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Tennessee Department of Health Vaccine-Preventable Diseases and Immunization Program and VFC interest form: Vaccine Operations Enrollment Hub Questions, please email [email protected] Key Takeaways The VFC program removes financial and logistical barriers to vaccination, allowing infants to receive life-saving vaccines at birth and during routine pediatric visits without cost to families. RSV immunization availability represents a major breakthrough in infant protection, with up to 90% effectiveness; birthing hospital enrollment is critical to reaching newborns during peak RSV season (October-March). Tennessee's declining kindergarten immunization rates and rising pertussis cases underscore the urgent need to expand VFC provider enrollment and improve vaccine access across the state. Hospital enrollment in VFC is administratively manageable with state support; the process includes paperwork, staff designation, temperature monitoring, and a site visit—not prohibitive barriers. Despite vocal vaccine hesitancy, most Tennessee parents support immunization; increasing provider enrollment directly addresses access issues rather than demand issues. Quotable Moments "VFC has prevented over 508 million illnesses across the U.S., avoided over 1.1 million deaths, and saved nearly $2.7 trillion." "Our ultimate goal is for babies to have access to life-saving vaccines before they leave the hospital." "These immunizations are up to 90% effective in preventing RSV-related hospital admissions. So we have a really, really great tool in our toolbox and we want to try to find a way to get this tool to all of our babies across Tennessee." "Most people still want their kids to be vaccinated. So I want everyone to take that home as like the main takeaway." Show Notes by Barevalue. No content or comments made in any TIPQC Healthy Mom Healthy Baby Podcast is intended to be comprehensive or medical advice. Neither healthcare providers nor patients should rely on TIPQC’s Podcasts in determining the best practices for any particular patient. Additionally, standards and practices in medicine change as new information and data become available and the individual medical professional should consult a variety of sources in making clinical decisions for individual patients. TIPQC undertakes no duty to update or revise any particular Podcast. It is the responsibility of the treating physician or health care professional, relying on independent experience and knowledge of the patient, to determine appropriate treatment.

In this episode of Healthy Mom, Healthy Baby Tennessee, Dr. Connie Graves and Dr. Lynlee Wolfe explore the critical role of patient event debriefs in perinatal care, with a particular focus on women with cardiac conditions during pregnancy. They discuss what a clinical debrief is, how it differs from informal feedback, and why structured debriefs are essential for improving team performance and patient safety. The conversation also touches on the emotional well-being of providers following adverse events, the emerging practice of patient-centered debriefs, and how simulation training has long modeled effective debriefing. A real-world example illustrates how a debrief led to a meaningful system change that directly improved care for future cardiac patients. Key Takeaways A clinical debrief is a structured, team-based conversation held after any clinical event — positive or negative — with the goal of identifying what went well, what could be improved, and what actionable system changes should follow. Women with cardiac conditions face heightened risks throughout pregnancy, labor, and the postpartum period, making regular and structured debriefs especially critical in their care. Debriefs differ from informal feedback in that they are structured, team-wide, and designed to maintain psychological safety by preventing blame, hierarchy, and emotion from dominating the discussion. Anyone on the care team can facilitate a debrief — the key is establishing a blame-free, improvement-focused environment where all voices are equally valued. Using a structured debrief form — whether from ACOG, AIM, SMFM, or a unit-developed version — is essential for keeping discussions on track, brief (typically five to ten minutes), and productive. Debriefs play a meaningful role in supporting provider well-being by addressing the "second victim" phenomenon, helping team members process difficult events without internalizing blame. Patient-centered debriefs, while not yet standard practice, are an emerging tool for addressing birth trauma and validating patient experiences following adverse events. Simulation training has long demonstrated the power of post-event debriefs, and clinical teams can draw directly from that model to strengthen real-world learning and outcomes. A real-world example showed that a single debrief following a cardiac patient's ICU admission led to a lasting system change — a dedicated, accessible location for patient care plans — that improved safety for all future patients. Quotable Moments "The process of doing a debrief is you go through an event. It can be a good event. It can be a bad event, a critical event, an adverse event. There's some clinical event that occurs and the team feels like it's time to sit down and discuss what happened." — Dr. Lynlee Wolfe "Everybody thinks pregnancy is not really a medical condition, but we all know it is a medical condition and there are definitely things that can happen." —Dr. Lynlee Wolfe "When we perform that debrief, we're trying to make sure everybody's input is taken and you do it in a non-punitive, non-blame-free environment." — Dr. Lynlee Wolfe "The purpose of the debrief is quality improvement. It's emotional processing. It is not blame. It is not to find mistakes or evaluate personal performance." — Dr. Lynlee Wolfe "We work as a team. We win as a team. We lose as a team. Everything's a team effort, especially on our labor and delivery units." — Dr. Lynlee Wolfe "The debrief is really that learning point. And as in that simulation cycle that solidifies knowledge and helps improve outcomes overall and long term." — Dr. Lynlee Wolfe "The best one is the one that you know you will use on a regular basis." — Dr. Lynlee Wolfe "What somebody feels is what they feel. So we need to validate and then help process through that rather than explain to them, no, this is actually what happened." — Dr. Lynlee Wolfe "There was a care plan in there. It did talk about fluid management and how we should be careful because even though she's physically stable at that moment, her ejection fraction was not at a point where we really needed to push anything." — Dr. Lynlee Wolfe Show Notes by Barevalue. No content or comments made in any TIPQC Healthy Mom Healthy Baby Podcast is intended to be comprehensive or medical advice. Neither healthcare providers nor patients should rely on TIPQC’s Podcasts in determining the best practices for any particular patient. Additionally, standards and practices in medicine change as new information and data become available and the individual medical professional should consult a variety of sources in making clinical decisions for individual patients. TIPQC undertakes no duty to update or revise any particular Podcast. It is the responsibility of the treating physician or health care professional, relying on independent experience and knowledge of the patient, to determine appropriate treatment.

