It’s hard to quantify how much of an impact postpartum health visits have on new mothers in rural Crawfordsville, Indiana.

“The word I generally use is immeasurable,” said Darren Forman, who runs Project Swaddle through the Crawfordsville Fire Department. 

“We’re doing everything we can to get data, but unfortunately some of what we’re doing is what I call proving a negative… I’m trying to prove that I’m keeping babies out of the NICU and moms out of the ER. Proving a negative is almost an impossibility.”

Project Swaddle is a home visitation program that provides care, education and support to pregnant and postpartum mothers in the town of just over 16,000 about 50 miles northwest of Indianapolis. Forman, who is a paramedic, and other first responders within the fire department help more than 200 women and their newborns stay healthy and safe.

The program is working, he said.

“Our breastfeeding has trended between 15% and 20% higher than the national averages and the previous Montgomery County averages, since the inception of my program,” he said. “Smoking reduction is off the charts. Fetal and maternal deaths are… very, very low compared to where they were previously.”

Recent studies show that postpartum education and support is vital in ensuring the health of mothers after giving birth but that rural women are more likely to have barriers to accessing that care

According to the Centers for Disease Control and Prevention (CDC), maternal death rates have been on the rise, increasing 40% in the last decade. Sixty percent of those deaths are preventable, research shows. More than 50% of maternal deaths are due to obstetric-related causes, while one in five are drug-related, or due to homicide or suicide.

“We do know from other recent studies that although maternal mortality increased in both rural and urban areas, it was nearly twice as high in rural areas,” said Mariana Tuttle, researcher with the University of Minnesota’s Rural Health Research Center. ”In 2019, our research showed that women had a 9% additional increased risk just because they lived in a rural area for deaths and near misses to severe maternal morbidity and mortality.”

Tuttle’s research found rural women often did not receive postpartum care like contraceptive counseling, depression screening, smoking screening, abuse screening, eating and exercise discussions, and birth-spacing counseling.

With many rural areas losing obstetrics programs within their local hospitals, or losing their hospitals all together, rural women face increased barriers to postpartum care, Tuttle said.

“It’s pretty clear that the decline of hospital-based obstetric services means you’ve got reduced access to high quality care for emergencies and generally in rural communities for postpartum care,” she said. “It’s also true that rural residents are more likely to be poor and they’re more likely to have chronic conditions. Some of those can be cardiovascular conditions that can be linked to higher rates of pre-eclampsia and things that can impact health in a negative way during postpartum.”

Additionally, mental health is also a factor, she said, which can put rural women at risk because of the shortage of mental healthcare providers in rural areas.

In Crawfordsville, Project Swaddle came about, Forman said, when the community recognized there was a need to help women and children. A community health needs assessment by both Franciscan Health Crawfordsville and the county health department found gaps in care for mothers and babies in the area after the hospital closed its birthing unit in 2011.

City and county officials recognized something needed to be done, Forman said. And what do you do when you’re in trouble? You call the fire department, he said.

Initially, the program started with Forman serving as a mobile connector to get women to engage in prenatal care and help them access social service resources if they needed them. Once a doctor in the community saw what Forman was doing, the program was expanded to reach high-risk parents throughout the county.

The program reduced ER visits by 85%. And the interpersonal relationships that he developed with the parents allowed him to talk with them on the phone if they had a concern rather than running to the hospital.

Tuttle said in another recently released study, that programs, like the one in Crawfordsville, can help rural women overcome those barriers to care.

“There are so many different kinds of postpartum supports that can help folks at varying degrees of their postpartum journey… We’ve seen a growing number of really innovative community-based programs that help support postpartum health in local rural communities,” she said.

Where there isn’t a local program, rural women can access national programs. Another recently released study looked at two national programs that combine virtual platforms with person-to-person support to bridge the gaps in access to care rural women face, she said. Those programs, the study found, can serve as examples to others as ways to help rural residents after the birth of a child.

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