assembly passed more than 200 bills during its 60-day session. They become law 90 days after adjournment of the legislature unless they have a defined effective date, are general appropriation bills, or are passed with an emergency clause. This year, the effective date was July 15.

Some of the health measures that are now law are:

Health Care Liability: House Bill 159, sponsored by Rep. Patrick Flannery, R-Olive Hill, protects health-care providers from criminal liability when a medical error harms a patient. The bill does not apply to harm resulting from gross negligence or wanton, willful, malicious or intentional misconduct.

Kratom: HB 293, sponsored by Rep. Kim Moser, R-Taylor Mill, aims to regulate kratom, an herbal drug frequently sold online and in convenience stores. The bill prohibits sales to people under 21 and provides guidelines for manufacturing and labeling the product.

This bill was included in a list of 22 laws mentioned in an April letter from Gov. Andy Beshear to legislators saying there is a lack of funding to implement them, so that puts this new law in limbo, Liam Niemeyer reports for the Kentucky Lantern.

Maternal health: Senate Bill 74, sponsored by Sen. Shelley Funke Frommeyer, R-Alexandria, aims to support maternal and infant health and reduce the high mortality rate for mothers in Kentucky. Several sections of the bill took effect July 15, including one that will provide more information about breastfeeding and safe sleep to at-risk parents. Others establish a state maternal-fatality review team and require Medicaid to cover lactation consulting, breastfeeding equipment, and in-home and telehealth services. The bill also requires state health officials to compile an annual report about the number and types of delivery procedures performed at each hospital. Other sections of the bill will not take effect until 2025. This bill includes the “Momnibus” bill, which was originally filed as HB10 by Moser.

Medical cannabis: HB 829, sponsored by Rep. Jason Nemes, R-Middletown, updates some aspects of Kentucky’s upcoming medical cannabis program. It allows schools to ban medical cannabis from their campuses and allow local governments to apply a small fee to the program, among other changes. Three sections of the bill related to applications for business licenses, state enforcement and patient pamphlets will not take effect until 2025.

Pseudoephedrine: HB 386, sponsored by Rep. Robert Duvall, R-Bowling Green, eases purchase limits on pseudoephedrine to help people with chronic allergies legally obtain enough of the medication to meet their medical needs.

Vaping in schools: HB 142, sponsored by Rep. Mark Hart, R-Falmouth, bans all tobacco, alternative nicotine and vapor products in Kentucky public schools. It also requires school districts to adopt disciplinary procedures for students who violate the bans.

Veteran suicide prevention: Under HB 30, sponsored by Rep. Michael Meredith, R-Oakland, the Kentucky Department of Veterans Affairs will create a suicide prevention program for service members, veterans and their families.

Youth medical records: HB 174, sponsored by Rep. Rebecca Raymer, R-Morgantown, stipulates that parents have access to their child’s medical records. Prior to this law, children ages 13 and older had to sign a waiver for parents to have access.

Alzheimer's education: HB 459, sponsored by Moser, requires advanced practice registered nurses and physician assistants who primarily work with Kentuckians ages 50 years and older to undergo continuing education related to the detection and treatment of Alzheimer’s and other forms of dementia. This language was added from SB 211, sponsored by Sen. Stephen Meredith, R-Leitchfield, in the final days of the session. The bill also involves the APRN national certification exam and Kentucky Board of Nursing appointments.

News releases from the Legislative Research Commission contributed to this story.

31% of Kentucky women live more than half an hour from a hospital with a maternity unit; across the U.S., only 9.7% do

Map from 2023 March of Dimes report

By John McGary, WEKU

“Estill Medical. This is Madisyn. How may I help you?”

It’s a few minutes before lunch at Estill Medical Clinic, in Irvine. The practice is owned by nurse practitioner and Estill native Donna Isfort. It offers many services, but, like every other medical facility in the county, no obstetrician/gynecologist.

Isfort said, “Many, many of my patients at least have to travel anywhere from 30 minutes to 60, 70, minutes just to get to obstetrical care. There's just not any here. We have no nurse midwives. . . . I do family practice, so I do a lot of women's health at my clinic, but not prenatal care.

Estill County does have a hospital, but a spokesman for Mercy Health-Marcum and Wallace Hospital said it hasn't delivered babies since 1986, not counting unplanned births in the emergency room.

According to a 2023 report by the March of Dimes, women living in what some call “maternity care deserts” like Estill and several nearby counties must travel more than twice as far to get the care they need. Multiple studies conclude that greater distance puts women, expectant and otherwise, at greater risk.