Key Takeaways Cardiac disease is one of the leading causes of maternal mortality in the United States, making multidisciplinary cardio-obstetrics teams essential for improving outcomes. Effective cardio-obstetrics teams should include maternal-fetal medicine specialists, experienced cardiologists, anesthesiologists, pharmacists, social workers, nurse navigators, and other specialists as needed, all centered around the patient. Starting a cardio-obstetrics program doesn't require having everything in place at once - begin by identifying existing strengths and building from there with passionate team members. Vaginal delivery is typically safer than cesarean section for women with cardiac conditions due to less blood loss and fewer rapid circulatory changes. Standardized protocols should form the foundation of care, with individualization based on patient-specific factors like exercise tolerance, other medical conditions, and other health factors. Communication style matters significantly in multidisciplinary teams - asking "can you tell me why" instead of "I'm not sure why" fosters collaboration rather than defensiveness. Telemedicine and technology can help overcome major barriers to care, particularly transportation challenges in rural areas where hospitals are closing. The biggest challenge in building cardio-obstetrics programs is often changing mindsets from competition to collaboration, with all team members understanding that the patient should be at the center. Quotable Moments "Cardiac disease is one of the leading killers of pregnant women in the United States in particular, not just during pregnancy, but in the postpartum period where women are left are often vulnerable." "The cardiologist is not the obstetrician. So what cardiologists should not do or there should not be an overlap between delivery planning." "Labor is like running a marathon and so therefore when one is in labor, there are a lot of shifts that go on that affect the heart." "Vaginal delivery is, is much easier. You're much less likely to lose blood. It is much better for the baby." "It is quite difficult to navigate pregnancy even when it's normal. But now when you're asking a patient to come in, take medications, see the cardiologist, see the maternal fetal medicine specialist, sometimes they already have an obstetrician, they need to have a scheduled appointment with the anesthesiologist, it can be overwhelming." "I believe in starting small is important, find what you need to do and, and we talk about this in the CCOC bundle. Find what your team is already doing." "The hallmark of care should be your standardized protocols. You should start there." "I think you have to balance moving toward programming. Say okay, if you want me to build a cardio obstetrics program because we are the level four regional perinatal center in my area, these are the resources I'm going to need." "I always talk about this a lot as how you ask questions and how you present yourself really helps team dynamics." "If I've conveyed to the patient as somehow one of the team members doesn't, is not trustworthy or really doesn't know what they're doing, then the patient loses trust in the whole team." "We should be talking about equity, but we should be talking about health justice. because there's so many barriers in the American medical system to getting care." "If the patient is at the center, then we all join hands around the patient to make sure that there are just no gaps in the care that the, that patient receives." Show Notes by Barevalue No content or comments made in any TIPQC Healthy Mom Healthy Baby Podcast is intended to be comprehensive or medical advice. Neither healthcare providers nor patients should rely on TIPQC’s Podcasts in determining the best practices for any particular patient. Additionally, standards and practices in medicine change as new information and data become available and the individual medical professional should consult a variety of sources in making clinical decisions for individual patients. TIPQC undertakes no duty to update or revise any particular Podcast. It is the responsibility of the treating physician or health care professional, relying on independent experience and knowledge of the patient, to determine appropriate treatment.

Infant Health Strategic Plan: https://www.tn.gov/content/dam/tn/health/program-areas/INFANT%20HEALTH%20STRATEGIC%20PLAN%202024-2028.pdfCFR Webpage: https://www.tn.gov/health/health-program-areas/fhw/child-fatality-review0.htmlFIMR Webpage: https://www.tn.gov/health/health-program-areas/fhw/infant-mortality-reduction.html Key Takeaways Tennessee's infant mortality rate of 6.6 deaths per 1,000 live births in 2022 consistently exceeds the national average, with over half of all child deaths occurring before a child's first birthday. The Tennessee Infant Health Strategic Plan (2024-2028) provides a comprehensive, data-driven roadmap with seven key strategic areas: family planning, prenatal care, birth outcomes infrastructure, safe sleep, preterm birth prevention, breastfeeding support, and smoking cessation. Approximately 25% of infant deaths in Tennessee are sleep-related, making education and implementation of the ABCs of safe sleep (Alone, on their Back, in a safe Crib) a critical prevention strategy. Early prenatal care is essential, with the goal to increase first-trimester access from 71.4% to 75% through programs like presumptive eligibility, TennCare enrollment, and the CHANT (Community Health Access and Navigation in Tennessee) program. New legislation (Senate Bill 1283) requires three syphilis screenings during pregnancy to combat rising congenital syphilis rates, demonstrating the state's commitment to evidence-based interventions. Successful implementation of the plan requires collaborative efforts across state agencies, healthcare providers, community organizations, and families, with all partners encouraged to think creatively about their role in promoting infant health. Supporting maternal health through comprehensive services—including mental health treatment, substance use disorder support, smoking cessation programs, and breastfeeding resources—is fundamental to improving infant outcomes. Quotable Moments "Our data shows us that in 2022, over half of all child deaths in Tennessee occurred before the child's first birthday from 2017 to 2022, the Tennessee infant mortality rate or a number of infants who died for every 1000 live births was consistently higher than the national rate with 6.6 deaths per 1000 live births in Tennessee in 2022." "The primary focus of this work is to bring that number down, increasing the number of children born in Tennessee that get to celebrate their first birthday and many more birthdays after." "In Tennessee, about a quarter of all infant deaths are sleep related. The American Academy of Pediatrics Safe Sleep recommendations play an important role in preventing these deaths and the ABCs of safe sleep." "A leading cause of infant mortality in Tennessee is preterm birth. Any infant born earlier than 37 weeks gestation is considered preterm and is at higher risk for adverse outcomes, including death." "These are real children and real families, and unfortunately, far too often real tragedies, we need to all work together to improve infant outcomes for families, communities, and the future of Tennessee." "Together we can help ensure that more babies born in Tennessee get to celebrate their first birthday and many more beyond that." Show Notes by Barevalue. Add Show Notes Here No content or comments made in any TIPQC Healthy Mom Healthy Baby Podcast is intended to be comprehensive or medical advice. Neither healthcare providers nor patients should rely on TIPQC’s Podcasts in determining the best practices for any particular patient. Additionally, standards and practices in medicine change as new information and data become available and the individual medical professional should consult a variety of sources in making clinical decisions for individual patients. TIPQC undertakes no duty to update or revise any particular Podcast. It is the responsibility of the treating physician or health care professional, relying on independent experience and knowledge of the patient, to determine appropriate treatment.

