August 29, 2025 • 37 mins
Quincy invites Frontier's new Dean of Nursing, Dr. Kristin Ashford, and the Public Health Director at the Woodford County Health Department, Cassie Prather, to discuss perinatal substance use (not abuse!) and local resources in overcoming addiction. ❤️
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Episode Transcript
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Unknown (00:00):
Thank you.
Speaker 00 (00:09):
Welcome back to Real Talk.
Today, I am joined by FrontierNursing University's new Dean of
Nursing, Dr.
Kristin Ashford, and the PublicHealth Director for the
Woodford County HealthDepartment, Cassie Prather, and
we will be discussing addictionand substance use.
Dr.
Ashford is a dedicatedresearcher in which a majority
of her research focuses onimproving health for pregnant
(00:29):
and postpartum women withaddiction, primarily tobacco,
electronic cigarettes, andopioid use disorder.
Not only is Cassie the PublicHealth director here in Woodford
County, but she also sits onthe board of directors for the
Woodford County Agency forSubstance Use Abuse Policy.
This organization began in 2003to address youth and adult
(00:51):
substance prevention,enforcement, and treatment
strategies within the community.
Thank you both for joining me.
Speaker 03 (00:56):
Thank you for having us.
Yes, we're excited.
Speaker 00 (01:00):
So one thing I want us to cover right away is a
verbiage that we're using.
So I've been saying substanceuse, but historically we may
have heard that referred to asubstance abuse can you all
share the difference and why wemay be saying use over abuse
Speaker 03 (01:17):
sure Cassie would you like me to start please
please typically when you thinkabout substance use and the the
culture around substance usepeople often have potentially
different thoughts about howthat impacts people and a big
part of the feelings is relatedto stigma and so many people
(01:40):
with substance use disorder feelothers may be judging or have a
stigma associated that andwords can matter and so when you
think about words like abuseversus use it it sounds more
harsh to be honest and so youwant someone to feel like
they're not being judged and soI think using terminology that
(02:05):
makes the person feel morecomfortable and um welcomed is
important.
Another word that I think hasoften been used in the past is,
are you clean?
Or using words along thoselines.
And so, you know, thinkingabout that, what does that
really, how does that make thatperson feel?
What we want people to feel isthat we are in support of their
(02:30):
journey.
And so thinking about terms andmaybe changing and reframing,
for example, using The wordrecovery, I think, is very
important in helping that personfeel not judged.
Speaker 01 (02:45):
I couldn't agree more.
And I think that it has to be atotal mind shift.
And I think a lot of peoplearen't even, they don't realize
that what they are saying can betaken as offensive to the
person that is struggling.
We have a harm reductionprogram at our health
(03:06):
department, which that a startedas a syringe exchange program.
And we quickly changed that toharm reduction because it's so
much more.
We don't just exchange dirtyneedles for clean needles.
(03:27):
We're doing lots of educationand safe injection practices and
making sure people have a safeway to dispose of their needles
when they're not at the healthdepartment.
Making sure law enforcementhave Narcan.
It's so much more than justsomeone coming in that is deep
(03:53):
within the throes of an illnessand trying to help them get out
of that.
Yes, it's that, but it truly isso much more.
And I always like to think ofour health department when they
come in.
It could be the only exchange,human to human, that they have
in their life where someone isrespecting them, trying to help
(04:18):
them, and not judging them.
And so, yes, our words matter.
And I think that part of that,how they are treated, it keeps
them coming back to get the helpthat they want.
Yeah, that's a
Speaker 00 (04:31):
good point.
So we're talking aboutsubstances.
What is a substance?
Because I feel like a lot of–what do we think of like I feel
like the when people think of asubstance they think opioid
right away but I
Speaker 03 (04:47):
think there's such a wide range of substances and
often people will first go toare they illegal or even the
term here again illicitsubstances because there's also
prescription substances that canbe not misused and I think
(05:08):
often also So when you'retalking about those substances,
you do often think about maybeheroin, opioids, misuse of
prescription drugs, Valium, andthings along those lines that
are different scheduled drugs.
But also, I think people don'talso think about tobacco.
And being in this state wherewe have among the highest rates
(05:33):
of perinatal tobacco use in thenation, which actually is the
most modifiable risk of poorpregnancy outcome.
So when I'm talking about, frommy heart, pregnant and
postpartum women and pregnantand parenting women and persons,
you think about what is goingto adversely affect their health
(05:55):
the most long-term and impact apregnancy the most.
And it actually is tobacco.
More women havepregnancy-related adverse
outcomes for example, a pretermbirth, low birth weight,
bleeding disorders in pregnancy,how it affects the infant.
They're more likely to be bornearly, which is associated with
(06:18):
lifelong complications.
And so certainly we wantanybody that has an addiction to
any substance, whether it betobacco, opioids, cannabis,
which is emerging, as well asany other drugs, we want them to
be able to get some support.
(06:39):
And I think an important piecehere, and I'm probably getting
ahead of the game, but is beingable to safely disclose that
information.
I do believe when we thinkabout substances in general,
people are afraid.
There's fear of that stigma.
There could be fear of legalconsequences, especially related
to pregnancy.
But what we've learned is thatwomen, especially pregnant and
(07:04):
parenting women that discloseearly and are seeking help,
they're more or likely to havethe support service they need to
get in recovery to bemaintained in recovery and to
have the supports they have fortheir children long term
Speaker 01 (07:20):
yes I actually learned quite a bit from your
response we do have a hugeproblem here with tobacco in
Kentucky specifically and thenof course with now vaping which
I think a lot of folks are underthe impression that it is safer
and that is certainly not thecase um but as far as substances
(07:46):
in general um like you saidthese can be things that are
perfectly legal just liketobacco alcohol things like that
um and i think sometimes peopledon't think of those things
that are so easily accessibleand also um really as a society
accepted um That's an excellentpoint.
Speaker 00 (08:09):
Yes, absolutely.
And still just as harmful.
Yes, yes.
But you have extensiveexperience in researching
perinatal substance use.
So how can substance use duringpregnancy impact mom and baby
and also during the postpartumperiod?
Speaker 03 (08:28):
It absolutely can affect the mom and baby and does
affect the mom and baby, but itreally is also somewhat
dependent on the substance Sodifferent substances affect the
mother and the infantdifferently, potentially.
But when I think about maternalmortality, which if you think
(08:51):
about the United States and evenwithin the United States,
Kentucky, we have among thehighest maternal mortality rate
among nations as well as just inKentucky among states.