The report says 31 percent of Kentucky women live more than 30 minutes form a birthing hospital; the national figure is 9.7%.

Isfort says she and her staff work closely with the Estill County Health Department to provide the help they can and out-of-county referrals for services they can’t provide.

Some think Kentucky’s maternity care deserts may spread. At a June 24 rally in Lexington to mark the two-year anniversary of the Supreme Court’s toppling of Roe v. Wade, second-year medical student Shriya Dodwani painted a bleak picture.

“The Accreditation Council for Graduate Medical Education requires that OB/GYN residents have access to abortion training,” Dodwani said. “This isn't about politics. It's about ensuring that we have the comprehensive skills needed to provide the best possible care for our patients. Without this training in Kentucky, we're left with no choice but to leave and pursue our education elsewhere.”

In a recent survey of students at Kentucky’s three medical universities, 62 percent of respondents said they’re considering finishing elsewhere because of the state’s near-total abortion ban.

A week later, University of Kentucky HealthCare officials unveiled a plan that could help some women in rural areas. The outreach division of UK Women’s Health OBGYN announced they’d add services at 19 new sites, several in Eastern Kentucky, and expand telehealth services.

Dr. Emily DeFranco is chair of UK’s Department of Obstetrics and Gynecology, said “We'll send a sonographer with an ultrasound machine to the site, and they'll perform the ultrasound and then virtually, by telemedicine, the physician who is in Lexington is able to view the images from the ultrasound, and then have a video conference with the patient on that site and counsel her about the findings.”

That sort of outreach could eliminate some of the long trips many women must make for routine care. Another program, funded in part by Medicaid and tobacco-settlement dollars, helps expectant and new mothers: HANDS, which stands for Health Access Nurturing Development Services. It’s available to all women during pregnancy through a child’s third birthday.

At the Estill County Health Department, Teresa Talbott is the ongoing home visitor, dropping in weekly with 15 to 20 families per year for the last 17 years.

“We're not coming in to look at your home. We're not coming, you know, to tell you what t“o do, Talbott said. “We're just coming in and giving you the information and helping you along with it.”

One woman she’s helping now is Whitney Bingham, who happens to be the health department’s Women, Infants and Children program coordinator. Talbott, who Bingham calls TT, is assisting her and her two-year-old son through challenges ranging from potty training to car-seat installations.

But Bingham says that when it’s time for her to leave for an OB-GYN visit, she makes the hour-long drive to Lexington.

The state Cabinet for Health and Family Services declined our request for an interview with the Department for Public Health’s director of women’s health.

Kentucky gets a 'D' grade on second annual report card on maternal mental health, a bit worse than the national average

By Melissa Patrick
Kentucky Health News

Kentucky received a D grade on the second annual report from the Policy Center for Maternal Mental Health, moving up from a D-minus in last year's report card. The national grade was D-plus; D was the most common grade, and 23 states had grades higher than Kentucky's.

“Maternal mental health is core to the health and well-being of women and families. Our report cards provide state government and advocacy leaders with a tool for identifying areas of opportunity and the ability to track annual progress,” Joy Burkhard, executive director of the policy center, said in a news release from the Milken Institute School of Public Health at George Washington University, which supported creation of the report cards.

“We are particularly hopeful about one of the new measures added this year, which tracks how often women are being screened for these disorders,” Burkhard said. ”Asking about symptoms is the first step toward diagnosis and treatment.”

The report notes that two things changed in Kentucky to improved the state's grade, however slightly. The state now meets the recommended maternal-mental-health prescriber ratio for the perinatal population and has a perinatal quality collaborative that prioritizes maternal mental health (a new category).  

The 2024 report cards include 18 measures that are divided into three key domains: Providers and Programs, Screening and Screening Reimbursement, and  Insurance Coverage and Treatment Payment. 

Kentucky met six of the 18 measures on the report card, with most of them in the Insurance Coverage and Treatment Payment domain, for things like expanding Medicaid, extending Medicaid coverage to one year after birth, and the ability to submit claims to proivate insurers for pre- and post-birth maternal mental-health treatment.

Kentucky got a D for providers and programs, an F for screening and screening reimbursement, and a C for insurance coverage and treatment payment.

What's Kentucky doing? 

