If we're going to reduce trauma and family stress, we have to start at the very beginning

As a mother of four, I am no stranger to prenatal care. From specialty perinatal care to extra ultrasounds to an antepartum hospital stay, I have spent countless hours accessing the maternal health services in central Iowa. Over the past five years, it was only natural that my personal and professional life connected at times, and I took special notice of maternal health research in the adverse childhood experiences and trauma informed movement.

Rewind to fall 2014. My oldest children, who are twins, had recently turned one. I had been serving as Program Manager for ACEs 360 for over six months, and was attending the Midwest ACEs Conference in Chicago. My first solo trip since becoming a mother. It was an outstanding conference, with the final keynote speaker capturing my attention. Dr. Colleen Kraft, a well-known pediatrician and recently the President of the American Academy of Pediatrics, presented on the outcomes of prenatal home-visitation project for mothers on Medicaid. Birth outcomes and maternal health improved. Community supports were identified. NICU stays were reduced.

This last data point stuck with me. My daughters stayed in the NICU for three weeks, and I am well aware of the cost of NICU care. With my professional hat on, I realized that providing social, emotional and community support was not only critical to maternal and child health, but it is an extremely positive return on investment.

Fast forward to fall 2017. Mid-Iowa Health Foundation had launched the HealthConnect Fellowship, and I was fortunate to be chosen as part of this outstanding group of fellows. My specific focus was to advance practice and policy change that connects evidenced based wrap-around services in the prenatal setting, documenting in aggregate any return on investment in health and cost savings. I had spent the last three years building knowledge around epigenetics, maternal stress, historical trauma, and the impact of trauma on maternal and child health outcomes. The timing of the HealthConnect Fellowship allowed me to shift from knowledge building to strategizing and taking action. The timing of the HealthConnect Fellowship was also coincidental in that it launched one month before my youngest child joined the world.

The past eighteen months has fast-tracked the efforts of ACEs 360, with the support of the HealthConnect Fellowship. Research conducted on home-visitation and prenatal community supports in Iowa. Cross analysis of ACEs indicators with pregnancy risk assessment data. Increasing review of state and national research documenting alarming maternal health disparities for mothers of color. Key data points that have helped accelerate this work include:

• 67% of Iowa mothers reported at least one stressor in the 12 months prior to giving birth, with 80% and 69% of African-American and Hispanic mothers reporting at least one stressor (Iowa PRAMS).
• Of Iowa mothers receiving public health insurance, almost 83% report experiencing 1 or more stressors, with 13% experiencing 6 or more stressors (Iowa PRAMS).
• Parent ACEs have been associated with low birth weight and shorter gestational age, maladaptive socioemotional symptoms at age 6 months, and poor physical and emotional health at 18 months (Felice le Scherban, 2018).
• Iowa children from birth to one year old are twice as likely to suffer abuse that any other one-year age cohort (US HHS, Child Maltreatment Publication).

These data points emphasize what has become my mantra—if we are going to reduce trauma and family stress, we have to start at the very beginning. If we know mothers are having significant levels of stress and trauma before their children are born, we must begin community supports prenatally. If we know parental ACEs can influence maternal and child health, we must begin supporting moms prenatally. If we know that historical trauma, implicit bias, and systemic bias are negatively impacting maternal and child health, we must address bias and better support mothers of color prenatally.

Over the past eighteen months, ACEs 360 has created curriculum on ACEs and the relationship to maternal health during the prenatal period and launched a train the trainer on the content. We have advocated for the inclusion of trauma and stress topics during child birth education courses. We have convened and facilitated the launched of Nine2Thrive in partnership with EveryStep, providing community supports to expecting mothers and families referred by their provider. We have added prenatal home visitation to our Iowa ACEs legislative agenda. Next month we will launch the ACEs Prenatal Collaborative.

ACEs 360 has far more work to do in this area, and we have outstanding partners to partner with in moving the work forward. The HealthConnect fellowship has been a critical influence to launch the work to where it is today.