And so when you think aboutthat, The safety issues, about a
third to a half ofpregnancy-related deaths are
(09:11):
caused by substance use that arepreventable, preventable.
Violence is another.
Violence in pregnancy isanother whole issue that we're
not here to talk about today.
But when you think about safetyto mother and baby and
mortality, you have to addresssubstance use because ultimately
(09:32):
it can cause death, oftenaccidental.
but not always and so it'ssomething that we definitely
need to keep funding programsand research that explore
positive pathways forprogramming and support and
treatment but generallysubstances used in pregnancy
(09:54):
when you're are going to becausing effects that are most
likely going to cause pretermbirth, low birth weight,
bleeding disorders.
One other piece I just wantedto add is that when you think
about that, those early birthshave lifelong implications on
the infant.
You would never think that ababy that's born preterm is
(10:16):
going to be more at risk forobesity later in life, more risk
for cardiovascular diseaselater in life, more at risk for
behavioral problems, forexample, ADHD.
So those early pregnancies,although they're born, they're
like, oh, well, if they grow,they're going to be better, and
they'll outgrow it.
No.
They can adapt, but they manytimes will be having those
(10:40):
lifelong consequences, whichactually are very costly, not
only in terms of health to thefamily, but also in terms of
dollars to the state and fundingprograms.
Speaker 00 (10:52):
That's a very good point.
So I want to give you all ascenario.
I've been using while pregnant,and I want help.
What can I do?
So Cassie, I'll let you gofirst.
Speaker 01 (11:03):
Okay.
Speaker 00 (11:04):
Let's say here in Woodford County.
Speaker 01 (11:05):
me
Speaker 00 (11:05):
for you that
Speaker 01 (11:06):
this happens okay um let me get you in contact with
someone you know that can helpyou i'm so glad you know that
would be my i'm so glad thatyou're sharing this with me and
um although here at the healthdepartment um we do not do any
kind of medication treatment orsubstance use treatment however
(11:30):
we can connect you with theresources that you need in order
to get um yourself and yourbaby and you know healthier um
and then you know i'll would sayone of the first things um is
having that person contact umfor sales police department if
(11:50):
they need a ride or if they wantto go get um treatment outside
of Woodford County we do nothave a lot of treatment offer
options in Woodford County we dohave Isaiah House which would
be one of the first places thatI would recommend because Isaiah
House is in Woodford and um, itis for women only.
(12:14):
Um, but then as close asJessamine and Frankfurt, um, we
actually have access to, um,some medication assisted
treatment, uh, options.
And so, um, a lot of people dochoose that because with that
also, um, comes, um, therapy,um, and counseling and things
(12:35):
like that.
And they will also connect youto, um, groups, um, that you can
go to throughout the week, talkto people who are either in the
same scenario or have been andthat can, you know, have lived
experiences and can help you inyour journey to getting healthy.
(12:59):
So that would be kind of theshort and sweet version of what
I would give them.
Right,
Speaker 00 (13:07):
so if they came to the health department, that's
what you would do?
That's what we would do, yes.
And Dr.
Ashford, you already a women'shealth nurse practitioner.
So if you would recommend themtalking to their provider, how
do they approach their providerabout this?
Speaker 03 (13:19):
Thank you so much.
And I think that's step one,reach out to your provider.
The state has really invested alot of great programming and
funds into the Perinatal QualityCollaborative, which is a
training system that Dr.
Connie White has led for manyyears to help providers and
(13:39):
hospital systems across the thestate be trained in these
particular areas and how to helpprovide supports for women with
substance use.
So there's been a lot oftraining invested.
We have wonderful programs.
We have home visitationprograms in all of our county's
hands.
We have Kentucky Moms Matters.
Voices of Hope is a phenomenalcommunity-based program that
(14:01):
helps support not only pregnantand parenting women, but also
adults and children of all agesthat can have that connection.
The Chrysalis House is also agreat resource for pregnant and
parenting women across thestate.
And each of the hospitalsystems really have unique
programs that bring together ateam.
(14:24):
It's not, I love, of course I'mbiased to nursing and nurse
practitioners, nurse midwives.
I think they're just innatelytrained to have that culture of
caring as one of our frontiergoals.
But also to have thatmultidisciplinary.
It takes all team members.
(14:46):
We need the physicians, thesocial workers, the community
workers, the community healthworkers, the local health
departments, all workingtogether to provide the supports
to these women and theirfamilies because it takes a team
and the school systems as well.
So number one, I guess to makeit short, be bold, be brave and
(15:10):
take that step and reach outbecause we are there to help you
very well said and we want tohelp you
Speaker 00 (15:19):
and that reminded me you talking about that
collaborative teamwork Frontierlast year for midwifery week
offered a CE session onsubstance use during pregnancy
and we had a nurse midwife fromFrontier present along with a
mental health provider and aregistered nurse so that's kind
(15:40):
of how all three of those cametogether and then presented that
because it is a
Speaker 01 (15:44):
teamwork absolutely it takes us all and that's one
of the things that you canexperience as a leader in the
community when you attend one ofthe ASAP meetings is that is
really where a lot of systemscoalesce to talk about the
(16:05):
substance use disorders and andhow we can help the people in
our community and connect themto all the resources.
I would love for you to attendone of those meetings.
I would love to attend.
Okay,
Speaker 00 (16:18):
okay.
So tell us more about WoodfordASAP.
Speaker 01 (16:22):
Woodford ASAP.
So I'm already thinking we needto change the acronym because
it does have the word abuse init.
But we're all learning.
That's right, exactly, exactly.
And we all have to be open tochanging our mindset and seeing
how even things that we're doingunintentionally can negatively
(16:43):
affect those that we are tryingto help.
But the ASAP, Agency forSubstance Use Policy, I'll just
use it that way.
There you go.
That is a group that has beenmeeting here in the community
and I believe is present in ifnot all of the 120 counties in
(17:06):
Kentucky, the majority.
And so that was established sothat we could have a network of
people at in the local communityat the local level really
talking about exploring optionsand really breaking down the
(17:27):
barriers for people who aresuffering with substance use
disorder and so that is more ofa it's more of a funding source
when I first joined my I thoughtit was more of a program or,
you know, we needed to be doingthis and this and this in the
community or, you know, reallyit's a funding source.
(17:49):
And it's a group of leadersthat look at policies and things
like that.
You know, back 25 years ago,people were still smoking in,
you know, community places.
So those are some of the thingsthat the group can help change
policy and influence policy.
That's another...
