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Mississippi moms and babies are dying. This training teaches first responders how to save their lives.

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Mississippi moms and babies are dying. This training teaches first responders how to save their lives.

Matt Greer of Brookhaven was driving home from his shift at the Mississippi Center for Emergency Services, where he works as a flight nurse, when he got a call from his younger sister. A few days earlier, she had given birth to a healthy baby girl after an uncomplicated pregnancy. Now, she told him she had a headache.

He asked her to check her blood pressure: 140/90.

For most , that reading isn't concerning. For a pregnant or postpartum woman, however, it's an indication of preeclampsia. Greer told her to go to the hospital and eventually she did, getting treatment to prevent seizure and stroke.

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But Greer thinks things might have gone very differently had he not completed a new training by the Mississippi Center for Emergency Services just a few weeks before his sister called.

The STORK Program equips first responders and medical professionals without specialized obstetrics training – emergency room doctors and nurses – to handle pregnancy and delivery complications like hypertension and hemorrhage. Doctors at the recognized that in a rural state with dwindling options for obstetrical care, women are likely to deliver outside of dedicated labor and delivery wards, and to need care from people who don't see pregnant patients every day. So they created the STORK training.

Greer has years of experience as a nurse, and his sister is a nurse, too. But without STORK, he would not have known how to interpret her blood pressure reading.

“I would have blown it off,” he said. “Without that fresh on my mind … I would have said, ‘that's not too bad. You'll be alright.'”

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Chronic health conditions like obesity and diabetes plus poor access to prenatal care contribute to Mississippi's worst-in-the-nation outcomes for moms and babies, and can't be treated during a single interaction with a health care provider. But potentially lethal hypertension and hemorrhage are not complicated to manage – if a provider knows what to watch for and what to do.

And even inside hospitals, that can be a big “if.”

“Obstetrics is most people's kryptonite,” said Dr. Rachael Morris, associate professor of maternal fetal medicine at UMMC, who created and the training. “Unless you're an obstetrician, even a well-trained E.R. physician or mid-level provider is going to tell you that you bring a pregnant lady into my E.R., and everyone's going to freak out.”

The STORK Program's half-day training includes lectures and simulations to change that dynamic. (STORK stands for Stabilizing OB and Neonatal Patients, Training for OB/Neonatal Emergencies, Outcome Improvements, Resource Sharing, and Kind Care for Vulnerable Families.) The training is funded with a grant from the W.K. Kellogg Foundation, which also allows participants to a bag of supplies they can use during deliveries. The program is run by MCES, a division of UMMC that houses critical care transport services – including helicopter teams – and the state's communications system for hospitals and first responders, Mississippi MED-COM.

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“In Mississippi, infant and maternal mortality rates for people of color are among the highest in the nation and many families have to travel considerable distance to access care, creating obstetric emergencies,” said Wesley Prater, Kellogg Foundation program officer. “Our support of UMMC ensures providers across the state have the proper training to stabilize mothers and babies who need critical care.”

So far, about 150 people from around the state – a mix of registered nurses, physicians, medical residents, firefighters and paramedics – have completed the training over 11 classes since it launched in June. The team has 18 more trainings on the calendar.

With the state likely to tally an additional 5,000 births annually thanks to the abortion ban that took effect in July, obstetric services in the state are actually shrinking. The labor and delivery ward at Greenwood-Leflore Hospital closed in the fall. The Delta lost its only neonatal intensive care unit this summer. The NICU at Merit Health Central, which serves predominantly Black and low-income neighborhoods, also closed.

Already, more than half of the state's counties are maternity care deserts: No labor and delivery ward. No OB-GYNs. No certified nurse midwives.

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Women in rural areas face long drives to the nearest labor and delivery ward. Sometimes, that means they can't make it there at all. Instead, they may give birth in an emergency room, at home while waiting for first responders to show up, or on the side of the road.

The STORK program staff hope training participants will be able to handle those situations effectively, saving lives along the way.

“These patients are going to be coming into really small hospitals and delivering or problems,” said Dr. Tara Lewis, assistant professor of emergency medicine at UMMC and a former labor and delivery nurse.

Lewis joined the program to tailor it to the needs of emergency room staff in small, rural hospitals.

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“If providers don't know how to make the diagnosis of what problem is going on, then they're not going to know how to take care of them.”

PHOTOS: First responders trained on how to deliver babies

“You look like a really good uterus,” Morris told a burly Flowood firefighter and paramedic who had joined three of his colleagues to attend a STORK training at MCES on a recent Wednesday morning.

She had just given a presentation on managing hypertension and hemorrhage, and now it was time to demonstrate how to assist during a delivery.

