May 13, 2024 • 30 mins
Talking with Dave Oberembt from the American Heart Association and Dr. Driver from the Clinton School about the state of Maternal Health in Arkansas as well as how moms (and moms-to-be) can find more information and support during and after childbirth. Plus we discuss upcoming legislation that could change the future of maternal health in the state, expectant mothers in rural areas, and other Mom related topics on this Mother's Day edition of Talk of the Rock.
Have a topic, group, or event to discuss on the show? Email djtaylor@iheartmedia.com with your information today.
Have a topic, group, or event to discuss on the show? Email djtaylor@iheartmedia.com with your information today.
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Episode Transcript
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(00:00):
Welcome and thanks for tuning in forTalk of the Rock public affairs, community
events, and public services for CentralArkansas from the iHeartRadio Studios in Little Rock.
Here's your host, DJ Taylor,and thank you for joining us for
Talk of the Rock. DJ Taylorhere with Dave Obrimp, the government relations
director for American Heart Association in Arkansas. How are you, sir? Good?
(00:21):
How are you doing doing fantastic?And also joined by doctor Nikola Driver.
You're the maternal health scholar at ClintonSchool. How are you, ma'am?
I'm great, Thanks for having usfantastic. Well, I want to
start out first of all, let'stalk about what it is that you do
at the Clinton School. A maternalhealth scholar. That sounds very focused and
(00:42):
very localized study. Yeah, So, I'm an associate professor at the Clinton
School right here in Little Rock.I'm a public health scholar, so I
really study health disparities, but Ihave that focus on maternal health. I'm
really interested in studying how do webetter support mothers throughout the lifetidle go from
everything from pregnancy to birth to postpartum. And I'm also a native Arcanson and
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mom, so I just really careabout our local communities and the mothers across
the state. Well, fantastic andhappy Mother's Day. Thank you, and
also Dave, all right, SoAmerican Heart Association no stranger to the program,
and it's a pleasure to have youin here. What is it that
you do, I mean your governmentrelations for the state of Arkansas. Tell
(01:26):
me a little bit about that.Yeah, So my role with American Heart
Association is to try to pass policiesthat will have positive impacts on cardiovascular disease.
And so the American Heart Association isactually also the American Stroke Association.
And so Arkansas has some one ofthe highest heart attack and stroke mortality rates
in the country, and so youknow, high obesity rates. There's a
(01:47):
lot of those risk factors in Arkansas. So we do things like we work
on trying to less smoking les tobaccouse. We try to promote activity and
nutrition and make sure hospitals take bettercare of patients when they come in and
make sure people have access to qualitycare. And so there's a wide variety
of policies we tried to pass bothat the federal but my primary work is
(02:07):
at the state and local level.Fantastic and I appreciate the work that you
do, sir. It's fantastic,indeed. And one of the things that
staggered me, it was during arecent interview with some of the folks from
the American Heart Association, is thatheart disease is the number one killer of
women across the country, but absolutelyrampant in Arkansas. And also that when
(02:30):
it comes to maternal health, Arkansasranks absolute last in the country. And
I know there are a lot ofdifferent things that could be done to fix
that, and that's part of whatwe're talking about here today. Now,
how would you describe Arkansas as comparedto the rest of the country in terms
(02:51):
of maternal health. What are someof the things that you see being done
differently in other states? Yeah?Sure, you know, I think Nikolao
Prie has a better perspect of kindof how the whole country goes. And
then I can maybe talk a littlebit about some of what we got going
on here. Sure, sure,absolutely what what what would you say on
that? So the big topic ofconversation lately is the maternal mortality rate,
(03:12):
right, So this is the termthat we use when a mother dies from
a pregnancy related health issue or anexisting condition that is made worse by pregnancy.
And so Arkansas, as you mentioned, has the highest maternal mortality rate
across all fifty states. We experiencearound forty five pregnancy related deaths per one
hundred thousand berths. So that maynot seem like such a large number,
(03:36):
but when we're comparing it to therest of the US, the average is
around thirty pregnancy related deaths and someof the best states they're sitting at right
around ten. So we are substantiallyhigher. And I think, you know,
the maternal mortality rate is just it'salso used as like a red flag
for larger issues happening. It's kindof like a proxy measure for how we're
(03:59):
doing. Oh, we're all inmaternal health and obviously not great. Yeah,
And I think it's also important toit and issues you relate to is
that maternal mortality is the worst outcome, right, but there's other health aspects
and stuff that come that hopefully wedon't get to the point of mortality,
right, And so you know,I think like she's saying that that's an
indicator of how we're doing in Arkansas, and you and you hit the nail
on the head here. We kindof talked about how our overall health is
(04:20):
and and lots of times. Youknow, one doctor u MS once said
that when we're talking about maternal mortalityin Arkansas, we're largely talking about cardiovascular
disease. It's a lot of issuesregarding hypertension and UH and some other kind
of diseases or kind of health aspectslike that. We have a very high
smoking rates. We UH, diabetesrates in Arkansas are very high. And
(04:45):
so you know, a lot ofthis too is that we have poor outcomes
before a lot of women are gettingpregnant, and then those health those health
outcomes are carrying through the pregnancy andinto the into birth. And I also
think too we talk a lot aboutmaternal mortality, but when we're talking about
mom, healthy moms, right,healthy mom's been healthy kids. Sure,
you know, you can't take careof your child if you're not feeling well,
if you have postparmon depression, ifyou have physical ailments, and so
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you know, in Arkansas, youknow, I think our infant mortality rate
is incredibly high as well. Sothese are all kind of related things,
and so you know, Arkansas ingeneral, like I said, we have
a very kind of poor health outcome. So there's a variety of factors for
that, but I think that's kindof what really is setting Arkansas apart for
the rest of the country. Sothose are definitely some of the contributing factors
(05:30):
that lead to the higher mortality rates. And I'm just gonna throw this statistic
out there. Is something I heardit blew my mind while my wife was
pregnant about five years ago. Isthat a pregnant woman's heart rate and cardiovascular
stress we'll call it, is theequivalent of somebody training for an ultra marathon.
We're talking about like that super long, like one hundred kilometer plus marathon.
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And so when you combine that withlike you were saying, poor cardiovascular
health to begin with hypertension, diabetes, things like that, it's all just
a big mix that has to bedealt with. And when you know,
when we look at this across thestate of Arkansas and these issues that are
faced, how do we compare ormaybe better to ask, how do we
(06:25):
cope with these issues? Do wesee anything in the medical field where doctors
are better trained here in Arkansas tohelp deal with maternity in those situations?
I mean, is there a specialtraining or a specialized aspect that we see
(06:46):
from doctors in the state. Well, I'll just say that, you know,
recently the Arkansas Department of Health,they found that over ninety percent of
the pregnancy related deaths in Arkansas werepreventable, and so I think there are
are a lot of things we cando to better support mothers during this time.