Contact information: West Tennessee: Sequitha LeFlore-Thomas, Email: [email protected] Phone/Fax: 901-448-9982 Instagram: @wombandwell_np Middle Tennessee: Susan Drummond, email: [email protected] [email protected] Perinatal Regionalization Program Class Registration Form East Tennessee: Michelle Oglesby, Email: [email protected] or [email protected] Phone: 865-305-9300 Office or 715-401-3548 Cell Southeast Tennessee: Jennifer Shelton, Email: [email protected] BEH Office: (423) 778-3547 Northeast Tennessee: Brandi Pratt, Email: [email protected] 423-431-5352 Key Takeaways Tennessee faces significant rural healthcare challenges with many counties lacking hospitals or obstetric services, making emergency department and EMS training critical for maternal and infant outcomes All five regions offer comprehensive, tailored education including fetal monitoring, high-risk pregnancy complications, simulation training for emergencies, and NRP certification for first responders Simulation-based training has proven immediately effective, with multiple examples of providers successfully applying learned skills within hours or days of receiving education Regional educators customize their offerings based on local equipment, resources, and scope of practice, ensuring practical application in real-world scenarios The statewide initiative provides free NRP training for EMS, fire departments, and police as first responders, recognizing that many deliveries occur outside hospital settings Collaboration between hospital systems, emergency departments, EMS, and educational teams is essential for improving maternal and infant health outcomes across Tennessee Healthcare providers can access these educational resources by contacting regional educators directly via email or phone to schedule customized training sessions Quotable Moments "I am passionate about women's health. I'm a Mississippi native, but Memphis has been home for me for about 15 years now." "Just seeing how confident they were in their skillset afterwards, we kinda assess it before the class and then again afterwards." "I've been in this position for over 30 years" "It's so rewarding to see a new nurse go from novice to expert in their skill in interpreting tracings, which is such an important part of care for patients in labor." "Many patients deliver far from home and first responders and emergency departments without OB services are often the first point of contact." "The crew arrived, delivered the baby, and successfully provided care for both mom and baby. Knowing that the education we provided was immediately applied in real life and made a difference for the family was incredibly rewarding" "I love having an opportunity to educate in several different variations of skill sets and to be able to have fun and allow them to walk away with that one wow factor that kind of sticks with them" "Without this education we would've never known what to do. I think that makes all of our jobs rewarding and it really hits home when we get to help celebrate those wins" "One of the things that I really focus on as part of the OB um, educator is being ready for the delivery with how to set up their warmer" "Being asked to come back always makes me feel like I'm doing a good job and that we're all taking part in and helping to take care of our moms." Show Notes by Barevalue. No content or comments made in any TIPQC Healthy Mom Healthy Baby Podcast is intended to be comprehensive or medical advice. Neither healthcare providers nor patients should rely on TIPQC’s Podcasts in determining the best practices for any particular patient. Additionally, standards and practices in medicine change as new information and data become available and the individual medical professional should consult a variety of sources in making clinical decisions for individual patients. TIPQC undertakes no duty to update or revise any particular Podcast. It is the responsibility of the treating physician or health care professional, relying on independent experience and knowledge of the patient, to determine appropriate treatment.

Key Takeaways Respectful care panels provide invaluable opportunities for healthcare teams to hear directly from patients in a non-clinical setting, bridging the gap between provider intentions and patient experiences. Simple actions like sitting down when speaking with patients, using their names, and making eye contact can dramatically improve how patients perceive their care and feel respected, often requiring no additional time. When recruiting patient and family partners for panels, plan to invite at least twice as many participants as you hope to have attend, as last-minute conflicts with young children and family illnesses are common. Financial stipends for patient participation demonstrate that healthcare organizations value patients' time and opinions, and can be especially important for economically disadvantaged families. Creating comfortable environments for patient panelists through thoughtful seating arrangements, positioning trusted advocates nearby, and using welcoming body language helps facilitate honest, open dialogue. Patient panel members can become ongoing resources for healthcare teams, providing quick feedback on proposed changes and helping ensure patient-centered decision-making beyond the initial panel event. Increasing survey response rates through accessible methods like QR codes on discharge instructions is essential for gathering actionable feedback to improve patient experiences. Quotable Moments "I think the patient family just gives the medical team another look just to sometimes that you just don't think of it. You think you're doing everything that you should be doing, but things slip through the cracks and this panel is able to, you know, kind of point those out." "I feel very strongly that the best way to be patient-centered and to make patient-centered changes is to listen directly to the patients." "Her doctor took the time and she said that when he pulled up the stool and sit down and, and called her by name, which I thought was so funny, called her by name and began to go through the next step with her that that changed how she felt about what was going on." "It is interesting how much things that we as providers consider to be small changes can really make such a huge impact in how the patient perceives their care and how they feel." "The best way to take care of patients and give good patient care is to listen to your patients." I would wholeheartedly agree with inviting at least twice as many patient family partners as you would like to have in attendance because there will always be last minute things that come up in conflicts where they're not able to attend." Show Notes by Barevalue. No content or comments made in any TIPQC Healthy Mom Healthy Baby Podcast is intended to be comprehensive or medical advice. Neither healthcare providers nor patients should rely on TIPQC’s Podcasts in determining the best practices for any particular patient. Additionally, standards and practices in medicine change as new information and data become available and the individual medical professional should consult a variety of sources in making clinical decisions for individual patients. TIPQC undertakes no duty to update or revise any particular Podcast. It is the responsibility of the treating physician or health care professional, relying on independent experience and knowledge of the patient, to determine appropriate treatment.