Kentucky has several groups working on this issue, including a mental-health initiative in the state Department for Public Health, called the Maternal Mental Health Collaborative, and the Kentucky Perinatal Quality Collaborative, an effort of hospitals, doctors, nurses, public-health experts and others.

Another group working on this issue is the Mind the Gap Kentucky Coalition, which includes Postpartum Support International along with a host of other members, led by Nikki Boyd, the director of maternal infant health initiatives with the March of Dimes. 

"One thing all the groups involved in maternal mental health are doing is being sure to work together, to share resources and reduce unnecessary duplication of effort across the board," Marcie Timmerman, executive director of Mental Health America Kentucky, said in an email. 

In 2023, the legislature passed Senate Bill 135 to require the Cabinet for Health and Family Services to make information on postpartum depression and a postpartum assessment tool available on its website. It also required the cabinet to develop and implement a collaborative program aimed at improving the quality of prevention and treatment of postpartum depression.

In 2024, legislators passed a multifaceted bill dubbed the "Momnibus" as part of Senate Bill 74. It was originally House Bill 10, sponsored by Rep. Kim Moser, D-Taylor Mill. The Momnibus portion of this bill came out of a working group of Republican and Democratic women in the House and the Senate. 

Among other things, the Momnibus ensures access to health-insurance coverage for pregnant women by adding pregnancy to the list of exceptions for enrollment outside the normal open-enrollment period.

It also establishes a mental-health hotline called Lifeline for Moms that allows providers access to an immediate mental-health consultation for a mother in need; expands the Health Access Nurturing Development Services (HANDS) home-visitation program and lets it be available up to three years after birth; covers lactation consultation and needed equipment to encourage breastfeeding; and will educate mothers on the benefits of safe sleep for infants. These services would also be available via telehealth.

"I'm not surprised by our report card here, but I am energized by the existence of more than one advocacy group, the commitment to improving maternal mental health by legislators who were involved in HB 10, which turned into SB 74, and by providers who are increasingly involved in this effort to improve and ultimately save lives," said Timmerman, of Mental Health America.

Boyd said the results of the report card drive a lot of work being done by the Mind the Gap Coalition and the state task force. 

"These are things that can't be done overnight," she said. "There's a lot of policy involved and a lot of across the aisle work that needs to happen for these to happen. . . . It's a good guide, a good metric to help us figure out what the needs are." 

Boyd said each measure on the report card needs to be considered related to the needs of the state. For example, the report card shows Kentucky does not have at least one inpatient maternal-mental-health treatment program, but does not consider that the state does not  have enough patient volume to support one. Places are available to provide this kind of care, but she said this is something the state should monitor. 

Boyd said she's excited that Kentucky is taking the reins on this issue. 

"Kentucky's really doing a good job around prioritizing this and doing small things to ensure that Kentuckians are getting access," she said. "So obviously, there's a long way to go, but  I think getting it started, it's a great, great start." 

National numbers and efforts

The national grade improved slightly from a D to a D+, with four states earning B grades, up from one in the 2023 report; 19 states receiving C grades, up from 10 in 2023; 24 states receiving D grades, down from 25 in 2023; and five states getting a failing grade, down from 15 in 2023.  

"The U.S. is failing mothers," says the report. 

On May 14, the U.S. Department of Health and Human Services released the Task Force on Maternal Mental Health's national strategy to address maternal mental health, calling it an "urgent public-health crisis." The news release said the U.S. has the highest maternal death rate among high-income countries and 22% of the deaths are related to suicide, drug overdose, mental-health issues and substance-use disorder. 

“Many of these tragic deaths can be prevented by eliminating health disparities and understanding the impact of mental health during pregnancy and in the first months as a parent,” said HHS Secretary Xavier Becerra. “We want to address the challenges people are facing, decrease stigma associated with these challenges, and improve access to support both inside and outside of the health-care system.”

The five pillars of the national strategy are: building a national infrastructure that prioritizes perinatal mental health and well-being, with a focus on reducing disparities; making care and services accessible, affordable, and equitable; using data and research to improve outcomes and accountability; promoting prevention and engaging, educating, and partnering with communities; and lifting up the voices of people with lived experience, according to the news release.

'Momnibus' bill to improve maternal health passes on final day, after being attached to another bill to avoid floor fight on abortion

Rep. Kim Moser presents SB 74
to the state House (Ky. LRC photo)

By Melissa Patrick and Al Cross
Kentucky Health News

On the last day of the 2024 legislative session, a bipartisan bill aimed at improving Kentucky's dismal maternal-mortality rate was finally passed, after parliamentary maneuvering to avoid divisive issues.