And in their report, they recommendedchanges in the way that practitioners can
(07:06):
provide care for pregnant and post partumwomen, specifically taking into account these risks
for hypertension and heart disease. Sothey're recommending more counseling for patients who are
at risk for these chronic diseases,and just more education overall for providers,
patients, and families to recognize thoseearly symptoms. So you know, not
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all the time will a mother recognizethose early symptoms in herself, and so
making sure that the families and spousesand partners are aware so that when something
happens they can bring it to theattention of the provider. Well, and
I also think it's very important thatyou know a lot of folks, we
all lead busy lives. That isjust a given this day and age.
We're always on the go and ohit'll pass or it'll it'll go away on
(07:53):
its own in a couple of days. But honestly, I've said it a
dozen times on the program. That'swhat doctors are there for. If you
feel like there's something wrong, gosee the doctor about. They're not going
to get mad at you or getupset with you because you came in.
Hey i'm having this weird feels likeflutters in my chest, or you know,
(08:13):
the baby is kicking an awful lot, or any number of different things.
I know, when we talk aboutthe American Heart Association, we talk
a lot about cardiovascular health and payattention to those signs and symptoms. Blood
pressure is a huge deal, ahuge factor in that, and also making
(08:35):
sure that you do maintain some sortof movements or just getting up and around
a little bit. But when itcomes to what you feel during a pregnancy,
I mean, as a guy,I can't speak for that, but
during a pregnancy, there are somany different things, so many different changes
(08:56):
to the human body during that timethat you know, a lot of people
I would think maybe equate that tojust being pregnant instead of a potential issue.
Yeah, definitely, I think thatmothers should trust their instincts and trust
their gut. You know, ifsomething feels off, take it seriously.
And like you said, don't worryabout what people are going to think about
(09:18):
you. Ask for support, andjust you know, keep an eye out
for those things your doctors telling you. Keep an eye out for pain,
keep an eye out for bleeding.And I'll also say too, for some
people, it can be difficult foraccess for these rights, right sure,
So you know, I think thatin rural parts of the country is not
just an unique to Arkansas, butit's hard to recruit doctors to some of
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these small hospitals and small towns,and and I think it's even harder when
you're talking about specialized care like obguI NS and so sometimes access is you
know, a long ways away.So you do having that weird pain or
that weird feeling or is this right, and you're like, am I going
to make a two hour four hourround trip, you know, two hours
each way to go get this checkedout or you know, or maybe get
(10:00):
the next appointments not for months orwhatever. And so I do think that
it's important that we're going to lookat some other kind of ways to address
that community health workers. But youknow, doulas is a big deal,
right, people that are trained andcertified, and that hopefully we get a
situation where insurance will even cover that. I think there's sometimes a misconception where
people are thinking of dula's as thesekind of crystal healers or hippies or something
(10:22):
like that, and they're no.I mean, you know, they are
medical professionals and and and medical ismaybe not even the right term, but
the professionals in this right sure,you know they're not they're not they're not
training to deliver babies or anything,but they're they're trained to be knowledgeable and
and they can identify warning signs andthey can help give tips and stuff.
And so I think having kind ofthose trained people in these communities where we
(10:45):
can't recruit doctors will kind of createa knowledge base where people can say like,
oh, you need to go orhey, that's the thing that happens.
I know, it's weird, right, And so I think that that's
an important thing that Arkansas needs tolook at and probably something we're lacking in
some other states. That's such greatpoints. You know, oftentimes we want
to think about these things in termsof the individual, like what did the
mother do, or the lifestyle factorsor the kind of life that the mother
(11:07):
was leading. But there are somany social and structural factors here that play
a role. For example, welive in a very rural state, as
you mentioned, Dave, and accordingto the Arkansas Center for Health Improvement,
sixty percent of rural hospitals in Arkansasdo not offer labor and delivery services.
Wow, So that means that ourkansins many are Kansas are living in what
we call a maternity care desert andhave to drive forty minutes or more,
(11:31):
some much farther to give birth ina safe facility. So this can not
only put their access to labor anddelivery services at risk, but their access
to prenatal care at risk. Andthe rural hospitals are also facing those staffing
challenges that you mentioned, So it'sjust kind of like this layered, layered
problem. And I also want tomention doulas. So doulas really are so
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their non clinical support, right.They can provide that emotional cycle, logical,
spiritual, and informational support for amother, and they can empower mothers
to make decisions for themselves when they'rein that really intense, overwhelming experience of
giving birth, and studies have shownthat mothers who have DULA support they have
(12:15):
overwhelmingly better outcomes. Right, Sothey're less likely to have ce sections that
are non medically necessary, they're lesslikely they have shorter duration of birth,
and they also are more likely tobreastfeed. And so doula's could be a
really important and impactful resource for fillingthis kind of medical care or maternity care
deserts that we're talking about well.And I think also it's important to note
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that these people are trained professionals,They've been educated properly in a lot of
this. Some people go to doctorGoogle, and that's just a bad idea.
I mean, honestly, you canlook up one thing and it could
lead you down the entirely wrong path. And usually time it's incurable cancer,
right, incurable? Can ye,I've got a headache and curable. Yeah,
(13:01):
I sprained my ankle and I'm yeah, I've got some rare disease from
timbuk too. It's yeah, it'sterrible. Now. You have mentioned a
whole lot about rural areas in Arkansas. Are these the areas where we see
the higher maternal mortality rates. Iknow that that's that's going to be an
issue, But is that one ofthe primary causes, do you think?
(13:22):
Yeah, so we're seeing them.We're seeing higher rates in the rural areas
and more specifically in the southern regionsof the state and the eastern regions of
the state. Yeah, And soI think rural is a big deal,
right, there's an access to carettsure there too. But I also think
we're seeing it too, which ispopulations that tend to be you know,
poorer, less educated across the state. So you know, we're seeing it.
(13:43):
I think it's an epidemic both ruraland kind of minority populations. It's
probably the places and so that's whatwe're seeing, you know, the Mississippi
Delta, you know, than thosekinds of places. And so I think
if you put a map over thestate and look at maternal health issues,
probably the similar places you're going tosee the diabetes issues, and you're going
to see cancer is higher rates ofcancer and diabetes and all these outcomes.
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And so, you know, Ithink there's something too to be addressed that
you know, we're working on outcomesfor maternal health, but you know,
a large This is kind of moreof an epidemic thing about how do we
get access to these populations both inrural and some urban areas of Arkansas.