Disclosures: Dr. Creech has disclosures of grant funding from NIH, CDC, Moderna, Pfizer and has been a consultant for Merck, Sanofi Paseur, TD. Cowen. Guidepoint Global, GSK, Delbiopharm, Dianthus, AstraZenecka and receives royalties from UpToDate Websites: Philadelphia Children's Hospital Vaccine Education & Resources VUMC Children's Immunization Guide AAP Recommended Books: Anxious Generation: How The Great Rewiring of Childhood Is Causing an Epidemic of Mental Illness, Jonathan Haidt Righteous Mind: Why Good People Are Divided by Politics and Religion, Jonathan Haidt Key Takeaways RSV prevention now includes both maternal vaccination during third trimester and monoclonal antibodies for infants, both showing 60-80% reduction in hospitalizations Hepatitis B vaccine is fundamentally a cancer prevention tool, and the birth dose is recommended at population level to prevent missed cases even when individual risk appears low Cocooning newborns through family immunization for influenza, pertussis, RSV, and measles is critical as community vaccination rates decline Effective vaccine conversations require avoiding shame and blame, expressing intellectual humility, asking "why" to understand concerns, and providing trusted resources rather than just education The future of vaccine development includes improved flu vaccines requiring less frequent administration, alternative delivery methods (intranasal, oral, microneedles), and advanced tools to understand rare adverse events While vaccine-preventable diseases like measles are increasing in pockets of under-vaccinated communities, maintaining high vaccination rates is essential to prevent widespread outbreaks of highly contagious diseases Parents face significant peer pressure around vaccine decisions, and healthcare providers should acknowledge this while modeling respectful dialogue with those who disagree Quotable Moments "What is hepatitis B vaccine? It's a cancer prevention vaccine period. It prevents liver cancer. Why would I not want a cancer preventing vaccine?" "An ounce of prevention is worth a pound of cure rather than knowing how to treat meningitis really effectively. Wouldn't it be great if we could prevent it all together?" "I think we need to recognize that we probably want the same thing, except in extraordinarily weird situations. We both want the health of that child." "I recognize that there is still much to learn about these things, but here's where I land." "Vaccines and your baby's health, that's just more complicated than 140 characters." "Measles is the second most contagious virus on the planet behind smallpox, which is eradicated. So it's the first most contagious virus on the planet." "I want to prevent you from coughing by jabbing this metal needle into your child's thigh. Like that's weird." "we need to find common ground. Ground. We need to be curious. We need to be intellectually humble. We need to invite conversation." Show Notes by Barevalue. No content or comments made in any TIPQC Healthy Mom Healthy Baby Podcast is intended to be comprehensive or medical advice. Neither healthcare providers nor patients should rely on TIPQC’s Podcasts in determining the best practices for any particular patient. Additionally, standards and practices in medicine change as new information and data become available and the individual medical professional should consult a variety of sources in making clinical decisions for individual patients. TIPQC undertakes no duty to update or revise any particular Podcast. It is the responsibility of the treating physician or health care professional, relying on independent experience and knowledge of the patient, to determine appropriate treatment.

Neonatal Resuscitation Contact Neonatal Outreach for Middle Tennessee Key Takeaways Tennessee has 55 out of 95 counties without OB services, making EMS preparedness for unexpected deliveries critical for saving newborn lives Neonatal Resuscitation Program (NRP) training for EMS has increased from less than 3% to almost 31% statewide through dedicated funding and outreach efforts Newborn resuscitation differs fundamentally from adult resuscitation, requiring ventilation first rather than compressions because babies have never breathed before Proper equipment including small masks, uncuffed tubes, and appropriate supplies must be available on ambulances for effective neonatal care Multiple EMS schools now require NRP certification before graduation, ensuring future EMS professionals are prepared to handle neonatal emergencies Regular simulation drills involving multiple disciplines (dispatch, EMS, ED, OB, pediatrics) are essential for maintaining skills and identifying system gaps The first few minutes of a baby's life are irreplaceable, making immediate, proper resuscitation techniques critical for positive outcomes Families should know their local EMS response times and which nearby hospitals offer OB services for emergency planning Quotable Moments "I think the most important thing that I have learned out of all of those travels is the most important thing in these babies' lives are the first responders, whoever is right there at delivery because we cannot give that time back to those babies." "I said, but can we put a price tag on a baby's life?" "So we have taken the numbers that have NRP from less than 3% in the state to almost 31%. So we're getting there one class at a time." "if you don't use it, you lose it." "And the babies are coming in in so much better shape than what they were before we started doing education." "I said there's really, there's only two, two facts about babies. One, they'll always be babies conceived. And two, no matter how good you are at your job, not all babies survive. But we owe it to them to do the best job we possibly can because that's why we're here." "No mother should have to bury a child." "I said, if you are not a little bit afraid, you scare me to death." "Time is important. We have a, a county on the northern border and they got a call from the county." "I'm hoping it won't be long until we have all the equipment on these trucks that we need" Show Notes by Barevalue. No content or comments made in any TIPQC Healthy Mom Healthy Baby Podcast is intended to be comprehensive or medical advice. Neither healthcare providers nor patients should rely on TIPQC’s Podcasts in determining the best practices for any particular patient. Additionally, standards and practices in medicine change as new information and data become available and the individual medical professional should consult a variety of sources in making clinical decisions for individual patients. TIPQC undertakes no duty to update or revise any particular Podcast. It is the responsibility of the treating physician or health care professional, relying on independent experience and knowledge of the patient, to determine appropriate treatment.