(18:10):
huge component is influencingpolicies that affect our health.
But one of the things that theydo is they offer mini grants to
people in the community.
And those can be, you can writethose mini grants.
They have applications that areavailable several times a year,
(18:31):
but they can be for treatment,education.
The school system uses them foreducation for kids,
scholarships we have severaldifferent scholarships that we
give students each year who haveeither been affected by
substance use disorder directlyor indirectly and then harm
(18:57):
reduction we talked about thatearlier you know we want to make
sure that all of the policedepartment the sheriff's
department they all have accessto Narcan in their units because
they may be the firstresponders to find someone who
is potentially overdosed and wewant to make sure that they have
(19:19):
what they need to save someoneand not have to wait on an
ambulance and EMS so of coursethose people will come later but
a lot of times the officers aretruly the first people to
respond and also to anyone inthe community we give Narcan to
anyone and so whether you'retrying to help a loved one that
(19:42):
may be you know suffering withsubstance use disorder or you're
just you want to be prepared asa community member so that's
another thing and then we alsoprovide sharps containers for
our police department and thenyou know other law enforcement
officers to make sure that theycan safely dispose of needles if
they should find them and theydo occasionally we do use
(20:05):
retractable in our program sothat it's it's their only one
time use and then that needleretractable tracks because we
also want to think about thecommunity and the safety so
those are just a few things thatASAP can assist in funding but
we also were the recipients ofthe opioid settlement funding
(20:29):
and so that's a larger chunk offunding ASAP usually doesn't get
a huge amount of funding eachyear but the opioid settlement
funding is going to be a largerchunk and so So we're really
right now just trying to gatherinformation on how we can best
utilize that funding, and we'retrying to look at what other
communities are doing and howthey've been successful in
(20:53):
assisting the substance usecommunity and really helping
them get the resources that theyneed.
Speaker 03 (21:04):
Cassie, there is so much there that also resonated
with me, and I just also want tojust encourage those that are
listening that to reach out tofind about more grants and more
opportunities.
Kentucky, I think it's almost abillion, as in a B, that the
state is going to be allocatedfor funding for opioid
(21:25):
abatement.
About half of that is already,you know, accounted for in
different programming over thecourse of, we're talking, I
think it's 10 years.
I could be wrong, could be 15.
I'm not sure if you know,Cassie.
I'm not sure.
It's not just over one yearoff.
obviously.
But also, but that other halfis really open to, they're
(21:46):
exploring the committee and theboard is exploring
opportunities.
They want to help communities.
That is their goal.
So more to come, be aware andreach out to Cassie or myself.
And if we don't know, we canhopefully get you in contact
where you could find some moreof those grants.
I know just from my experiencefrom at University of Kentucky
(22:08):
College of Nursing, there areresearchers there that are
offering mini grants.
I know Dr.
Amanda Fallon Bennett has amini grant program that people
from every county could applyfor.
It's more focused on pregnantand parenting women.
The Pathways program atUniversity of Kentucky is the
(22:30):
one I know best.
And they have been in existencefor a long time specifically to
help pregnant and parentingwomen.
So U.K.
pathways program can really getyou connected they also have a
postpartum program that that wasformerly referred to as beyond
birth but I think it's now thesmart parenting program so
(22:51):
there's lots of resources outthere but in general all of
these programs are ready to meetyou where you are if you're
talking about starting fromtobacco there's tobacco
cessation programs and I knowthe health departments do a
phenomenal job with that if youif it's opioids if it's cannabis
because it is not safe inpregnancy either and So I think
(23:12):
just understanding what arethose real effects and reaching
out to the health providers andthe community supports that you
have is a great first step.
Speaker 00 (23:23):
And you both have mentioned hands.
So both nod your head real bigwhenever it's come up.
So if you guys want to talkabout that a little bit.
Speaker 01 (23:33):
Yes, I can talk about that.
So that program, it stands forHealth Access Nurturing and
Development Services.
services and that's actuallyhoused within the health
department here in Woodford Iknow it's in most health
departments however not allhealth departments are required
to have that other agencies maymanage that but every person in
(23:59):
Kentucky should have access tothat if you are a new or
expectant mom or dad and that'swhat I love they keep this this
program is evidence-based andyou know very very very
beneficial and uses a lot of thethings that you know our
(24:25):
medical staff social workingstaff have so it's kind of like
an all-in-one but they keepexpanding who is actually able
to utilize this and a lot oftimes it's I think there's
because it's offered within thehealth department they think
that there's some kind offinancial limitation there's not
(24:47):
we are we literally see peoplethat are homeless to living on
horse farms and that isabsolutely no joke and I think
that the law enforcement wouldtell you that that's the same
thing that they see inresponding to overdoses it is
really there's it serve everyonebut in that program we will
(25:10):
follow you as soon as you findout you're pregnant to usually
when the child turns three yearsold and we will be with you
every step of the way that's whyI like that it's hands because
we literally hold your hand andfollow the steps I love I'm a
mother of five and so this isone of my favorite programs that
(25:32):
we offer we usually get incontact with our families when
they come in for other servicesand they just don't know that
this is one of the other ones weoffer but we help make sure mom
and baby are developing growingproperly we're going to do ages
and stages we're going to doall kinds of assessments with
(25:54):
you to make sure um you knowbaby is feeding eating properly
growing properly that the baby'ssafe and that we do you know we
do home checklists to make sureyou know because there are
things in homes that you don'tthink of that can be harmful and
so it really the program doesso much and so it's hard to
(26:15):
really put it down into like afew sentences um but really
every parent needs another setof hands and eyes and ears and
that's really what this is andlike i said it's also for um new
fathers yeah and so and we knowevery baby is different so even
(26:36):
if it's just your second thirdchild that you can be accepted
into the program.
And again, there are many,many, many, many, many ways to
qualify.
In fact, it's harder to notqualify for the program.
And so if you have questionsabout it, please go to our
website.
That's actually out on ourfront sign in the health
(26:58):
department.
The state has a great website,but we have social workers and
nurses on our team.
We also have several people onour hands team that are are
fluent in Spanish and English.
And so we know here inWoodford, we do have a lot of
Hispanic families who alsoutilize our programs.
(27:22):
And so, yes, if you know ofanybody that is expectant or
just had a baby, I think it'swithin 90 days that they may be
qualified for the program.
And we offer many, manyincentives for program or, you
know, the appointments that arekept.
And again, appointments It'sreally just a visit.
And we can do those virtuallyif needed.
(27:46):
So a lot of different options.