Well, now, let me askyou about this and let me see if
this kind of correlates a little bit. I know Governor Huckeby Sanders, Uh,
(14:28):
she got the Arkansas Strategic Committee fromMaternal Health uh to sort of work
on problems. What what is thestatus on that committee? How is that
coming along? And I really likedto applaud Governor Huckerbry Sanders. I'm kind
of taking a real proactive approach,and we're identifying an issue here and and
looking for those solutions and and bringingthis committee together to solve those And so
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I plot her for taking it veryseriously and putting this group together. So
what they've done is they've they're they'regetting stakeholders from across the country. You
know, I think our first stakeholdermeeting probably had around one hundred different people
in it. We broke out anddid different specialties, and we just started
kind of bouncing ideas off the walland looking at kind of ideas from other
states and and and it was areal kind of listening session and brainstorming session.
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We can get a real idea ofwhat's being done and what we can
do, and what other states aredoing and so. And I think that
was the kind of the first meetingand the first step. I know they're
meeting with this kind of other varioustypes of stakeholders, and we're gonna keep
having those meetings here. I thinkthe whole task force is supposed to go
for about six months, so Ithink we have about four or five months
of it left. But yeah,I think that I hope. I think
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we'll have some good solutions and somegood ideas heading into the next legislature for
hopefully to make some really impact fantasticAnd again, you know, I mean,
this is a very fitting conversation.It is Maternal Health month. Of
course, Mother's Day weekend here withus, and just really quickly, I
mean, because it's I've got afive year old at home. So this
has been a recent I don't wantto say battle, because we had a
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fairly mostly normal pregnancy and everything thatwent along with it. But one of
the things that really got to me, you know, obviously travel time.
If you live in a city,then you've got a little bit better access
to healthcare and things like that,and then once the baby is here,
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then you've got all the issues ofpostpartum. I know mom's typically they might
be allowed a couple of weeks outof work, you know, if they've
got the vacation time or the sicktime. My wife burned through all of
hers with our youngest, as didI burn through a lot of mind as
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well, trying to stay home andhelp mom out because immediately following birth,
the body has taken I don't wantto say taken a beating, but it's
pretty close to it. There's alot of stress on a woman's body.
And I know that there's also beentalk about a postpartum Medicaid expansion for women
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to extend their postpartum coverage from Medicaidsixty days now to maybe a year now.
This is something that most of thecountry is either adopted already or they're
looking at extending this out. Whatis going on with Arkansas on that front,
Yeah, I appreciate you bringing thatup, so you know, the
governor. I think Arkansas is goingto be one of maybe two or three
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states at the end of the yearthat probably has not incorporated this. But
Arkansas does have a unique medicaid expansionprogram. And I think it's important too
when we're talking about this, thatwe're talking about not just not just you
know, people without jobs during pointpeople, but it is largely the working,
the working kind of class people,right, the lower end of that
financial spectrum. Right, These peopletend to be working and have jobs,
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and so they qualify largely for medicaidjust because they're pregnant. In Arkansas,
we call it pregnant Women Medicaid,and so we can extend that after they
get birth for up to the year. The federal governm and recently allowed this.
Now, so I was mentioning Arkansashas a little bit different kind of
program, and so the Arkansas andthe governor said, hey, I don't
think we need to extend this program. I think we can make it work
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here in Arkansas. And so we'vetaken some steps to do that. It
might not be kind of as aI don't know what we want to say
is a clean looking from the outside, it's like, oh, there's just
extended it, right, but wedo have some programs to make sure that
there's coverage and all these women willbe eligible for coverage. I think we
are going to have to address somegaps making sure that it's affordable, it's
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seamless. You know, you're nothaving to do a navigate in a complicated
insurance thing when you're two months inpostpartum. I mean, I work in
the health field, and I don'tlike to navigate the insurance thing right let
alone if you're not getting sleep andnot feeling well. So we want to
make sure that the transition is seamless, it's affordable, and they can continue
the care they're getting. They don'thave to switch doctors or anything like that.
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But postpartum, I think is areally important thing that we've kind of
are realizing more and more how importantit is. The Arkansas Center for Health
Improvement fantastic group that does a lotof the data analysis for health. Here,
they did a great breakdown of kindof some postpartum stuff. Eighty seven
percent of women get an internal postpartumcheckup. I would think that would be
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one hundred after giving birth and gettinga check up to make sure. I
think a lot of times, youknow, it's access to care, but
a lot of times, pege,you're so focused on the child, you
might not be as focused on yourself, but we know seeing that has been
a much higher rate. One infive or experienced postpartum depression one and twelve
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or twelve percent of women smoke cigarettesafter giving birth. So breastfeeding, smoking,
smoking, and tobacco use is agiant problem in Arkansas. I can
kind of get into some of thereasons with that, but I think we
can tie that into maternal health aswell. There was an oh and eighty
percent breastfeeding postpartum, and brestfeeding isa huge deal for the health of infants
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and the health of babies, butthat slowly moves down to about fifty percent
at eight weeks, and so thatalso is not just a deal for maternal
health, but infant health as well, and so making sure that they have
that access to care in those regularcheckups and seeing doctors. We really hope
to kind of approve a lot ofthose numbers and I think we'll see a
lot better health outcomes because of it. Very nice and one of the things
that I do want to talk aboutalso pregnancy and postpartum. I know that
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there are programs. There are alot of women that could use these programs
across the country, whether it befor physical or for mental health. I
know that mental health can be abig issue with women during and after pregnancy.
Are there any specific types of programsthat women should look for perhaps when
(20:42):
it comes to that. Yeah,I think one really interesting model that UAMS
has been proposing or has been workingon for several years now is the centering
pregnancy model. We actually just publisheda study on this to show the effectiveness
of it. So centering pregnancy isit's an alternative to traditional prenatal care.
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You know, traditional prenatal care,you meet these her doctor for maybe like
what ten to fifteen minutes, andask questions, do some do some measurements,
do your blood pressure check? Thingslike that, and then you leave.
With centering pregnancy, it's very different. It's a group prenatal care model
where you have anywhere from like eightto twelve women all sitting in a room
together with a healthcare provider and ahealth educator in the room. So they're
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getting their basic measurements done blood pressurecheck, fundl height measurement, things like
that, but they're also meeting otherwomen who are at the same gestational age,
so other women who are experiencing thesame things, who are experiencing the
same stress, experiencing the same challenges, have like similar demographics maybe yes,
you know, like later giving birds. Maybe they're from a similar area of
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the state, you know, Soit's a situation where these women kind of
are relatable and you have those thingsin common. It's a really important thing,
and this was one of the thingsthat's being talked about here here in
Arkansas about implementing with the Taskbard.Yeah. And what that does is it
creates sort of an informal support systemfrom others, especially low income mothers who
don't have a lot of support andkind of filling that gap. There's another
(22:08):
extension to that which I don't thinkyou AMS has approached it, or maybe
they're thinking about it, but it'scentering parenting. So it's after the baby
is born, during this postpartum period, still getting together with mothers to build
that social support and work through challenges. And it really does change. It
changes knowledge about staying healthy during pregnancy, knowledge about breastfeeding, as well as
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just changing norms. So if youcome from a community where breastfeeding isn't super
common, or talking about your feelingsduring postpartum isn't super common, that can
change norms from others. And makethem feel more comfortable during those times.