Website: www.charitylasha.com Contact Charity: [email protected] Key Takeaways Miracles require going through difficult processes - wanting a miracle and being willing to endure the challenging journey to achieve it are two different things that require faith and commitment. Parents of NICU babies need support too - while medical teams and loved ones focus on the sick infant, parents often neglect their own emotional and physical wellbeing and need reminders that they will also be okay. Hope can be cultivated through small daily practices - naming a feeding tube "Hope" transformed a medical device into a daily reminder of possibility and positive thinking. Pushing children beyond their comfort zones builds critical skills - introducing children to various activities like music, cooking, and sports develops executive function, dexterity, and self-confidence, especially important for children with developmental challenges. Living in the present moment provides strength during crisis - focusing on "we're still alive right now" rather than catastrophic future possibilities can provide the resilience needed to continue fighting. Statistics don't determine individual outcomes - despite a 7% chance of normal life, faith, determination, and consistent effort can lead to outcomes that defy medical predictions. Reframing negative self-talk matters - changing "I'm a sick kid" to "I'm a kid that gets sick" shifts perspective from identity to temporary circumstance. Quotable Moments "Who am I to stop the opportunity at life? But at the same time, I didn't want to be selfish." - Charity on making the decision to give Leia a chance at life. "I think oftentimes we like to want miracles to happen in our lives, and we're excited to hear about other people experiencing miracles, but we're not always willing to go through the process of what that looks like practically." - Charity on the reality of miracles. "I decided that we had two options. I was either going to leave the hospital with my kid or I was going to leave the hospital with my kid." - Charity on refusing to consider giving up. "The idea of thinking about having a funeral for a 6-year-old was just not an option." - Charity on what drove her determination. "Hope, which is the belief that a positive future is possible. And it's often accompanied by a sense of expectation and desire for an outcome to occur." - Charity defining why she named the feeding tube Hope. "Stay encouraged and stay courageous." - Leia's message to babies in the NICU and their families "I think the one thing I would have wanted to know is that charity, you're going to be okay too." - Charity on what she wishes someone had told her during the NICU stay. "Jesus is not dead. He's alive." - Charity's billboard message. "Strong elephant actually meant that I was going to get through it. And like, I'm very strong and brave 'cause elephants are not scared of anything." - Leia explaining her book illustration. "With practice and consistency and me encouraging her to believe in herself. She then gets things that someone else may have said she would never be able to do." - Charity on her parenting philosophy. Show Notes by Barevalue.

Help us improve the health of all moms and babies | March of Dimes Key Takeaways: Perinatal quality collaboratives like TIPQC serve as essential engines for change by building local trust and driving clinic-by-clinic, hospital-by-hospital improvements that create momentum for state and national progress. Data-driven approaches that engage diverse stakeholders can shift harmful narratives and create more effective, compassionate policy solutions, as demonstrated by Tennessee's neonatal abstinence syndrome surveillance system. Maternity care deserts are not naturally occurring phenomena but result from deliberate policy decisions, requiring intentional policy solutions around reimbursement models and workforce development. Clinicians should leverage their expertise in policy and advocacy spaces, starting with addressing frustrations in their own practice settings and recognizing they are the experts policymakers need. The United States faces a maternal and infant health crisis with two women dying daily during pregnancy or postpartum and two babies dying hourly before their first birthday. Low-dose aspirin for preventing preeclampsia is a cost-effective intervention that remains woefully underutilized, with less than half of high-risk women receiving recommendations from providers. Progress is possible even in challenging circumstances, as Tennessee has shown statistically significant improvement in preterm birth rates through focused efforts on interventions like pregnancy smoking cessation. Effective maternal and infant health improvement requires collaboration across multiple sectors including hospitals, clinics, community health centers, Medicaid programs, community-based organizations, and retail pharmacies. Quotable Moments "Every single day we lose two women in this country either during pregnancy or labor and delivery or the year postpartum. And every hour of every day, we lose two babies in this country before their first birthday." "The solution to this crisis can't be driven solely by the federal government or by, by state governments or by a single organization." "What works in one state may not work in another. In fact, what works in Memphis may not work in Knoxville or Nashville." "I promise you, you are far and away the expert in maternal health or infant health in the room. You, you eat, sleep and breathe this every day." "Unlike those naturally occurring deserts where species have adapted over millennia to, to thrive in an, in an environment of scarcity, the deserts we're talking about are the result of deliberate policy decisions and deliberate resource allocations." "Those very basic easy questions should never be the stumbling block to a family meeting their breastfeeding goals." "We were able to show from our data collection that the majority of babies born with withdrawal were born to moms who were using at least one substance prescribed to them by a licensed prescriber in the state of Tennessee." "Start where you are. So if, if there's a, a challenge in the way, for example, your hospital approaches low dose aspirin for reducing the risk of preeclampsia, maybe you work in an outpatient clinical setting and you haven't built in the standardized screening to assess a pregnant woman's risk for preeclampsia." Show Notes by Barevalue. No content or comments made in any TIPQC Healthy Mom Healthy Baby Podcast is intended to be comprehensive or medical advice. Neither healthcare providers nor patients should rely on TIPQC’s Podcasts in determining the best practices for any particular patient. Additionally, standards and practices in medicine change as new information and data become available and the individual medical professional should consult a variety of sources in making clinical decisions for individual patients. TIPQC undertakes no duty to update or revise any particular Podcast. It is the responsibility of the treating physician or health care professional, relying on independent experience and knowledge of the patient, to determine appropriate treatment.