It's very flexible, but it'salso very beneficial for really
the family as a whole.
You continue to make goalsthroughout the program.
So I'm sorry, I don't want totake up all the time talking
about hands, but it is a truepassion.
It's a wonderful,
Speaker 03 (28:01):
yes, it is a wonderful program.
And I think in all 120counties.
Speaker 00 (28:06):
Yes.
And it's not just for checkingin on the child.
it's checking in on the parentsas well yes
Speaker 01 (28:12):
and it's yes and you know a lot of things that other
programs or other entities mayenforce I guess that's not
that's not really what we do ofcourse if if if baby's having
you know some some issues let'ssay with feeding or something
like that we may refer you to anoutside source but unless
(28:34):
something is just true you knowwe're not there to report you
for anything you know thatthat's That's a really common
misconception.
Yeah, people think that that's,and that's truly not, you know,
we're not reporting anything toICE.
It's nothing like that.
You know, we really are just inthere to help make sure that
(28:55):
mom, baby, the whole family haveaccess and all the resources
that they need.
Speaker 00 (29:00):
Right, that's excellent.
Well, anything else you twowant to mention?
Speaker 03 (29:07):
Just to build on something that Cassie said about
policy I mean because it's soimportant in your organization
is so important and so thinkingabout how we can advocate more
at the local policy we have verysupportive mayors in our area
in our local areas that arereally have this as a priority
(29:29):
our state legislators ourfederal congresspersons senators
they are I believe leave reallyat the forefront of trying to
help provide supports.
I did have an experience whereI was able to be on a committee
in Washington, D.C.
(29:50):
and work with some of ourcongresspersons there.
And while I was there, therewas actually funding on the
committee.
I was at four home visitationprograms.
And I'm just very proud to saythat our Kentucky
congresspersons were all insupport for the funding
continuation of the home homevisitation programs and hands
(30:12):
was one of the exemplars and sonot only is it just wonderful
here in Woodford County and thestate but it is known nationwide
and there are other programs inthe nation that do home
visitation but again we need tocontinue to advocate for those
programs because they are soimpactful they are they are and
(30:34):
I did I
Speaker 01 (30:35):
did forget to mention we we have at my last
check over 70 families in ourcounty on the program which is
pretty significant for ourpopulation size especially when
considering Fayette neighboringcounty much larger and at that
(30:55):
time I checked that we actuallyhad more families on our program
so outreach is huge for us andmaking sure that people know who
we are what we do and thensometimes what we don't do
because that can be more of aprogram draw and so I think just
(31:16):
exactly we have to use any kindof voice and any kind of time
that we have with those folksthat are making the decisions
and have the funding to reallyboast about our program and how
effective they are because youthink you know in in 120
(31:41):
counties, we have this program,we have health departments.
And so if you're looking forsomething to infiltrate your
community, you already have abrick and mortar of a health
department that is serving.
And so I think down the road,we're probably gonna see health
departments doing more in theway of assisting those with
(32:01):
substance use disorder, becausewe've already been able to, I
think we have more harmreduction programs in our
counties than any other state.
And we need it.
So I think that building onthose programs, we have the
trust of the people that we needto trust us.
And so, yes, I think that is soimportant.
(32:24):
Using our voice and any chancewe get for the legislators and
the powers that be to reallytell them what we do.
And I think it's just storieslike this that we can use.
And this affects everyone.
Speaker 03 (32:39):
It crosses all socioeconomic classes, all
persons of every ethnicity, age.
And so, yes, I completelyagree.
And Cassie, you said the wordtrust.
And that is, I think, what isgoing to continue to draw people
(33:00):
to the programs is that knowingthat they can trust us.
They can trust to come to usthat we are going to do our best
to get them the care that theyneed and if it's okay with you I
would love to Quincy be able tojust put a plug in we need more
nurses in the nation andthinking about policy and
(33:23):
advocacy and workforce and I'msure from the health department
standpoint too we need morenurses and and so Kentucky has a
and wonderful programs acrossthe state but I don't think
anybody really realizes that Wehave in Woodford County,
Frontier Nursing University.
(33:43):
I believe in my heart that ithas the most significant impact
in communities across thenation.
Our mission is to help provideexemplar health care services
through midwife and nursepractitioner education to
underserved and ruralcommunities.
(34:03):
That is our heart.
That is our mission.
And we need those listening outthere, our All those in middle
school, high school, adults thatare looking for maybe that
second career, nursing is such aphenomenal calling.
And that trust is what made methink of that, Cassie, when you
said the word trust, because weare the most trusted profession.
(34:25):
It's cliche, but it's thetruth.
And so if you have an interestin becoming a nurse or a nurse
practitioner, please reach outto us.
There's just such greatresources right here in your
backyard.
Speaker 01 (34:39):
Yes.
that's a great way to end Ialso want to say maybe hopefully
I'll be sending two nurses yourway but my oldest daughters are
very interested in nursing butalso I want to give you a thank
you you all this education issecond to none and one of your
(35:02):
graduates actually identifiedour first case of measles I
don't know that you all knowthat but Dr.
Christy Grider with VersaillesUrgent Care called me 8 o'clock
at night and says I have apatient in the next room and it
(35:23):
is a textbook case of measlesshe's the reason why we had the
early identification and herstaff were the reason why we
were able to stop the spread andthat's what we do as part of
controlling communicablediseases just the foundational
purposes of public health.
And I've worked with otherpractitioners that have
(35:48):
graduated from this program aswell.
And so, again, second to none,the absolute best.
And I'm so thankful that you'rein our community.
Well, and send your daughtersmy way.
Speaker 03 (36:00):
Or sons, if they're there.
I don't know.
Because it's one of my mostfavorite things to do.
My husband actually says, youmay want to stay away from her
because she will be alreadyrecruiting you into nursing.
And so I would love to talkwith them.
I have four children as well.
And unfortunately, they havewonderful professions, but none
of them are nursing.
I did actually get severalnieces and nephews into the
(36:22):
profession, but not my children.
But anyways, and I completelybelieve, agree with you.
My first granddaughter,grandchild was delivered by a
frontier midwife.
And so I have ultimate trusttrust in the program
Speaker 01 (36:41):
yes my first two my adult first actually my first
three children were delivered bymidwife
Speaker 00 (36:47):
oh yeah look at this full circle yes yes yes thank
you both so much for joining metoday and for sharing your
expertise I think this wasreally a fruitful episode and I
know I learned a ton so thankyou both so much thank you so
much thank you this podcast is acommunity health initiative
brought to you by FrontierNursing University in the
Woodford County Chamber ofCommerce to improve community
(37:09):
health We'll see you next time.