Provisions of House Bill 10, known as the "Momnibus" bill for its varied approach, were added to Senate Bill 74, a bill to require analysis of child and maternal fatalities and add reporting requirements.

The Momnibus bill, sponsored by Republican Rep. Kim Moser of Taylor Mill, came from an informal, bipartsan House-Senate workgroup of female legislators who tackled a big problem: the nation's second highest rate of death of mothers in the year following childbirth. 

From that came a multifaceted bill that ensures access to health-insurance coverage for pregnant women by adding pregnancy to the list of exceptions for enrollment outside the normal open-enrollment period, and several other things.

It establishes a mental-health hotline called Lifeline for Moms that allows providers access to an immediate mental-health consultation for a mother in need; expands the Health Access Nurturing Development Services (HANDS) home-visiation program and lets it be available up to three years after birth; covers lactation consultation and needed equipment to encourage breastfeeding; and will educate mothers on the benefits of safe sleep for infants. These services would also be available via telehealth.

Democratic Sen. Cassie Chambers Armstrong of Louisville told the Senate that Moser "brought together a bicameral, bipartisan group of women legislators and "This is a truly great piece of legislation that will absolutely save lives."

The final bill dropped controversial language that added by a Senate committee. It would have required all hospitals, birthing centers and midwives to refer patients to a perinatal palliative-care program if the patient had a prenatal diagnosis that indicated a "baby" might die before or after birth. Kentucky abortion law does not allow for the termination of such pregnancies, though it is considered a standard of care for a nonviable pregnancy.

Abortion prompted the parliamentary maneuvering. Democratic senators filed floor amendments to Moser's HB 10 to change "baby" to "fetus"; let a physician terminate a pregnancy if it is complicated by a fatal fetal anomaly, or in the good-faith belief that the pregnancy was caused by rape or incest. To avoid a Senate floor fight over the issue, Moser looked for another vehicle.

She found SB 74, sponsored by Sen. Shelley Funke Frommeyer, R-Alexandria, with an apt title. "I saw 'An act relating to maternal health'," she recalled. "It was germane, and apropos. . . . It works really well with the underlying bill."

Funke Frommyer said SB 74 was viewed favorbaly by a House committee, but didn't get a floor vote before legislators recessed to give Gov. Andy Beshear time to veto legislation and give them time to override his vetoes. Moser said the House considered the bill safe from a veto because it was non-controversial.

The original parts of SB 74 require the Cabinet for Health and Family Services to publish a report on its website for the most recent five years of available data on the number and types of delivery procedures for pregnancy by hospital.  It also has cleanup language for a number of health-cabinet programs.

The revised, combined bill passed the House 91-1, with Rep. Courtney Gilbert, R-Hodgenville, voting against it. On the House floor, Rep. Lindsey Burke, D-Lexington, praised the bill and Moser's work.

 "I have never been more delighted, proud or excited to vote for any single piece of legislation," Burke said. "It is a gift to the families of the commonwealth. I thank her for her hard work." 

The Senate agreed to the changes on a 29-5-2 vote, with Republicans Greg Elkins of Winchester, Jimmy Higdon of Lebanon, Chris McDaniel of Ryland Heights, Robby Mills of Henderson and Stephen West of Paris voting no and Republicans Donald Douglas of Nicholasville and Adrienne Southworth of Lawrenceburg passing. Republican John Schickel was absent.

Sen. Amanda Mays Bledsoe, R-Lexington, told the Senate, "I thought it was fantastic to have a Kentucky-crafted legislation that looked at solutions for us and not other states. . . . I just complement the bill sponsors and members of that working group for the good work."

Abortion did hit the Senate floor late in the day, as Sen. David Yates, D-Louisville, tried to bring up his SB 99, which would have added rape and incest exceptions to state abortion laws. Senate leaders ruled his action out of order, and when he appealed the ruling, senators upheld it largely along party lines.

State's high maternal-death rate gets study; pregnancy-related deaths mostly from violence, substance use, anxiety, depression

UK researchers studying the state's high maternal-mortality rate include (front row, left to right) Anna Chamberlain, Ann Coker, Linda Berry, Heather Bush; (back, left to right) John O'Brien, Cynthia Cockerham, Dana Quesinberry and Josh Bush. (Photo by Jeremy Blackburn, UK Research Communications)

Thursday, April 11 is the International Day of Maternal Health and Rights.