Articles: https://publications.aap.org/pediatrics/article/149/3/e2021056036/184866/Vitamin-K-and-the-Newborn-Infant https://www.healthychildren.org/English/ages-stages/prenatal/delivery-beyond/Pages/Where-We-Stand-Administration-of-Vitamin-K.aspx Key Takeaways Vitamin K deficiency bleeding (VKDB) can occur in three time periods: early (1-2 days), classic (2-7 days), and late (2-12 weeks), with late VKDB being particularly dangerous and often presenting as catastrophic bleeding Injectable vitamin K is superior to oral formulations because babies' immature guts don't absorb it well, there's no FDA-approved oral formulation in the US, and injectable vitamin K provides both immediate protection and stores vitamin K in the liver for months Common myths about vitamin K include confusion with vaccines, concerns about the boxed warning (which applies only to IV formulations, not the newborn IM injection), leukemia risk (thoroughly debunked), and assumptions that it causes jaundice (not with current formulations) Breastfed babies are at highest risk for VKDB because breast milk contains minimal vitamin K regardless of maternal diet or supplementation, while formula-fed babies receive vitamin K supplementation in their formula Healthcare providers should approach each conversation about vitamin K with openness and adequate time, identifying the family's specific concern and providing evidence-based responses while offering strategies to minimize infant discomfort during administration The rate of vitamin K refusal has increased significantly from 2.9% in 2017 to 5.18% recently, mirroring broader trends in medical distrust and requiring healthcare providers to be prepared for these conversations While vitamin K quickly corrects laboratory abnormalities in babies with VKDB, the damage from intracranial hemorrhage or other serious bleeding often results in long-term complications or death, making prevention critical Quotable Moments "Vitamin K is one of your coagulation factors. It was actually discovered by two scientists back in the early 20th century who received the Nobel Prize for medicine for their discovery. And the K is because the word coagulation in German has a K in it." "Babies are born with very low levels of it. Vitamin K doesn't cross the placenta well from mom into babies." "Babies can have early vitamin K deficient bleeding, which is really within the first day or two of life, which is more related to mom being on certain medications" "These babies can have kind of long-term impacts related to their bleeding complications." "I've never seen early, that's the one I've never seen, but I've seen classic and I've seen late. It's really a, a tragedy when those things happen." "The babies aren't very good at absorbing vitamin K just related to some of their gut immaturity. And then also because we don't have a standard uh, formulation of oral vitamin K in the United States." "We've had several that have come in over the past year that have had bleeding into their brain with intercranial hemorrhage." "If you're already having significant bleeding into your brain or into another kind of enclosed space in your body, that can cause significant problems that even if you fix the bleeding, you might still have complications related to that." "I never had a family refuse or decline their vitamin K until maybe 10, 15 years ago. And it really seems to have mirrored some of the distrust in medicine in general." "It gets lumped in I think with other kind of vaccines, but it's certainly not a vaccine in any way. It's a, it's a vitamin that the babies just aren't able, able to make at that time in their life" "I think sometimes it's really hard for parents to kind of wrap their heads around doing something that they know is going to hurt their own child." "it's been several generations now. And so, the ability for families to kind of know someone who they've had this happen to is, is pretty rare" "There are a lot of things we do to support an infant when they're first born, right?" "Infant mortality rates are in the 19 hundreds or 165 per thousand. So, you know, we've gone down dramatically since then." "The boxed warning on the IV form for the benzoyl alcohol, correct me if I'm wrong, I think is for more of kind of allergic type reactions, which we don't have that kind of preservative in the intramuscular form" "I sometimes hear is we're giving babies antifreeze and, and that of course is incorrect." "We do not consider babies to have kind of normal vitamin K levels, normal coagulation pathways until they're a little bit closer to six months." "Jaundice is so ubiquitous in this newborn population, but if you look back at the original forms of vitamin K that were given, there were higher reports of jaundice." "It's got to last for some months. Right." "Maternal milk does not contain very high amounts of vitamin K regardless of kind of how much you eat or how much you supplement or those sorts of things." "The levels that mom has to take to get detectable levels in the breast milk are like not available like in any way in the store or anything like that." "We do not have a kind of, um, approved version of oral vitamin K that's given in the United States." "In Denmark they moved to oral and then went back to injectable because of the increased rates of vitamin K deficiency bleeding." "This is where I think it's really helpful to talk to your pediatrician or to talk to another medical provider that you trust" "I'm a parent and I've had these, you know, thoughts, uh, when my daughter was born and it's very hard to kind of recommend, uh, getting something that may or may not be an issue." "It's the first time for that family, right? And so approaching that conversation with the same level of openness and time commitment that you would on your first time versus your 30th time" "I think it's hard when something's been recommended and in use since 1961 to really grasp on kind of a population level of like what happens if you don't do it because most people haven't seen that" Show Notes by Barevalue. No content or comments made in any TIPQC Healthy Mom Healthy Baby Podcast is intended to be comprehensive or medical advice. Neither healthcare providers nor patients should rely on TIPQC’s Podcasts in determining the best practices for any particular patient. Additionally, standards and practices in medicine change as new information and data become available and the individual medical professional should consult a variety of sources in making clinical decisions for individual patients. TIPQC undertakes no duty to update or revise any particular Podcast. It is the responsibility of the treating physician or health care professional, relying on independent experience and knowledge of the patient, to determine appropriate treatment.