Thank you.
Speaker 00 (00:09):
Welcome back to Real Talk.
Today, I am joined by FrontierNursing University's new Dean of
Nursing, Dr.
Kristin Ashford, and the PublicHealth Director for the
Woodford County HealthDepartment, Cassie Prather, and
we will be discussing addictionand substance use.
Dr.
Ashford is a dedicatedresearcher in which a majority
of her research focuses onimproving health for pregnant
(00:29):
and postpartum women withaddiction, primarily tobacco,
electronic cigarettes, andopioid use disorder.
Not only is Cassie the PublicHealth director here in Woodford
County, but she also sits onthe board of directors for the
Woodford County Agency forSubstance Use Abuse Policy.
This organization began in 2003to address youth and adult
(00:51):
substance prevention,enforcement, and treatment
strategies within the community.
Thank you both for joining me.
Speaker 03 (00:56):
Thank you for having us.
Yes, we're excited.
Speaker 00 (01:00):
So one thing I want us to cover right away is a
verbiage that we're using.
So I've been saying substanceuse, but historically we may
have heard that referred to asubstance abuse can you all
share the difference and why wemay be saying use over abuse
Speaker 03 (01:17):
sure Cassie would you like me to start please
please typically when you thinkabout substance use and the the
culture around substance usepeople often have potentially
different thoughts about howthat impacts people and a big
part of the feelings is relatedto stigma and so many people
(01:40):
with substance use disorder feelothers may be judging or have a
stigma associated that andwords can matter and so when you
think about words like abuseversus use it it sounds more
harsh to be honest and so youwant someone to feel like
they're not being judged and soI think using terminology that
(02:05):
makes the person feel morecomfortable and um welcomed is
important.
Another word that I think hasoften been used in the past is,
are you clean?
Or using words along thoselines.
And so, you know, thinkingabout that, what does that
really, how does that make thatperson feel?
What we want people to feel isthat we are in support of their
(02:30):
journey.
And so thinking about terms andmaybe changing and reframing,
for example, using The wordrecovery, I think, is very
important in helping that personfeel not judged.
Speaker 01 (02:45):
I couldn't agree more.
And I think that it has to be atotal mind shift.
And I think a lot of peoplearen't even, they don't realize
that what they are saying can betaken as offensive to the
person that is struggling.
We have a harm reductionprogram at our health
(03:06):
department, which that a startedas a syringe exchange program.
And we quickly changed that toharm reduction because it's so
much more.
We don't just exchange dirtyneedles for clean needles.
(03:27):
We're doing lots of educationand safe injection practices and
making sure people have a safeway to dispose of their needles
when they're not at the healthdepartment.
Making sure law enforcementhave Narcan.
It's so much more than justsomeone coming in that is deep
(03:53):
within the throes of an illnessand trying to help them get out
of that.
Yes, it's that, but it truly isso much more.
And I always like to think ofour health department when they
come in.
It could be the only exchange,human to human, that they have
in their life where someone isrespecting them, trying to help
(04:18):
them, and not judging them.
And so, yes, our words matter.
And I think that part of that,how they are treated, it keeps
them coming back to get the helpthat they want.
Yeah, that's a
Speaker 00 (04:31):
good point.
So we're talking aboutsubstances.
What is a substance?
Because I feel like a lot of–what do we think of like I feel
like the when people think of asubstance they think opioid
right away but I
Speaker 03 (04:47):
think there's such a wide range of substances and
often people will first go toare they illegal or even the
term here again illicitsubstances because there's also
prescription substances that canbe not misused and I think
(05:08):
often also So when you'retalking about those substances,
you do often think about maybeheroin, opioids, misuse of
prescription drugs, Valium, andthings along those lines that
are different scheduled drugs.
But also, I think people don'talso think about tobacco.
And being in this state wherewe have among the highest rates
(05:33):
of perinatal tobacco use in thenation, which actually is the
most modifiable risk of poorpregnancy outcome.
So when I'm talking about, frommy heart, pregnant and
postpartum women and pregnantand parenting women and persons,
you think about what is goingto adversely affect their health
(05:55):
the most long-term and impact apregnancy the most.
And it actually is tobacco.
More women havepregnancy-related adverse
outcomes for example, a pretermbirth, low birth weight,
bleeding disorders in pregnancy,how it affects the infant.
They're more likely to be bornearly, which is associated with
(06:18):
lifelong complications.
And so certainly we wantanybody that has an addiction to
any substance, whether it betobacco, opioids, cannabis,
which is emerging, as well asany other drugs, we want them to
be able to get some support.
(06:39):
And I think an important piecehere, and I'm probably getting
ahead of the game, but is beingable to safely disclose that
information.
I do believe when we thinkabout substances in general,
people are afraid.
There's fear of that stigma.
There could be fear of legalconsequences, especially related
to pregnancy.
But what we've learned is thatwomen, especially pregnant and
(07:04):
parenting women that discloseearly and are seeking help,
they're more or likely to havethe support service they need to
get in recovery to bemaintained in recovery and to
have the supports they have fortheir children long term
Speaker 01 (07:20):
yes I actually learned quite a bit from your
response we do have a hugeproblem here with tobacco in
Kentucky specifically and thenof course with now vaping which
I think a lot of folks are underthe impression that it is safer
and that is certainly not thecase um but as far as substances
(07:46):
in general um like you saidthese can be things that are
perfectly legal just liketobacco alcohol things like that
um and i think sometimes peopledon't think of those things
that are so easily accessibleand also um really as a society
accepted um That's an excellentpoint.
Speaker 00 (08:09):
Yes, absolutely.
And still just as harmful.
Yes, yes.
But you have extensiveexperience in researching
perinatal substance use.
So how can substance use duringpregnancy impact mom and baby
and also during the postpartumperiod?
Speaker 03 (08:28):
It absolutely can affect the mom and baby and does
affect the mom and baby, but itreally is also somewhat
dependent on the substance Sodifferent substances affect the
mother and the infantdifferently, potentially.
But when I think about maternalmortality, which if you think
(08:51):
about the United States and evenwithin the United States,
Kentucky, we have among thehighest maternal mortality rate
among nations as well as just inKentucky among states.
And so when you think aboutthat, The safety issues, about a
third to a half ofpregnancy-related deaths are
(09:11):
caused by substance use that arepreventable, preventable.