I'll have to say too, theArkansas Pediatric Society has been doing some fantastic
work about a program called Healthy Steps, and the idea there is that when
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a mom brings the child in tothe pediatrician, that they're also working with
the mother and the families and stuff, and so that they're looking for those
warning signs and those health things andthe mothers as well, and so that
they're kind of doing that kind ofwhole health approach with both the child and
the mother to kind of help outwith that so that we're not segmenting all
(23:14):
of our care all the time.Absolutely, and I think it's really great
that you would have a group ofmoms, not only that they can share
information with each other, they cancompare notes because no two people are exactly
the same, but a lot ofthese women may be going through similar issues
or having similar experiences, and justa chance to build that network, that
(23:38):
support group like you were talking about, that is a fantastic idea. Now,
what are some of the other policiesor some of the other programs that
are being looked at to help lowerthe maternal mortality rate here in Arkansas,
and we've touched on a few Ithink you know currently in Arkansas, we
talked about in dula's a lot,but the dula's only aren't certified. There's
(24:00):
not a certification program in Arkansas.So we just want to make sure that
there's a certification program and also makingsure that they're covered with a Medicaid and
so that people have access to thatcare. So I think that's one of
the solutions that people are talking alot about. We talk about access to
care, and so few hospitals arehaving labor and delivery programs and so warm's
(24:22):
problems with that is the reimbursement rate, especially from Medicaid, and so we
have a very low reimbursement rate,and so increasing that reimbursement rate will create
more incentives for more hospitals to beable to have these programs. And and
you know, one of the difficultthings is is you think, oh,
they just need an O, B, G, Y N there and they
can start giving delivering babies, right. But when you start to think about
(24:44):
it, it's more complicated because unlikeif you have like ankle sprange or something,
babies don't come nine to five,right, So you need a couple
O B g yn to make sureyou can cover all that. But then
people also like days off and theydon't want to there are eighty hours a
week and stuff, and so youneed like four or five obg y ns
and so it's a significant investment.We've got to make sure hospitals are getting
(25:07):
reimbursed at a proper rate for that, and so I think that's something that
we'll be looking at as well.We talked about, you know, the
postpartum access to care issues, andyou know, I think there's another thing
too, is making sure that whensomeone comes in to a hospital when they're
excuse me, when someone comes intothe hospital and it seems very obviously they're
eligible for Medicaid, let's go aheadand treat them, and you know,
(25:30):
get them going on through that Medicaidapplication, and so we can kind of
do a thing where it's like apredetermination where we're saying, this person obviously
qualifies for Medicaid. We don't wantto have that have to come back in.
We can treat them right now,we can get them going through the
process, and we can go andthen that payment will get reimbursed. And
so less something we're looking at aswell well. And you know, I
think, honestly, between that andthe possible expansion to rural areas, maybe
(25:55):
for a better transport system, ifnothing else, or some sort of ability
to get these moms and moms tobe a chance to actually get the travel
time that they need, or maybea vehicle to get them there. Some
sort of transport system could be apotential help in the future. And I'm
(26:17):
glad to see that so many differentthings are being done from a local and
from a national standpoint when we cometo this. Also, just one quick
question, I've noticed that the AmericanHeart Association so active in maternal health.
We're hearing so much more about that. What was the big swing for the
American Heart Association on that. Yeah, oftentimes when I go these maternal health
(26:41):
meetings and people are like the AmericanHeart Associations here, We're glad to see
you, but no, I youknow, I think a lot of times
for these programs started, we hadyou know, the kidney groups and the
hard groups, and for some reason, I don't know if the liver got
a group, but I don't know. But anyway, we kind of,
you know, back in the day, I think we kind of siloed off
a lot of this care, andso you know, the American Heart is
Asociation has taken approach where these thingsare all connected. Right. You've got
(27:03):
kidney issues, it's going to leadto hypertension issues. And you've got heart
issues, it's going to be affectingsomething else, and so they're all connected,
right. So we're really looking fora full kind of wellness approach now,
and so I think we are kindof breaking into areas that are kind
of non traditionally might not think ofthe American Heart Association is. But we
also mentioned too that when it comesto mortality rates, it's largely a cardiovascular
problem, and so I do thinkthere is probably a natural fit for the
(27:26):
Heart Association and traditional sense. Butas American Heart Association looks at a whole
health approach and we're kind of breakingout into some new important kind of medical
areas, this is one of them, and it's a big priority for the
American Heart Association right now. Acrossthe country. We've been really kind of
being forward and doing these postpartum extensionplans across the country as well as some
(27:48):
other issues. And so I thinkthis is it's exciting that we're able to
be a part of this, andwe're really excited about the leadership we're team
from the Governor's office and so muchmore momentum with all these stakeholders and stuff
involved. It seems like there's areal lot of momentum right now in Arkansas
to address this, and then we'rereally happy about that. I feel like
it's it's well deserved momentum and I'mglad to see it happening. Just about
to run out of time for today. Last closing thoughts, well, I
(28:12):
kind of almost feel like I justclosed a little bit, but no,
I just wanted to say like that, you know, there is momentum right
now. There's a lot being done. I think in the next legislative session
in twenty twenty five. We justfinished a fiscal session, but the next
legislative session, I do anticipate alot of these issues coming up. If
you want to follow along, AmericanHeart Association will be very active, So
(28:34):
please follow us at yearthicure dot comand sign up and you know we'll keep
you up to data on what's goingon and what we're working on and proposing.
But we you know, all thesupport we can get, and we
really hope that people will help usand be active in some of these issues.
And so doctor Jrevor, what aboutyou. Yeah, I would just
say, you know, maternal healthcan be a dreary picture. But I'm
(28:55):
really inspired. I'm really inspired seeingall the amazing work that is happening at
uam AS, at Arkansas Center forHealth Improvement, at the Governor's Office,
at Darkansas Department of Health. Somuch is going on and so many people
are talking about it. I mean, we're here today talking about it,
and so I think that's a reallygood sign and I think that we are
on a good path to better supportmothers. Fantastic And of course it is
(29:18):
Mother's Day. Happy birthday to allof the moms, all of the moms
to be, And I just wantto throw out there, if you are
a mom to be and you havequestions, do not be afraid to ask.
Whether it's a family member, whetherit's a doctor, whether it's a
friend, if you have friends inyour circle that are moms, or maybe
(29:38):
a chance to meet new moms andmake new friends. Ask those questions because
they are so important and we wantto change the experience of mothers and mothers
to be here in Arkansas. Thanky'all so much for being a part of
the program. I appreciate you comingin today. Thank you. Thanks.