By Lindsay Travis
University of Kentucky

A team of health-care providers and researchers at the University of Kentucky is working with community and government leaders across the state to address a pressing issue facing the state: its high rate of death and illness among women who give birth.

“Kentucky has one of the highest maternal mortality rates in the country. Lowering the proportion of women dying during or after childbirth in our state is not just a goal, but a necessity to safeguard the health and futures of both mothers and their children,” said Dr. John O’Brien, director of the Division of Maternal Fetal Medicine at UK HealthCare. O'Brien is also a professor in the Department of Obstetrics and Gynecology in the UK College of Medicine, and the appointed chair of the Kentucky Maternal Morbidity and Mortality Task Force in the state’s Cabinet for Health and Family Services.

The task force is funded by a $5.2 million, five-year grant from the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

The state has a Maternal Mortality Review Committee that determines the causes of maternal deaths and identify opportunities for preventing future deaths, through policy or practice. The panel has documented that substance use, injury and behavioral-health conditions are all common contributing factors to maternal death or maternal illness, also called maternal morbidity.

“In Kentucky, the study of severe maternal morbidities reveals a stark reality that these outcomes are deeply intertwined with health-care disparities,” O’Brien said. “Rural communities and people of color bear a disproportionate burden, highlighting the urgent need to address systemic inequalities in maternal healthcare access and quality.”

O'Brien's task force will work with hospitals, other health-care providers, community partners and state agencies to implement and promote best practices to make birth safer, improve maternal health outcomes and, ultimately, save lives.

The task force will work with state agencies to develop a scorecard to track severe maternal-health issues, using hospital records. The team will also create a data surveillance system to monitor maternal deaths and injuries, with a goal of making this information publicly available.

“Our team also wants to be able to provide critically important hands-on learning opportunities for smaller hospitals to be prepared to handle pregnancy-related complications,” said O’Brien. “We also want to extend and assist coordination of telehealth services to birthing facilities throughout the state as we have shown reduction of severe morbidity in rural communities is possible through telehealth availability.”

The federal grant will also fund bystander-informed violence intervention and prevention training specifically for obstetric health-care providers to address maternal health related to violence.

“In Kentucky, the majority of pregnancy-associated maternal deaths stem from partner or family violence, substance use and anxiety or depression,” said Dana Quesinberry, associate director of the Kentucky Injury and Prevention Research Center and an assistant professor of health management and policy in the UK College of Public Health. “Our goal is to leverage our collective expertise to share violence intervention and prevention training models statewide to make a targeted effort to reduce these types of death.”

“The majority of violence-related maternal deaths ARE preventable. We are firm in our belief that this proactive approach will offer hope to mothers in our state and make a measurable difference in health outcomes,” said Ann Coker, one of the team leaders on the project. She is the Verizon Wireless Endowed Chair in the Center for Research on Violence Against Women and a professor of epidemiology in the Department of Obstetrics and Gynecology.

O'Brien said, “This task force is a comprehensive project involving multiple stakeholders and a crucial step for Kentucky moving forward. By uniting expertise, resources and advocacy, our goal is to ensure every mother receives care and support.”

In addition to the grant, HRSA provided $170,233 to be used for Medicaid redetermination and postpartum-care coverage navigation for pregnant and postpartum individuals and their families. “We have utilized these funds to establish a Perinatal Community Health Worker Program . . . to provide culturally and linguistically matched services to pregnant and postpartum persons in the state,” said Cynthia Cockerham, community program and research director for UK HealthCare’s Division of Maternal Fetal Medicine.

The study team also includes Linda Berry, a registered nurse and perinatal substance use coordinator at UK HealthCare; Public Health Dean Heather Bush, an endowed professor in the Center for Research on Violence Against Women; and Dr. Barbara Parilla, medical director of the UK HealthCare Perinatal Assistance and Treatment Home (PATHways) program and a professor in the Department of Obstetrics and Gynecology.

To inquire about the task force, email Kentucky_MMM@uky.edu. For more information about the Perinatal Community Health Worker Program, email PerinatalCHW@uky.edu.

A webinar to discuss how a new Transforming Maternal Health Model provides opportunities to improve rural maternal-health access will be held at 12:30 p.m. ET April 18. This is the newest model from the Centers for Medicare and Medicaid Services.  At 2 p.m. April 23, the Rural Helath Information Hub is hosting a webinar obstetric readiness in rural facilities without birth units.