The Naloxone Project Key Takeaways Discharge prescriptions for naloxone have fill rates of less than 1-2% among highest-risk patients, making direct distribution at hospitals essential for reaching vulnerable populations Overdose and suicide combined are leading causes of maternal mortality, surpassing traditional obstetrical complications like hemorrhage, eclampsia, and sepsis in multiple states Colorado's maternal overdose deaths dropped 60% (from 20 to 8 deaths) in one year after implementing universal naloxone distribution programs in birthing hospitals The postpartum period represents a particularly high-risk time for overdose deaths, and since most women give birth in hospitals, this creates a critical intervention point Universal opt-out distribution models normalize naloxone access and reach mothers who may be struggling silently with substance use disorders Naloxone protects entire households, not just the intended recipient, with studies showing it often saves fathers, children, and even pets from accidental overdoses Tennessee's pilot program will distribute over 20,000 naloxone kits paired with first aid supplies across approximately 10 birthing hospitals starting in early 2026 Empowering healthcare workers with proper education on substance use disorders and harm reduction improves their interactions with at-risk families and makes hospitals more welcoming spaces Quotable Moments "How does a young lady like you become addicted to something like heroin? And she shared a story where she said, funny, it was because of an emergency doctor like you who prescribed me opioids for an ankle sprain." "We're not always offer it along with all of the other medical care, behavioral healthcare, and addiction care that we should be providing. And so we really feel that those things should go hand in hand." "Someone is at such high risk of overdose after they've experienced a non-fatal overdose. We know that that immediate timeframe is very high risk." "I quickly realized that there are people outside of the medical institution who are doing a better job of caring patients than we were within medical institutions." Overdose and suicide were neck and neck leading maternal mortality for our state. And that those causes combined were really more than all of the other quote unquote medical causes that we were seeing." "In 2023, we just got this data, um, maternal overdose death dropped by 60% and they dropped from 20 in 2022 to eight in 2023." "We have an opportunity to give 20002nd chances to families out there. And that's a beautiful, beautiful thing, right? Everyone deserves a second chance." "This should be the standard of care. Okay? I know that we're asking you to be a part of a pilot and sometimes that can be a little scary, but the hope is that we iron this out so that this is truly the standard of care for every new mom, new family." Show Notes by Barevalue. No content or comments made in any TIPQC Healthy Mom Healthy Baby Podcast is intended to be comprehensive or medical advice. Neither healthcare providers nor patients should rely on TIPQC’s Podcasts in determining the best practices for any particular patient.  Additionally, standards and practices in medicine change as new information and data become available and the individual medical professional should consult a variety of sources in making clinical decisions for individual patients. TIPQC undertakes no duty to update or revise any particular Podcast. It is the responsibility of the treating physician or health care professional, relying on independent experience and knowledge of the patient, to determine appropriate treatment.  

Quotable Moments "I remember the fear of having this, you know, tiny new baby at home and also sending a bigger kid to daycare and being afraid of my daughter contracting illness." "We tell families that our responsibility is to make recommendations and to provide them with information and answer the questions that they have so that they can make the decisions that are best for them" "It would take something like greater than 10,000 vaccines, administered at one time in order to overwhelm the system." "If someone's trying to make a decision and they're not getting good evidence-based information, then they don't have the tools they need to make the best decision for themselves and their family." "The family is the greatest influence on the health to care decisions that they make." "Parents have the opportunity by considering vaccination to prevent having a child that's sick and miserable and full of snot and struggling to breathe" "The RSV vaccine is safe, effective, and very beneficial for your baby." "Women to know that they're not alone as they navigate this, as they think about how they're going to keep their baby healthy." Show Notes by Barevalue Resources: ACOG: https://www.acog.org/programs/immunization-infectious-disease-public-health/tools-and-resources/infographic-respiratory-syncytial-virus?utm_source=redirect&utm_medium=web&utm_campaign=int https://www.acog.org/programs/immunization-infectious-disease-public-health/tools-and-resources/infographic-rsv-vaccine-top-3-reasons CDC https://www.cdc.gov/rsv/vaccines/index.html Society for Maternal Fetal Medicine https://www.highriskpregnancyinfo.org/vaccine-guide-for-pregnancy-2024 https://www.smfm.org/rsv Video: https://youtu.be/BnpKnTlWZaI?si=mN4bxvw-S3NcAaKz Healthy Children.org https://www.healthychildren.org/English/family-life/Media/Pages/follow-pediatricians-for-trustworthy-content-on-childrens-health.aspx ACOG: https://www.acog.org/programs/immunization-infectious-disease-public-health/tools-and-resources/infographic-respiratory-syncytial-virus?utm_source=redirect&utm_medium=web&utm_campaign=int American Academy of Family Physicians https://www.aafp.org/pubs/fpm/issues/2024/0700/maternal-rsv-vaccination.pdf American College of Nurse Midwives https://midwife.org/immunization-resources-for-providers/ Association of women’s health and neonatal nurses (AWHONN) https://www.awhonn.org/resources-and-information/rsv/ Advisory Committee on Immunization Practices (ACIP)** Website: ACIP RSV Recommendations www.Immunize.org/askexperts Healthy Children.org (American Academy of Pediatrics) HealthyChildren.org March of Dimes https://www.marchofdimes.org/ No content or comments made in any TIPQC Healthy Mom Healthy Baby Podcast is intended to be comprehensive or medical advice. Neither healthcare providers nor patients should rely on TIPQC’s Podcasts in determining the best practices for any particular patient.  Additionally, standards and practices in medicine change as new information and data become available and the individual medical professional should consult a variety of sources in making clinical decisions for individual patients. TIPQC undertakes no duty to update or revise any particular Podcast. It is the responsibility of the treating physician or health care professional, relying on independent experience and knowledge of the patient, to determine appropriate treatment.  

Resources: ACOG: https://www.acog.org/programs/immunization-infectious-disease-public-health/tools-and-resources/infographic-respiratory-syncytial-virus?utm_source=redirect&utm_medium=web&utm_campaign=int https://www.acog.org/programs/immunization-infectious-disease-public-health/tools-and-resources/infographic-rsv-vaccine-top-3-reasons CDC https://www.cdc.gov/rsv/vaccines/index.html Society for Maternal Fetal Medicine https://www.highriskpregnancyinfo.org/vaccine-guide-for-pregnancy-2024 https://www.smfm.org/rsv Video: https://youtu.be/BnpKnTlWZaI?si=mN4bxvw-S3NcAaKz Healthy Children.org https://www.healthychildren.org/English/family-life/Media/Pages/follow-pediatricians-for-trustworthy-content-on-childrens-health.aspx ACOG: https://www.acog.org/programs/immunization-infectious-disease-public-health/tools-and-resources/infographic-respiratory-syncytial-virus?utm_source=redirect&utm_medium=web&utm_campaign=int American Academy of Family Physicians https://www.aafp.org/pubs/fpm/issues/2024/0700/maternal-rsv-vaccination.pdf American College of Nurse Midwives https://midwife.org/immunization-resources-for-providers/ Association of women’s health and neonatal nurses (AWHONN) https://www.awhonn.org/resources-and-information/rsv/ Advisory Committee on Immunization Practices (ACIP)** Website: ACIP RSV Recommendations www.Immunize.org/askexperts Healthy Children.org (American Academy of Pediatrics) HealthyChildren.org March of Dimes https://www.marchofdimes.org/ No content or comments made in any TIPQC Healthy Mom Healthy Baby Podcast is intended to be comprehensive or medical advice. Neither healthcare providers nor patients should rely on TIPQC’s Podcasts in determining the best practices for any particular patient.  Additionally, standards and practices in medicine change as new information and data become available and the individual medical professional should consult a variety of sources in making clinical decisions for individual patients. TIPQC undertakes no duty to update or revise any particular Podcast. It is the responsibility of the treating physician or health care professional, relying on independent experience and knowledge of the patient, to determine appropriate treatment.  