(30:00):
We're listening to Talk of the Rock, public affairs and community events from the
iHeartRadio studios in Little Rock. Besure to subscribe to this podcast and listen
next week as we talk to moreguests about public service, local charities,
and events going on in your neighborhood.
Welcome and thanks for tuning in forTalk of the Rock public affairs, community
events, and public services for CentralArkansas from the iHeartRadio Studios in Little Rock.
Here's your host, DJ Taylor,and thank you for joining us for
Talk of the Rock. DJ Taylorhere with Dave Obrimp, the government relations
director for American Heart Association in Arkansas. How are you, sir? Good?
(00:21):
How are you doing doing fantastic?And also joined by doctor Nikola Driver.
You're the maternal health scholar at ClintonSchool. How are you, ma'am?
I'm great, Thanks for having usfantastic. Well, I want to
start out first of all, let'stalk about what it is that you do
at the Clinton School. A maternalhealth scholar. That sounds very focused and
(00:42):
very localized study. Yeah, So, I'm an associate professor at the Clinton
School right here in Little Rock.I'm a public health scholar, so I
really study health disparities, but Ihave that focus on maternal health. I'm
really interested in studying how do webetter support mothers throughout the lifetidle go from
everything from pregnancy to birth to postpartum. And I'm also a native Arcanson and
(01:06):
mom, so I just really careabout our local communities and the mothers across
the state. Well, fantastic andhappy Mother's Day. Thank you, and
also Dave, all right, SoAmerican Heart Association no stranger to the program,
and it's a pleasure to have youin here. What is it that
you do, I mean your governmentrelations for the state of Arkansas. Tell
(01:26):
me a little bit about that.Yeah, So my role with American Heart
Association is to try to pass policiesthat will have positive impacts on cardiovascular disease.
And so the American Heart Association isactually also the American Stroke Association.
And so Arkansas has some one ofthe highest heart attack and stroke mortality rates
in the country, and so youknow, high obesity rates. There's a
(01:47):
lot of those risk factors in Arkansas. So we do things like we work
on trying to less smoking les tobaccouse. We try to promote activity and
nutrition and make sure hospitals take bettercare of patients when they come in and
make sure people have access to qualitycare. And so there's a wide variety
of policies we tried to pass bothat the federal but my primary work is
(02:07):
at the state and local level.Fantastic and I appreciate the work that you
do, sir. It's fantastic,indeed. And one of the things that
staggered me, it was during arecent interview with some of the folks from
the American Heart Association, is thatheart disease is the number one killer of
women across the country, but absolutelyrampant in Arkansas. And also that when
(02:30):
it comes to maternal health, Arkansasranks absolute last in the country. And
I know there are a lot ofdifferent things that could be done to fix
that, and that's part of whatwe're talking about here today. Now,
how would you describe Arkansas as comparedto the rest of the country in terms
(02:51):
of maternal health. What are someof the things that you see being done
differently in other states? Yeah?Sure, you know, I think Nikolao
Prie has a better perspect of kindof how the whole country goes. And
then I can maybe talk a littlebit about some of what we got going
on here. Sure, sure,absolutely what what what would you say on
that? So the big topic ofconversation lately is the maternal mortality rate,
(03:12):
right, So this is the termthat we use when a mother dies from
a pregnancy related health issue or anexisting condition that is made worse by pregnancy.
And so Arkansas, as you mentioned, has the highest maternal mortality rate
across all fifty states. We experiencearound forty five pregnancy related deaths per one
hundred thousand berths. So that maynot seem like such a large number,
(03:36):
but when we're comparing it to therest of the US, the average is
around thirty pregnancy related deaths and someof the best states they're sitting at right
around ten. So we are substantiallyhigher. And I think, you know,
the maternal mortality rate is just it'salso used as like a red flag
for larger issues happening. It's kindof like a proxy measure for how we're
(03:59):
doing. Oh, we're all inmaternal health and obviously not great. Yeah,
And I think it's also important toit and issues you relate to is
that maternal mortality is the worst outcome, right, but there's other health aspects
and stuff that come that hopefully wedon't get to the point of mortality,
right, And so you know,I think like she's saying that that's an
indicator of how we're doing in Arkansas, and you and you hit the nail
on the head here. We kindof talked about how our overall health is
(04:20):
and and lots of times. Youknow, one doctor u MS once said
that when we're talking about maternal mortalityin Arkansas, we're largely talking about cardiovascular
disease. It's a lot of issuesregarding hypertension and UH and some other kind
of diseases or kind of health aspectslike that. We have a very high
smoking rates. We UH, diabetesrates in Arkansas are very high. And
(04:45):
so you know, a lot ofthis too is that we have poor outcomes
before a lot of women are gettingpregnant, and then those health those health
outcomes are carrying through the pregnancy andinto the into birth. And I also
think too we talk a lot aboutmaternal mortality, but when we're talking about
mom, healthy moms, right,healthy mom's been healthy kids. Sure,
you know, you can't take careof your child if you're not feeling well,
if you have postparmon depression, ifyou have physical ailments, and so
(05:08):
you know, in Arkansas, youknow, I think our infant mortality rate
is incredibly high as well. Sothese are all kind of related things,
and so you know, Arkansas ingeneral, like I said, we have
a very kind of poor health outcome. So there's a variety of factors for
that, but I think that's kindof what really is setting Arkansas apart for
the rest of the country. Sothose are definitely some of the contributing factors
(05:30):
that lead to the higher mortality rates. And I'm just gonna throw this statistic
out there. Is something I heardit blew my mind while my wife was
pregnant about five years ago. Isthat a pregnant woman's heart rate and cardiovascular
stress we'll call it, is theequivalent of somebody training for an ultra marathon.
We're talking about like that super long, like one hundred kilometer plus marathon.
(05:57):
And so when you combine that withlike you were saying, poor cardiovascular
health to begin with hypertension, diabetes, things like that, it's all just
a big mix that has to bedealt with. And when you know,
when we look at this across thestate of Arkansas and these issues that are
faced, how do we compare ormaybe better to ask, how do we
(06:25):
cope with these issues? Do wesee anything in the medical field where doctors
are better trained here in Arkansas tohelp deal with maternity in those situations?
I mean, is there a specialtraining or a specialized aspect that we see
(06:46):
from doctors in the state. Well, I'll just say that, you know,
recently the Arkansas Department of Health,they found that over ninety percent of
the pregnancy related deaths in Arkansas werepreventable, and so I think there are
are a lot of things we cando to better support mothers during this time.