Violence is another.
Violence in pregnancy isanother whole issue that we're
not here to talk about today.
But when you think about safetyto mother and baby and
mortality, you have to addresssubstance use because ultimately
(09:32):
it can cause death, oftenaccidental.
but not always and so it'ssomething that we definitely
need to keep funding programsand research that explore
positive pathways forprogramming and support and
treatment but generallysubstances used in pregnancy
(09:54):
when you're are going to becausing effects that are most
likely going to cause pretermbirth, low birth weight,
bleeding disorders.
One other piece I just wantedto add is that when you think
about that, those early birthshave lifelong implications on
the infant.
You would never think that ababy that's born preterm is
(10:16):
going to be more at risk forobesity later in life, more risk
for cardiovascular diseaselater in life, more at risk for
behavioral problems, forexample, ADHD.
So those early pregnancies,although they're born, they're
like, oh, well, if they grow,they're going to be better, and
they'll outgrow it.
No.
They can adapt, but they manytimes will be having those
(10:40):
lifelong consequences, whichactually are very costly, not
only in terms of health to thefamily, but also in terms of
dollars to the state and fundingprograms.
Speaker 00 (10:52):
That's a very good point.
So I want to give you all ascenario.
I've been using while pregnant,and I want help.
What can I do?
So Cassie, I'll let you gofirst.
Speaker 01 (11:03):
Okay.
Speaker 00 (11:04):
Let's say here in Woodford County.
Speaker 01 (11:05):
me
Speaker 00 (11:05):
for you that
Speaker 01 (11:06):
this happens okay um let me get you in contact with
someone you know that can helpyou i'm so glad you know that
would be my i'm so glad thatyou're sharing this with me and
um although here at the healthdepartment um we do not do any
kind of medication treatment orsubstance use treatment however
(11:30):
we can connect you with theresources that you need in order
to get um yourself and yourbaby and you know healthier um
and then you know i'll would sayone of the first things um is
having that person contact umfor sales police department if
(11:50):
they need a ride or if they wantto go get um treatment outside
of Woodford County we do nothave a lot of treatment offer
options in Woodford County we dohave Isaiah House which would
be one of the first places thatI would recommend because Isaiah
House is in Woodford and um, itis for women only.
(12:14):
Um, but then as close asJessamine and Frankfurt, um, we
actually have access to, um,some medication assisted
treatment, uh, options.
And so, um, a lot of people dochoose that because with that
also, um, comes, um, therapy,um, and counseling and things
(12:35):
like that.
And they will also connect youto, um, groups, um, that you can
go to throughout the week, talkto people who are either in the
same scenario or have been andthat can, you know, have lived
experiences and can help you inyour journey to getting healthy.
(12:59):
So that would be kind of theshort and sweet version of what
I would give them.
Right,
Speaker 00 (13:07):
so if they came to the health department, that's
what you would do?
That's what we would do, yes.
And Dr.
Ashford, you already a women'shealth nurse practitioner.
So if you would recommend themtalking to their provider, how
do they approach their providerabout this?
Speaker 03 (13:19):
Thank you so much.
And I think that's step one,reach out to your provider.
The state has really invested alot of great programming and
funds into the Perinatal QualityCollaborative, which is a
training system that Dr.
Connie White has led for manyyears to help providers and
(13:39):
hospital systems across the thestate be trained in these
particular areas and how to helpprovide supports for women with
substance use.
So there's been a lot oftraining invested.
We have wonderful programs.
We have home visitationprograms in all of our county's
hands.
We have Kentucky Moms Matters.
Voices of Hope is a phenomenalcommunity-based program that
(14:01):
helps support not only pregnantand parenting women, but also
adults and children of all agesthat can have that connection.
The Chrysalis House is also agreat resource for pregnant and
parenting women across thestate.
And each of the hospitalsystems really have unique
programs that bring together ateam.
(14:24):
It's not, I love, of course I'mbiased to nursing and nurse
practitioners, nurse midwives.
I think they're just innatelytrained to have that culture of
caring as one of our frontiergoals.
But also to have thatmultidisciplinary.
It takes all team members.
(14:46):
We need the physicians, thesocial workers, the community
workers, the community healthworkers, the local health
departments, all workingtogether to provide the supports
to these women and theirfamilies because it takes a team
and the school systems as well.
So number one, I guess to makeit short, be bold, be brave and
(15:10):
take that step and reach outbecause we are there to help you
very well said and we want tohelp you
Speaker 00 (15:19):
and that reminded me you talking about that
collaborative teamwork Frontierlast year for midwifery week
offered a CE session onsubstance use during pregnancy
and we had a nurse midwife fromFrontier present along with a
mental health provider and aregistered nurse so that's kind
(15:40):
of how all three of those cametogether and then presented that
because it is a
Speaker 01 (15:44):
teamwork absolutely it takes us all and that's one
of the things that you canexperience as a leader in the
community when you attend one ofthe ASAP meetings is that is
really where a lot of systemscoalesce to talk about the
(16:05):
substance use disorders and andhow we can help the people in
our community and connect themto all the resources.
I would love for you to attendone of those meetings.
I would love to attend.
Okay,
Speaker 00 (16:18):
okay.
So tell us more about WoodfordASAP.
Speaker 01 (16:22):
Woodford ASAP.
So I'm already thinking we needto change the acronym because
it does have the word abuse init.
But we're all learning.
That's right, exactly, exactly.
And we all have to be open tochanging our mindset and seeing
how even things that we're doingunintentionally can negatively
(16:43):
affect those that we are tryingto help.
But the ASAP, Agency forSubstance Use Policy, I'll just
use it that way.
There you go.
That is a group that has beenmeeting here in the community
and I believe is present in ifnot all of the 120 counties in
(17:06):
Kentucky, the majority.
And so that was established sothat we could have a network of
people at in the local communityat the local level really
talking about exploring optionsand really breaking down the
(17:27):
barriers for people who aresuffering with substance use
disorder and so that is more ofa it's more of a funding source
when I first joined my I thoughtit was more of a program or,
you know, we needed to be doingthis and this and this in the
community or, you know, reallyit's a funding source.
(17:49):
And it's a group of leadersthat look at policies and things
like that.
You know, back 25 years ago,people were still smoking in,
you know, community places.
So those are some of the thingsthat the group can help change
policy and influence policy.
That's another...
(18:10):
huge component is influencingpolicies that affect our health.
But one of the things that theydo is they offer mini grants to
people in the community.
And those can be, you can writethose mini grants.
