Baby bexar: healing families and building community in bexar county and beyond - expectant and post-partum mothers in south-central texas face a combination of adverse maternal health outcomes,…

Baby bexar: healing families and building community in bexar county and beyond - expectant and post-partum mothers in south-central texas face a combination of adverse maternal health outcomes, socioeconomic conditions, and the chronic disease triad of obesity, hypertension and diabetes. Over 5,000 pregnant and postpartum women are seen annually at university health: more than 80% are hispanic and over 85% are uninsured or on medicaid. Hispanic women experience some of the highest rates of severe maternal morbidity (SMM), nearly 30% higher than non-hispanic white women. Some of the highest rates of SMM in texas are among women without private payer insurance coverage. By integrating social services that support expectant and post-partum women into perinatal and post-partum care, we can help mothers overcome these and other challenges they face in raising a health family. University health proposes the baby-bexar (pronounced bear): healing families and building community, an integrated perinatal-comss program. Using a health equity, culturally-competent, trauma-informed lens tailored to the population of focus, baby-bexar will make a measurable impact on maternal and infant health outcomes by a) increasing access to healthcare including mental healthcare, b) mitigating the effects of obesity, hypertension and diabetes on pregnancy, maternal and infant health outcomes, and c) connecting women and families to supportive services that reduce the negative impacts of sdoh. Baby-bexar will be deployed at university health women's health clinics throughout bexar county which annually serve over 5,000 expectant and postpartum mothers from bexar and 27 surrounding counties in texas public health region 8. Every expectant and post-partum mother seen at a university health clinic will be screened for connection to program services, with a focus on mothers who are ethnic or racial minorities, mothers who are medically high-risk due to obesity, hypertension, or diabetes or other conditions, mothers with depression, and mothers who are uninsured or medicaid beneficiaries. Each baby-bexar mother will be assigned a community health worker who will provide education and information, ensure medical care follow-up, and connect the MOM to comss partners as appropriate (education includes a pregnancy companion smart-phone APP integrated with the electronic health record system that provides patient education during the pre-and post-natal periods with special modules for gestational diabetes, blood pressure, and weight gain). Baby-bexar participating mothers will have access to a perinatal nurse who will educate them and their and families about self-care and infant care, resolve medical questions, and conduct home visits as needed. Mothers who choose to do so will be matched with a doula for prenatal, postpartum, labor and delivery support, courtesy of the partnership with catholic charities and SAN antonio birth doulas. Those mothers who screen positive for depression or anxiety will receive mental wellness support via the partnership with family service. Mothers who screen positive for other sdoh will be connected to wrap-around support services, including support for families of children with a medical diagnosis through our partnership with any baby can, and other wrap-around sdoh support, such transportation and food through collaboration with family service, catholic charities and alamo regional transit. Incentives, such as diapers and other helpful items, will be used to encourage patient engagement. University health and partners are excited to implement baby-bexar and achieve improved health outcomes and health equity for the families, mothers, and babies of south-central texas.