And in their report, they recommendedchanges in the way that practitioners can
(07:06):
provide care for pregnant and post partumwomen, specifically taking into account these risks
for hypertension and heart disease. Sothey're recommending more counseling for patients who are
at risk for these chronic diseases,and just more education overall for providers,
patients, and families to recognize thoseearly symptoms. So you know, not
(07:29):
all the time will a mother recognizethose early symptoms in herself, and so
making sure that the families and spousesand partners are aware so that when something
happens they can bring it to theattention of the provider. Well, and
I also think it's very important thatyou know a lot of folks, we
all lead busy lives. That isjust a given this day and age.
We're always on the go and ohit'll pass or it'll it'll go away on
(07:53):
its own in a couple of days. But honestly, I've said it a
dozen times on the program. That'swhat doctors are there for. If you
feel like there's something wrong, gosee the doctor about. They're not going
to get mad at you or getupset with you because you came in.
Hey i'm having this weird feels likeflutters in my chest, or you know,
(08:13):
the baby is kicking an awful lot, or any number of different things.
I know, when we talk aboutthe American Heart Association, we talk
a lot about cardiovascular health and payattention to those signs and symptoms. Blood
pressure is a huge deal, ahuge factor in that, and also making
(08:35):
sure that you do maintain some sortof movements or just getting up and around
a little bit. But when itcomes to what you feel during a pregnancy,
I mean, as a guy,I can't speak for that, but
during a pregnancy, there are somany different things, so many different changes
(08:56):
to the human body during that timethat you know, a lot of people
I would think maybe equate that tojust being pregnant instead of a potential issue.
Yeah, definitely, I think thatmothers should trust their instincts and trust
their gut. You know, ifsomething feels off, take it seriously.
And like you said, don't worryabout what people are going to think about
(09:18):
you. Ask for support, andjust you know, keep an eye out
for those things your doctors telling you. Keep an eye out for pain,
keep an eye out for bleeding.And I'll also say too, for some
people, it can be difficult foraccess for these rights, right sure,
So you know, I think thatin rural parts of the country is not
just an unique to Arkansas, butit's hard to recruit doctors to some of
(09:39):
these small hospitals and small towns,and and I think it's even harder when
you're talking about specialized care like obguI NS and so sometimes access is you
know, a long ways away.So you do having that weird pain or
that weird feeling or is this right, and you're like, am I going
to make a two hour four hourround trip, you know, two hours
each way to go get this checkedout or you know, or maybe get
(10:00):
the next appointments not for months orwhatever. And so I do think that
it's important that we're going to lookat some other kind of ways to address
that community health workers. But youknow, doulas is a big deal,
right, people that are trained andcertified, and that hopefully we get a
situation where insurance will even cover that. I think there's sometimes a misconception where
people are thinking of dula's as thesekind of crystal healers or hippies or something
(10:22):
like that, and they're no.I mean, you know, they are
medical professionals and and and medical ismaybe not even the right term, but
the professionals in this right sure,you know they're not they're not they're not
training to deliver babies or anything,but they're they're trained to be knowledgeable and
and they can identify warning signs andthey can help give tips and stuff.
And so I think having kind ofthose trained people in these communities where we
(10:45):
can't recruit doctors will kind of createa knowledge base where people can say like,
oh, you need to go orhey, that's the thing that happens.
I know, it's weird, right, And so I think that that's
an important thing that Arkansas needs tolook at and probably something we're lacking in
some other states. That's such greatpoints. You know, oftentimes we want
to think about these things in termsof the individual, like what did the
mother do, or the lifestyle factorsor the kind of life that the mother
(11:07):
was leading. But there are somany social and structural factors here that play
a role. For example, welive in a very rural state, as
you mentioned, Dave, and accordingto the Arkansas Center for Health Improvement,
sixty percent of rural hospitals in Arkansasdo not offer labor and delivery services.
Wow, So that means that ourkansins many are Kansas are living in what
we call a maternity care desert andhave to drive forty minutes or more,
(11:31):
some much farther to give birth ina safe facility. So this can not
only put their access to labor anddelivery services at risk, but their access
to prenatal care at risk. Andthe rural hospitals are also facing those staffing
challenges that you mentioned, So it'sjust kind of like this layered, layered
problem. And I also want tomention doulas. So doulas really are so
(11:54):
their non clinical support, right.They can provide that emotional cycle, logical,
spiritual, and informational support for amother, and they can empower mothers
to make decisions for themselves when they'rein that really intense, overwhelming experience of
giving birth, and studies have shownthat mothers who have DULA support they have
(12:15):
overwhelmingly better outcomes. Right, Sothey're less likely to have ce sections that
are non medically necessary, they're lesslikely they have shorter duration of birth,
and they also are more likely tobreastfeed. And so doula's could be a
really important and impactful resource for fillingthis kind of medical care or maternity care
deserts that we're talking about well.And I think also it's important to note
(12:39):
that these people are trained professionals,They've been educated properly in a lot of
this. Some people go to doctorGoogle, and that's just a bad idea.
I mean, honestly, you canlook up one thing and it could
lead you down the entirely wrong path. And usually time it's incurable cancer,
right, incurable? Can ye,I've got a headache and curable. Yeah,
(13:01):
I sprained my ankle and I'm yeah, I've got some rare disease from
timbuk too. It's yeah, it'sterrible. Now. You have mentioned a
whole lot about rural areas in Arkansas. Are these the areas where we see
the higher maternal mortality rates. Iknow that that's that's going to be an
issue, But is that one ofthe primary causes, do you think?
(13:22):
Yeah, so we're seeing them.We're seeing higher rates in the rural areas
and more specifically in the southern regionsof the state and the eastern regions of
the state. Yeah, And soI think rural is a big deal,
right, there's an access to carettsure there too. But I also think
we're seeing it too, which ispopulations that tend to be you know,
poorer, less educated across the state. So you know, we're seeing it.
(13:43):
I think it's an epidemic both ruraland kind of minority populations. It's
probably the places and so that's whatwe're seeing, you know, the Mississippi
Delta, you know, than thosekinds of places. And so I think
if you put a map over thestate and look at maternal health issues,
probably the similar places you're going tosee the diabetes issues, and you're going
to see cancer is higher rates ofcancer and diabetes and all these outcomes.
(14:07):
And so, you know, Ithink there's something too to be addressed that
you know, we're working on outcomesfor maternal health, but you know,
a large This is kind of moreof an epidemic thing about how do we
get access to these populations both inrural and some urban areas of Arkansas.
Well, now, let me askyou about this and let me see if
this kind of correlates a little bit. I know Governor Huckeby Sanders, Uh,
(14:28):
she got the Arkansas Strategic Committee fromMaternal Health uh to sort of work
on problems. What what is thestatus on that committee? How is that
coming along? And I really likedto applaud Governor Huckerbry Sanders. I'm kind
of taking a real proactive approach,and we're identifying an issue here and and
looking for those solutions and and bringingthis committee together to solve those And so
(14:50):
I plot her for taking it veryseriously and putting this group together. So
what they've done is they've they're they'regetting stakeholders from across the country. You
know, I think our first stakeholdermeeting probably had around one hundred different people
in it. We broke out anddid different specialties, and we just started
kind of bouncing ideas off the walland looking at kind of ideas from other
states and and and it was areal kind of listening session and brainstorming session.