They have applications that areavailable several times a year,
(18:31):
but they can be for treatment,education.
The school system uses them foreducation for kids,
scholarships we have severaldifferent scholarships that we
give students each year who haveeither been affected by
substance use disorder directlyor indirectly and then harm
(18:57):
reduction we talked about thatearlier you know we want to make
sure that all of the policedepartment the sheriff's
department they all have accessto Narcan in their units because
they may be the firstresponders to find someone who
is potentially overdosed and wewant to make sure that they have
(19:19):
what they need to save someoneand not have to wait on an
ambulance and EMS so of coursethose people will come later but
a lot of times the officers aretruly the first people to
respond and also to anyone inthe community we give Narcan to
anyone and so whether you'retrying to help a loved one that
(19:42):
may be you know suffering withsubstance use disorder or you're
just you want to be prepared asa community member so that's
another thing and then we alsoprovide sharps containers for
our police department and thenyou know other law enforcement
officers to make sure that theycan safely dispose of needles if
they should find them and theydo occasionally we do use
(20:05):
retractable in our program sothat it's it's their only one
time use and then that needleretractable tracks because we
also want to think about thecommunity and the safety so
those are just a few things thatASAP can assist in funding but
we also were the recipients ofthe opioid settlement funding
(20:29):
and so that's a larger chunk offunding ASAP usually doesn't get
a huge amount of funding eachyear but the opioid settlement
funding is going to be a largerchunk and so So we're really
right now just trying to gatherinformation on how we can best
utilize that funding, and we'retrying to look at what other
communities are doing and howthey've been successful in
(20:53):
assisting the substance usecommunity and really helping
them get the resources that theyneed.
Speaker 03 (21:04):
Cassie, there is so much there that also resonated
with me, and I just also want tojust encourage those that are
listening that to reach out tofind about more grants and more
opportunities.
Kentucky, I think it's almost abillion, as in a B, that the
state is going to be allocatedfor funding for opioid
(21:25):
abatement.
About half of that is already,you know, accounted for in
different programming over thecourse of, we're talking, I
think it's 10 years.
I could be wrong, could be 15.
I'm not sure if you know,Cassie.
I'm not sure.
It's not just over one yearoff.
obviously.
But also, but that other halfis really open to, they're
(21:46):
exploring the committee and theboard is exploring
opportunities.
They want to help communities.
That is their goal.
So more to come, be aware andreach out to Cassie or myself.
And if we don't know, we canhopefully get you in contact
where you could find some moreof those grants.
I know just from my experiencefrom at University of Kentucky
(22:08):
College of Nursing, there areresearchers there that are
offering mini grants.
I know Dr.
Amanda Fallon Bennett has amini grant program that people
from every county could applyfor.
It's more focused on pregnantand parenting women.
The Pathways program atUniversity of Kentucky is the
(22:30):
one I know best.
And they have been in existencefor a long time specifically to
help pregnant and parentingwomen.
So U.K.
pathways program can really getyou connected they also have a
postpartum program that that wasformerly referred to as beyond
birth but I think it's now thesmart parenting program so
(22:51):
there's lots of resources outthere but in general all of
these programs are ready to meetyou where you are if you're
talking about starting fromtobacco there's tobacco
cessation programs and I knowthe health departments do a
phenomenal job with that if youif it's opioids if it's cannabis
because it is not safe inpregnancy either and So I think
(23:12):
just understanding what arethose real effects and reaching
out to the health providers andthe community supports that you
have is a great first step.
Speaker 00 (23:23):
And you both have mentioned hands.
So both nod your head real bigwhenever it's come up.
So if you guys want to talkabout that a little bit.
Speaker 01 (23:33):
Yes, I can talk about that.
So that program, it stands forHealth Access Nurturing and
Development Services.
services and that's actuallyhoused within the health
department here in Woodford Iknow it's in most health
departments however not allhealth departments are required
to have that other agencies maymanage that but every person in
(23:59):
Kentucky should have access tothat if you are a new or
expectant mom or dad and that'swhat I love they keep this this
program is evidence-based andyou know very very very
beneficial and uses a lot of thethings that you know our
(24:25):
medical staff social workingstaff have so it's kind of like
an all-in-one but they keepexpanding who is actually able
to utilize this and a lot oftimes it's I think there's
because it's offered within thehealth department they think
that there's some kind offinancial limitation there's not
(24:47):
we are we literally see peoplethat are homeless to living on
horse farms and that isabsolutely no joke and I think
that the law enforcement wouldtell you that that's the same
thing that they see inresponding to overdoses it is
really there's it serve everyonebut in that program we will
(25:10):
follow you as soon as you findout you're pregnant to usually
when the child turns three yearsold and we will be with you
every step of the way that's whyI like that it's hands because
we literally hold your hand andfollow the steps I love I'm a
mother of five and so this isone of my favorite programs that
(25:32):
we offer we usually get incontact with our families when
they come in for other servicesand they just don't know that
this is one of the other ones weoffer but we help make sure mom
and baby are developing growingproperly we're going to do ages
and stages we're going to doall kinds of assessments with
(25:54):
you to make sure um you knowbaby is feeding eating properly
growing properly that the baby'ssafe and that we do you know we
do home checklists to make sureyou know because there are
things in homes that you don'tthink of that can be harmful and
so it really the program doesso much and so it's hard to
(26:15):
really put it down into like afew sentences um but really
every parent needs another setof hands and eyes and ears and
that's really what this is andlike i said it's also for um new
fathers yeah and so and we knowevery baby is different so even
(26:36):
if it's just your second thirdchild that you can be accepted
into the program.
And again, there are many,many, many, many, many ways to
qualify.
In fact, it's harder to notqualify for the program.
And so if you have questionsabout it, please go to our
website.
That's actually out on ourfront sign in the health
(26:58):
department.
The state has a great website,but we have social workers and
nurses on our team.
We also have several people onour hands team that are are
fluent in Spanish and English.
And so we know here inWoodford, we do have a lot of
Hispanic families who alsoutilize our programs.
(27:22):
And so, yes, if you know ofanybody that is expectant or
just had a baby, I think it'swithin 90 days that they may be
qualified for the program.
And we offer many, manyincentives for program or, you
know, the appointments that arekept.
And again, appointments It'sreally just a visit.
And we can do those virtuallyif needed.
(27:46):
So a lot of different options.
It's very flexible, but it'salso very beneficial for really
the family as a whole.
You continue to make goalsthroughout the program.
