The North Carolina Medical Society supports the following areas of focus[1] to improve maternal and infant health:

Developing a Risk Appropriate Regional Perinatal System of Care

• Promote the adoption of national maternal and infant risk-appropriate level of care standards
• Encourage use of multi-disciplinary assessment teams to utilize the CDC Levels of Care Assessment Tool to assist facilities in establishing self-identified maternal and neonatal levels of care
• Support required external verification of birthing facilities’ maternal and neonatal level of care designations
• Encourage re-establishment of North Carolina’s perinatal and neonatal outreach coordinator program
• Support outpatient risk-appropriate perinatal system of care

Ensuring Access to Perinatal Care

• Ensure access to comprehensive prenatal care for women ineligible for Medicaid
• Support efforts to extend coverage for group prenatal care and doula support
• Ensure that all pregnant women and high-risk infants have access to the appropriate level of care through a well-established regional perinatal system
• Promote increased utilization and completion percentages of childbirth education classes
• Encourage clinicians providing perinatal care to practice in rural areas of the State
• Support efforts to ensure the availability of obstetrical care by family medicine physicians and obstetricians, the continuation of obstetrical training in family medicine programs, and statewide access to quality and cost-effective obstetrical care
• Encourage standardized screening and treatment for perinatal mental health and substance use
• Support expanded perinatal access to mental health services

Promoting Patient-Centered and Evidence-Based Perinatal Care

• Expand the use of evidence-based clinical standards and models of prenatal care
• Support efforts to improve access to and utilization of first trimester prenatal care.
• Promote care coordination/case management/home visiting services that includes promotion of resiliency, mental health screening, substance use intervention, tobacco cessation and prevention, reproductive life planning, chronic disease management, perinatal mood disorders and access to health care
• Promote the provision of evidence-based culturally competent patient education and anticipatory guidance
• Support activities and programs that promote healthy behaviors including activities that prevent smoking initiation and promote smoking cessation and programs that promote healthy diet and physical activity during pregnancy
• Encourage efforts to increase the quality and frequency of risk assessment at the postpartum clinic visit

Promoting Perinatal Care Quality Improvement

• Encourage data collection on outcomes and quality improvement efforts that address racial and ethnic disparities in care
• Support the review of all pregnancy-related deaths in North Carolina on an annual basis to discover ways to reduce or prevent such deaths
• Support birthing facilities in quality improvement efforts to address racial and ethnic disparities in care
• Support patient and family advisory councils in quality improvement efforts related to maternal-fetal health
• Support education of health care providers and community health workers on the implications of racism and bias on perinatal health
• Support the linkage of clinically significant maternal prenatal testing results to neonatal health information reports for epidemiological and outcomes analysis with full protection of patient privacy and confidentiality

Enhancing Services and Supports

• Encourage alignment of perinatal care regional maps with Medicaid transformation maps
• Support parent navigator programs in birthing facilities
• Use community health workers to support families in their communities
• Encourage family-friendly workplace policies including paid parental and sick leave policies
• Encourage the use of evidence-based strategies to promote healthy family relationships, promote parenting and co-parenting skills, and include parents and partners in preconception, prenatal, and interconception services
• Promote access to comprehensive breastfeeding support services including medical lactation services
• Support evidence-based practices for patient education that encourages breastfeeding.
• Support policies and programs that decrease barriers to breastfeeding
• Promote affordable, available, and accessible high-quality childcare
• Promote access to and utilization of immunization according to the CDC’s Advisory Committee on Immunization Practices guidelines

[1]Several of the policy statements contained herein are consistent with recommendations from the North Carolina Institute of Medicine Perinatal System of Care Task Force Report and the North Carolina Division of Public Health’s 2016-2020 Perinatal Health Strategic Plan.