(15:13):
We can get a real idea ofwhat's being done and what we can
do, and what other states aredoing and so. And I think that
was the kind of the first meetingand the first step. I know they're
meeting with this kind of other varioustypes of stakeholders, and we're gonna keep
having those meetings here. I thinkthe whole task force is supposed to go
for about six months, so Ithink we have about four or five months
of it left. But yeah,I think that I hope. I think
(15:35):
we'll have some good solutions and somegood ideas heading into the next legislature for
hopefully to make some really impact fantasticAnd again, you know, I mean,
this is a very fitting conversation.It is Maternal Health month. Of
course, Mother's Day weekend here withus, and just really quickly, I
mean, because it's I've got afive year old at home. So this
has been a recent I don't wantto say battle, because we had a
(15:58):
fairly mostly normal pregnancy and everything thatwent along with it. But one of
the things that really got to me, you know, obviously travel time.
If you live in a city,then you've got a little bit better access
to healthcare and things like that,and then once the baby is here,
(16:19):
then you've got all the issues ofpostpartum. I know mom's typically they might
be allowed a couple of weeks outof work, you know, if they've
got the vacation time or the sicktime. My wife burned through all of
hers with our youngest, as didI burn through a lot of mind as
(16:40):
well, trying to stay home andhelp mom out because immediately following birth,
the body has taken I don't wantto say taken a beating, but it's
pretty close to it. There's alot of stress on a woman's body.
And I know that there's also beentalk about a postpartum Medicaid expansion for women
(17:03):
to extend their postpartum coverage from Medicaidsixty days now to maybe a year now.
This is something that most of thecountry is either adopted already or they're
looking at extending this out. Whatis going on with Arkansas on that front,
Yeah, I appreciate you bringing thatup, so you know, the
governor. I think Arkansas is goingto be one of maybe two or three
(17:26):
states at the end of the yearthat probably has not incorporated this. But
Arkansas does have a unique medicaid expansionprogram. And I think it's important too
when we're talking about this, thatwe're talking about not just not just you
know, people without jobs during pointpeople, but it is largely the working,
the working kind of class people,right, the lower end of that
financial spectrum. Right, These peopletend to be working and have jobs,
(17:48):
and so they qualify largely for medicaidjust because they're pregnant. In Arkansas,
we call it pregnant Women Medicaid,and so we can extend that after they
get birth for up to the year. The federal governm and recently allowed this.
Now, so I was mentioning Arkansashas a little bit different kind of
program, and so the Arkansas andthe governor said, hey, I don't
think we need to extend this program. I think we can make it work
(18:08):
here in Arkansas. And so we'vetaken some steps to do that. It
might not be kind of as aI don't know what we want to say
is a clean looking from the outside, it's like, oh, there's just
extended it, right, but wedo have some programs to make sure that
there's coverage and all these women willbe eligible for coverage. I think we
are going to have to address somegaps making sure that it's affordable, it's
(18:30):
seamless. You know, you're nothaving to do a navigate in a complicated
insurance thing when you're two months inpostpartum. I mean, I work in
the health field, and I don'tlike to navigate the insurance thing right let
alone if you're not getting sleep andnot feeling well. So we want to
make sure that the transition is seamless, it's affordable, and they can continue
the care they're getting. They don'thave to switch doctors or anything like that.
(18:52):
But postpartum, I think is areally important thing that we've kind of
are realizing more and more how importantit is. The Arkansas Center for Health
Improvement fantastic group that does a lotof the data analysis for health. Here,
they did a great breakdown of kindof some postpartum stuff. Eighty seven
percent of women get an internal postpartumcheckup. I would think that would be
(19:12):
one hundred after giving birth and gettinga check up to make sure. I
think a lot of times, youknow, it's access to care, but
a lot of times, pege,you're so focused on the child, you
might not be as focused on yourself, but we know seeing that has been
a much higher rate. One infive or experienced postpartum depression one and twelve
(19:33):
or twelve percent of women smoke cigarettesafter giving birth. So breastfeeding, smoking,
smoking, and tobacco use is agiant problem in Arkansas. I can
kind of get into some of thereasons with that, but I think we
can tie that into maternal health aswell. There was an oh and eighty
percent breastfeeding postpartum, and brestfeeding isa huge deal for the health of infants
(19:56):
and the health of babies, butthat slowly moves down to about fifty percent
at eight weeks, and so thatalso is not just a deal for maternal
health, but infant health as well, and so making sure that they have
that access to care in those regularcheckups and seeing doctors. We really hope
to kind of approve a lot ofthose numbers and I think we'll see a
lot better health outcomes because of it. Very nice and one of the things
that I do want to talk aboutalso pregnancy and postpartum. I know that
(20:19):
there are programs. There are alot of women that could use these programs
across the country, whether it befor physical or for mental health. I
know that mental health can be abig issue with women during and after pregnancy.
Are there any specific types of programsthat women should look for perhaps when
(20:42):
it comes to that. Yeah,I think one really interesting model that UAMS
has been proposing or has been workingon for several years now is the centering
pregnancy model. We actually just publisheda study on this to show the effectiveness
of it. So centering pregnancy isit's an alternative to traditional prenatal care.
(21:03):
You know, traditional prenatal care,you meet these her doctor for maybe like
what ten to fifteen minutes, andask questions, do some do some measurements,
do your blood pressure check? Thingslike that, and then you leave.
With centering pregnancy, it's very different. It's a group prenatal care model
where you have anywhere from like eightto twelve women all sitting in a room
together with a healthcare provider and ahealth educator in the room. So they're
(21:26):
getting their basic measurements done blood pressurecheck, fundl height measurement, things like
that, but they're also meeting otherwomen who are at the same gestational age,
so other women who are experiencing thesame things, who are experiencing the
same stress, experiencing the same challenges, have like similar demographics maybe yes,
you know, like later giving birds. Maybe they're from a similar area of
(21:48):
the state, you know, Soit's a situation where these women kind of
are relatable and you have those thingsin common. It's a really important thing,
and this was one of the thingsthat's being talked about here here in
Arkansas about implementing with the Taskbard.Yeah. And what that does is it
creates sort of an informal support systemfrom others, especially low income mothers who
don't have a lot of support andkind of filling that gap. There's another
(22:08):
extension to that which I don't thinkyou AMS has approached it, or maybe
they're thinking about it, but it'scentering parenting. So it's after the baby
is born, during this postpartum period, still getting together with mothers to build
that social support and work through challenges. And it really does change. It
changes knowledge about staying healthy during pregnancy, knowledge about breastfeeding, as well as
(22:30):
just changing norms. So if youcome from a community where breastfeeding isn't super
common, or talking about your feelingsduring postpartum isn't super common, that can
change norms from others. And makethem feel more comfortable during those times.