So I'm sorry, I don't want totake up all the time talking
about hands, but it is a truepassion.
It's a wonderful,
Speaker 03 (28:01):
yes, it is a wonderful program.
And I think in all 120counties.
Speaker 00 (28:06):
Yes.
And it's not just for checkingin on the child.
it's checking in on the parentsas well yes
Speaker 01 (28:12):
and it's yes and you know a lot of things that other
programs or other entities mayenforce I guess that's not
that's not really what we do ofcourse if if if baby's having
you know some some issues let'ssay with feeding or something
like that we may refer you to anoutside source but unless
(28:34):
something is just true you knowwe're not there to report you
for anything you know thatthat's That's a really common
misconception.
Yeah, people think that that's,and that's truly not, you know,
we're not reporting anything toICE.
It's nothing like that.
You know, we really are just inthere to help make sure that
(28:55):
mom, baby, the whole family haveaccess and all the resources
that they need.
Speaker 00 (29:00):
Right, that's excellent.
Well, anything else you twowant to mention?
Speaker 03 (29:07):
Just to build on something that Cassie said about
policy I mean because it's soimportant in your organization
is so important and so thinkingabout how we can advocate more
at the local policy we have verysupportive mayors in our area
in our local areas that arereally have this as a priority
(29:29):
our state legislators ourfederal congresspersons senators
they are I believe leave reallyat the forefront of trying to
help provide supports.
I did have an experience whereI was able to be on a committee
in Washington, D.C.
(29:50):
and work with some of ourcongresspersons there.
And while I was there, therewas actually funding on the
committee.
I was at four home visitationprograms.
And I'm just very proud to saythat our Kentucky
congresspersons were all insupport for the funding
continuation of the home homevisitation programs and hands
(30:12):
was one of the exemplars and sonot only is it just wonderful
here in Woodford County and thestate but it is known nationwide
and there are other programs inthe nation that do home
visitation but again we need tocontinue to advocate for those
programs because they are soimpactful they are they are and
(30:34):
I did I
Speaker 01 (30:35):
did forget to mention we we have at my last
check over 70 families in ourcounty on the program which is
pretty significant for ourpopulation size especially when
considering Fayette neighboringcounty much larger and at that
(30:55):
time I checked that we actuallyhad more families on our program
so outreach is huge for us andmaking sure that people know who
we are what we do and thensometimes what we don't do
because that can be more of aprogram draw and so I think just
(31:16):
exactly we have to use any kindof voice and any kind of time
that we have with those folksthat are making the decisions
and have the funding to reallyboast about our program and how
effective they are because youthink you know in in 120
(31:41):
counties, we have this program,we have health departments.
And so if you're looking forsomething to infiltrate your
community, you already have abrick and mortar of a health
department that is serving.
And so I think down the road,we're probably gonna see health
departments doing more in theway of assisting those with
(32:01):
substance use disorder, becausewe've already been able to, I
think we have more harmreduction programs in our
counties than any other state.
And we need it.
So I think that building onthose programs, we have the
trust of the people that we needto trust us.
And so, yes, I think that is soimportant.
(32:24):
Using our voice and any chancewe get for the legislators and
the powers that be to reallytell them what we do.
And I think it's just storieslike this that we can use.
And this affects everyone.
Speaker 03 (32:39):
It crosses all socioeconomic classes, all
persons of every ethnicity, age.
And so, yes, I completelyagree.
And Cassie, you said the wordtrust.
And that is, I think, what isgoing to continue to draw people
(33:00):
to the programs is that knowingthat they can trust us.
They can trust to come to usthat we are going to do our best
to get them the care that theyneed and if it's okay with you I
would love to Quincy be able tojust put a plug in we need more
nurses in the nation andthinking about policy and
(33:23):
advocacy and workforce and I'msure from the health department
standpoint too we need morenurses and and so Kentucky has a
and wonderful programs acrossthe state but I don't think
anybody really realizes that Wehave in Woodford County,
Frontier Nursing University.
(33:43):
I believe in my heart that ithas the most significant impact
in communities across thenation.
Our mission is to help provideexemplar health care services
through midwife and nursepractitioner education to
underserved and ruralcommunities.
(34:03):
That is our heart.
That is our mission.
And we need those listening outthere, our All those in middle
school, high school, adults thatare looking for maybe that
second career, nursing is such aphenomenal calling.
And that trust is what made methink of that, Cassie, when you
said the word trust, because weare the most trusted profession.
(34:25):
It's cliche, but it's thetruth.
And so if you have an interestin becoming a nurse or a nurse
practitioner, please reach outto us.
There's just such greatresources right here in your
backyard.
Speaker 01 (34:39):
Yes.
that's a great way to end Ialso want to say maybe hopefully
I'll be sending two nurses yourway but my oldest daughters are
very interested in nursing butalso I want to give you a thank
you you all this education issecond to none and one of your
(35:02):
graduates actually identifiedour first case of measles I
don't know that you all knowthat but Dr.
Christy Grider with VersaillesUrgent Care called me 8 o'clock
at night and says I have apatient in the next room and it
(35:23):
is a textbook case of measlesshe's the reason why we had the
early identification and herstaff were the reason why we
were able to stop the spread andthat's what we do as part of
controlling communicablediseases just the foundational
purposes of public health.
And I've worked with otherpractitioners that have
(35:48):
graduated from this program aswell.
And so, again, second to none,the absolute best.
And I'm so thankful that you'rein our community.
Well, and send your daughtersmy way.
Speaker 03 (36:00):
Or sons, if they're there.
I don't know.
Because it's one of my mostfavorite things to do.
My husband actually says, youmay want to stay away from her
because she will be alreadyrecruiting you into nursing.
And so I would love to talkwith them.
I have four children as well.
And unfortunately, they havewonderful professions, but none
of them are nursing.
I did actually get severalnieces and nephews into the
(36:22):
profession, but not my children.
But anyways, and I completelybelieve, agree with you.
My first granddaughter,grandchild was delivered by a
frontier midwife.
And so I have ultimate trusttrust in the program
Speaker 01 (36:41):
yes my first two my adult first actually my first
three children were delivered bymidwife
Speaker 00 (36:47):
oh yeah look at this full circle yes yes yes thank
you both so much for joining metoday and for sharing your
expertise I think this wasreally a fruitful episode and I
know I learned a ton so thankyou both so much thank you so
much thank you this podcast is acommunity health initiative
brought to you by FrontierNursing University in the
Woodford County Chamber ofCommerce to improve community
(37:09):
health We'll see you next time.
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