TN Report Card: 2025March Of Dimes Report Card For Tennessee | PeriStats | March of Dimes U.S. Report Card: 2025March Of Dimes Report Card For United States | PeriStats | March of Dimes Middle TN March for Babies Walk: Saturday, April 11th at First Horizon Park: March for Babies - Join March for Babies Event in Middle Tennessee Memphis March for Babies Walk: Saturday, May 16th at Audubon Park: Marchfor Babies - Join March for Babies Event in Memphis March for Babies Meals that Matter Program: https://www.facebook.com/share/p/17o8564ZaB/ Show Notes: In this episode, Karen Schetzina, TIPQC Infant Medical Director, interviews Kelley Marshburn, Executive Director of Market Impact for the March of Dimes in Tennessee. They discuss the recently released March of Dimes Report Card, which shows Tennessee improved from a D- to a D grade in preterm birth rates, though the state still performs worse than the national average in key maternal and infant health metrics. Kelley shares the important work March of Dimes does in Tennessee, including their NICU Family Support Program in Memphis, educational initiatives, and community events like their annual walks. The conversation highlights both the progress being made and the significant work still needed to improve maternal and infant health outcomes across Tennessee. Episode Highlights 00:02:37: Kelly explains the March of Dimes Report Card as an annual publication of facts and figures that provides comprehensive data on preterm birth rates and related metrics for the US, broken down by state and county, released every November since 2008. 00:03:47: Discussion of the Report Card as a valuable, user-friendly resource with interactive website features, PDFs, and detailed data that many people use to understand maternal and infant health statistics. 00:04:14: Kelely details that the Report Card data comes primarily from the National Center for Health Statistics, covers various time periods depending on the topic, and focuses heavily on preterm birth as the leading cause of complications and death for infants and mothers. 00:06:04: Tennessee received a D grade in 2025, an improvement from D- the previous year, with the preterm birth rate improving from 11.3% to 10.9%, though the US overall received a D+ and Tennessee still performs worse than the national average. 00:07:01: Kelley emphasizes that Tennessee ranks worse than the national average on preterm birth rate, infant mortality rate, maternal mortality rate, and adequate prenatal care, despite having significant healthcare resources, particularly in Nashville. 00:08:15: Overview of March of Dimes programs in Tennessee including fundraising events, walks, educational initiatives, and the NICU Family Support Program, with particular focus on counties like Shelby County which ranks as the worst in the state for preterm birth rates. 00:09:09: Detailed explanation of the NICU Family Support Program, which places a March of Dimes social worker at Regional One Hospital in Memphis to support families, noting that while babies receive extensive care, families often have limited resources and support. 00:09:58: Kelly describes how the NICU Family Support coordinator provides resources, support, and preparation for families taking babies home, expressing hope to expand this program to Nashville hospitals. 00:10:48: Description of the annual "Meals That Matter" program every November, where March of Dimes brings warm meals, handwritten notes, care packages, and snacks to NICU families and staff, providing emotional support and connection. 00:12:17: Kelley mentions upcoming educational programs being developed with Nashville Public Library to create support group-style educational series for NICU moms who have returned home. 00:12:34: Kelly invites healthcare workers, families with healthy outcomes, and anyone interested to get involved with March of Dimes, emphasizing that the organization's 87 years of history and resources have contributed to improving pregnancy outcomes. 00:13:29: Announcement of upcoming March of Dimes walks: Nashville spring walk on April 11th and Memphis walk on May 16th, describing the walks as the biggest support group of the year where families can connect with others who share similar experiences. Key Takeaways Tennessee improved its preterm birth grade from D- to D in 2025, with rates decreasing from 11.3% to 10.9%, demonstrating that progress is possible through collaborative efforts, though significant work remains to reach optimal outcomes. Despite having substantial healthcare resources, Tennessee performs worse than the national average on critical metrics including preterm birth rate, infant mortality rate, maternal mortality rate, and adequate prenatal care access. The March of Dimes NICU Family Support Program addresses a critical gap by providing social workers to support families, recognizing that while babies receive extensive medical care, families often lack adequate resources and preparation for taking babies home. Simple interventions like the "Meals That Matter" program can have significant emotional impact on NICU families and staff by providing warm meals, care packages, and human connection during difficult times. Community involvement in maternal and infant health improvement is important for everyone, not just those who have experienced complications, as healthy pregnancies also result from decades of research, education, and resources provided by organizations like March of Dimes. County-level data reveals significant disparities within states, with Shelby County ranking as Tennessee's worst for preterm birth rates, highlighting the need for targeted interventions in specific geographic areas. Quotable Moments "We know that that is kind of the leading cause for complications death, whether it be infant or mom. Um, and so we are really focused on preterm birth." "You don't really rank for being a healthcare mecca, if you will, and, and having tons of healthcare in certainly Nashville, but just in Tennessee, we aren't scoring where I think we all know we should be." "There's tons of care for the baby. There's a just limited resources and support and care for the families and the moms and people that are going to be taking these babies home." "I've been really shocked at the impact that can have on just one person or a family that comes in that day." "I think it's important not only that we talk about the complications and the scenarios where we've had worse outcomes, but also just healthy pregnancies and how those are improving." "The walk, I like to call kind of the biggest...