I'll have to say too, theArkansas Pediatric Society has been doing some fantastic
work about a program called Healthy Steps, and the idea there is that when
(22:51):
a mom brings the child in tothe pediatrician, that they're also working with
the mother and the families and stuff, and so that they're looking for those
warning signs and those health things andthe mothers as well, and so that
they're kind of doing that kind ofwhole health approach with both the child and
the mother to kind of help outwith that so that we're not segmenting all
(23:14):
of our care all the time.Absolutely, and I think it's really great
that you would have a group ofmoms, not only that they can share
information with each other, they cancompare notes because no two people are exactly
the same, but a lot ofthese women may be going through similar issues
or having similar experiences, and justa chance to build that network, that
(23:38):
support group like you were talking about, that is a fantastic idea. Now,
what are some of the other policiesor some of the other programs that
are being looked at to help lowerthe maternal mortality rate here in Arkansas,
and we've touched on a few Ithink you know currently in Arkansas, we
talked about in dula's a lot,but the dula's only aren't certified. There's
(24:00):
not a certification program in Arkansas.So we just want to make sure that
there's a certification program and also makingsure that they're covered with a Medicaid and
so that people have access to thatcare. So I think that's one of
the solutions that people are talking alot about. We talk about access to
care, and so few hospitals arehaving labor and delivery programs and so warm's
(24:22):
problems with that is the reimbursement rate, especially from Medicaid, and so we
have a very low reimbursement rate,and so increasing that reimbursement rate will create
more incentives for more hospitals to beable to have these programs. And and
you know, one of the difficultthings is is you think, oh,
they just need an O, B, G, Y N there and they
can start giving delivering babies, right. But when you start to think about
(24:44):
it, it's more complicated because unlikeif you have like ankle sprange or something,
babies don't come nine to five,right, So you need a couple
O B g yn to make sureyou can cover all that. But then
people also like days off and theydon't want to there are eighty hours a
week and stuff, and so youneed like four or five obg y ns
and so it's a significant investment.We've got to make sure hospitals are getting
(25:07):
reimbursed at a proper rate for that, and so I think that's something that
we'll be looking at as well.We talked about, you know, the
postpartum access to care issues, andyou know, I think there's another thing
too, is making sure that whensomeone comes in to a hospital when they're
excuse me, when someone comes intothe hospital and it seems very obviously they're
eligible for Medicaid, let's go aheadand treat them, and you know,
(25:30):
get them going on through that Medicaidapplication, and so we can kind of
do a thing where it's like apredetermination where we're saying, this person obviously
qualifies for Medicaid. We don't wantto have that have to come back in.
We can treat them right now,we can get them going through the
process, and we can go andthen that payment will get reimbursed. And
so less something we're looking at aswell well. And you know, I
think, honestly, between that andthe possible expansion to rural areas, maybe
(25:55):
for a better transport system, ifnothing else, or some sort of ability
to get these moms and moms tobe a chance to actually get the travel
time that they need, or maybea vehicle to get them there. Some
sort of transport system could be apotential help in the future. And I'm
(26:17):
glad to see that so many differentthings are being done from a local and
from a national standpoint when we cometo this. Also, just one quick
question, I've noticed that the AmericanHeart Association so active in maternal health.
We're hearing so much more about that. What was the big swing for the
American Heart Association on that. Yeah, oftentimes when I go these maternal health
(26:41):
meetings and people are like the AmericanHeart Associations here, We're glad to see
you, but no, I youknow, I think a lot of times
for these programs started, we hadyou know, the kidney groups and the
hard groups, and for some reason, I don't know if the liver got
a group, but I don't know. But anyway, we kind of,
you know, back in the day, I think we kind of siloed off
a lot of this care, andso you know, the American Heart is
Asociation has taken approach where these thingsare all connected. Right. You've got
(27:03):
kidney issues, it's going to leadto hypertension issues. And you've got heart
issues, it's going to be affectingsomething else, and so they're all connected,
right. So we're really looking fora full kind of wellness approach now,
and so I think we are kindof breaking into areas that are kind
of non traditionally might not think ofthe American Heart Association is. But we
also mentioned too that when it comesto mortality rates, it's largely a cardiovascular
problem, and so I do thinkthere is probably a natural fit for the
(27:26):
Heart Association and traditional sense. Butas American Heart Association looks at a whole
health approach and we're kind of breakingout into some new important kind of medical
areas, this is one of them, and it's a big priority for the
American Heart Association right now. Acrossthe country. We've been really kind of
being forward and doing these postpartum extensionplans across the country as well as some
(27:48):
other issues. And so I thinkthis is it's exciting that we're able to
be a part of this, andwe're really excited about the leadership we're team
from the Governor's office and so muchmore momentum with all these stakeholders and stuff
involved. It seems like there's areal lot of momentum right now in Arkansas
to address this, and then we'rereally happy about that. I feel like
it's it's well deserved momentum and I'mglad to see it happening. Just about
to run out of time for today. Last closing thoughts, well, I
(28:12):
kind of almost feel like I justclosed a little bit, but no,
I just wanted to say like that, you know, there is momentum right
now. There's a lot being done. I think in the next legislative session
in twenty twenty five. We justfinished a fiscal session, but the next
legislative session, I do anticipate alot of these issues coming up. If
you want to follow along, AmericanHeart Association will be very active, So
(28:34):
please follow us at yearthicure dot comand sign up and you know we'll keep
you up to data on what's goingon and what we're working on and proposing.
But we you know, all thesupport we can get, and we
really hope that people will help usand be active in some of these issues.
And so doctor Jrevor, what aboutyou. Yeah, I would just
say, you know, maternal healthcan be a dreary picture. But I'm
(28:55):
really inspired. I'm really inspired seeingall the amazing work that is happening at
uam AS, at Arkansas Center forHealth Improvement, at the Governor's Office,
at Darkansas Department of Health. Somuch is going on and so many people
are talking about it. I mean, we're here today talking about it,
and so I think that's a reallygood sign and I think that we are
on a good path to better supportmothers. Fantastic And of course it is
(29:18):
Mother's Day. Happy birthday to allof the moms, all of the moms
to be, And I just wantto throw out there, if you are
a mom to be and you havequestions, do not be afraid to ask.
Whether it's a family member, whetherit's a doctor, whether it's a
friend, if you have friends inyour circle that are moms, or maybe
(29:38):
a chance to meet new moms andmake new friends. Ask those questions because
they are so important and we wantto change the experience of mothers and mothers
to be here in Arkansas. Thanky'all so much for being a part of
the program. I appreciate you comingin today. Thank you. Thanks.
(30:00):
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