Written by Brieanne Lyda-McDonald

Infant mortality has been slowly improving over the past 20 years in North Carolina, yet babies born here are still more likely to die than those in 37 other states. While maternal and infant outcomes need to be improved for all, women and infants of color are significantly more likely to have poor pregnancy and birth outcomes. Black babies are more likely to die in utero, be born preterm and low birth weight, and die in their first year of life than white infants, and Black women are 3 to 4 times more likely to die from pregnancy-related causes than their white peers.

The COVID-19 pandemic and recent protests against police brutality and systemic racism are shining light on the stark realities of the social and health disparities that Black people face in our country. It is with this backdrop that the North Carolina Institute of Medicine is sharing the recently published recommendations of the Task Force on a Perinatal System of Care for North Carolina in the report, “Healthy Moms, Healthy Babies: Building a Risk-Appropriate Perinatal System of Care for North Carolina.”

In 2016, the Women’s Health Branch of the North Carolina Department of Health and Human Services (NC DHHS) released a 12-point Perinatal Health Strategic Plan to address infant mortality, maternal health, maternal morbidity and mortality, and the health status of women and men of child bearing age. The plan was developed based on a framework of closing the Black/white disparity gap in birth outcomes that is applicable to all populations. In response to one of the plan’s goals, as well as Session Law 2018-93, NCIOM partnered with the North Carolina Division of Public Health and NC DHHS to convene a task force to develop recommendations to ensure that pregnant women and high-risk infants have access to the risk-appropriate level of care through a well-established regional perinatal system.

This task force met a total of 11 times throughout 2018-2019 and developed 20 recommendations, including:

• Developing a risk-appropriate regional perinatal system of care that uses national maternal and infant risk-appropriate level of care standards,
• Re-establishing North Carolina’s Perinatal and Neonatal Outreach Coordinator Program,
• Expanding access to health care services for women who are uninsured,
• Extending coverage for group prenatal care and doula support,
• Granting full practice authority for Certified Nurse-Midwives,
• Expanding access to perinatal mental health services,
• Collecting and reporting data on maternal and infant outcomes by race and ethnicity,
• Engaging in quality improvement efforts with insurers and birthing facilities to address racial and ethnic disparities in care,
• Developing parent navigator programs at birthing facilities, and
• Supporting pregnant women, infants, and their families through the use of community health workers and family-friendly work policies.

These recommendations call on state government, health care providers, health professional and trade organizations, health care payers, and other stakeholders to support the development of a regionalized and risk-appropriate perinatal system of care and to address some of the nonclinical health needs of moms and babies in North Carolina.

The task force was co-chaired by Walidah Karim, DNP, CNM, Certified Nurse Midwife at Cone Health Medical Group – Center for Women’s Healthcare at Women’s Hospital; Kelly Kimple, MD, MPH, FAAP, Section Chief for the NC DHHS, Division of Public Health – Women and Children’s Health Section; M. Katherine Menard, MD, MPH, Professor, Vice Chair for Obstetrics and Director at the UNC Maternal-Fetal Medicine; and LaToshia Rouse, Parent, Speaker and Parent Advisor for the Newborn Individualized Developmental Care and Assessment Program.

Read the full report here.