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The paramedic held a rubber baby as Morris demonstrated how a baby's head will generally turn to one side as it leaves the birth canal, and how to use a finger to gently loosen the umbilical cord if it has looped around the neck.

In addition to the Flowood firefighters, attendees included a pediatric emergency room nurse at UMMC, a women's health nurse in Meridian, and an emergency room nurse at Magee General Hospital who has assisted with three deliveries in the last year alone.

“That's a lot considering it's a small hospital with no labor and delivery resources,” she said.

There are regular STORK trainings at MCES open to people from all over the state. But the training is also conducted at hospitals, so participants don't have to travel and can see how to apply what they learn where they work.

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After Morris finished her presentation, Emily Wells, a nurse practitioner and member of UMMC's neonate transport team, explained how to care for newborns in the moments after birth. Since Jan. 1 of this year, the team has transported 390 babies to higher levels of care, and participated in 20 emergency room deliveries.

She described the recent delivery of a “rest stop baby,” who was born in a Toyota Camry en route to a hospital during a cold snap.

“Cold babies die,” she said, so the team had cranked up the heat inside the car and done everything they could to keep the baby warm.

In a hospital, the baby would be placed in an incubator. But in a pinch, any kind of plastic bag – maybe one that had been used to hold supplies now in use – could be placed around the baby's body to conserve heat.

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Health professionals and emergency responders practice with helping a simulator breath after delivering a baby during a training called STORK at Mississippi Center For Emergency Services in Jackson, Miss., Wednesday, December 7, 2022.

A woman had just delivered a baby at 26 weeks in her car, and now both had made it to the emergency room of their small-town hospital. She had delivered the placenta, too, but was still bleeding.

What should happen next? Half of the training participants gathered around their patient – a life-size mannequin lying on a hospital bed shouting “I'm bleeding” – and discussed what to do.

“At 26 weeks, I think the placenta abrupted,” Morris explained.

Blood trickled from the mannequin's vagina, soaking a pad underneath her body. This was an important lesson, Leslie Cannon, now an educator with STORK after 25 years as a labor and delivery nurse, pointed out: In patients who aren't pregnant, life-threatening hemorrhage often looks like a dramatic gush.

“Hemorrhage postpartum, it's this trickle,” she said. “It's a huge deal, because that trickle just keeps going.”

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That's important to keep in mind especially because it's often not obvious when a woman is at serious risk because of bleeding.

“A young, healthy pregnant lady is going to look really good — until she's about dead,” Morris had warned of hemorrhaging patients.

The students administered tranexamic acid to slow the bleeding.

As Morris had explained during her lecture, a student reached an arm into the uterus to sweep for pieces of retained placenta, which can cause life-threatening bleeding. (“It's not a comfortable thing to do,” Morris warned.) Another student massaged the mannequin's belly to cause the uterus to contract.

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Eventually, the trickle slowed and stopped. Morris estimated the patient had lost a liter of blood.

Before everyone left, Morris and Wells gave out their cell phone numbers. Kace Ragan, project manager for STORK, explained that participants get supply bags that include QR codes they can scan to request refills — as long as the grant funding holds out — and report their experiences during deliveries.

Morris urged the attendees to text or call her with questions any time. Morris treats some of the most challenging pregnancies in the state and serves as obstetric COVID director at UMMC, meaning she's spent the last two years witnessing devastating loss.

And yet, she told the training participants, she has “the luxury” of working in a hospital with plenty of resources and specialized training.

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“Y'all are in the trenches doing things that I have to do, too, but with so much less,” she said.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

Mississippi Today

Senate committee passes Medicaid ‘expansion’ bill that leaves hundreds of millions in federal dollars on table

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mississippitoday.org – Sophia Paffenroth and Taylor Vance – 2024-03-27 16:39:21

The only surviving Medicaid expansion bill in the passed the Senate Medicaid Committee Wednesday and is headed to the full Senate for a vote. 

But the proposal, as it passed the Senate committee, is not considered traditional “expansion” under the Affordable Care Act, and therefore would not qualify for the enhanced federal funding the grants to newly-expanded states. It would leave the cost of the expanded coverage up to the state.

The Senate committee passed the House Republican bill with a strike-all, meaning it replaced the bill's original language with its own plan, which Medicaid Committee Chairman Kevin Blackwell, R-Southaven, refers to as “expansion light.”

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Blackwell estimated about 80,000 people would be eligible under this version of expansion, and half of that would apply. The House plan was expected to cover more than 200,000 people.

When a draft of the Senate's bill was leaked on March 20, Blackwell stressed to Mississippi that he and Senate were still tweaking parts of the legislation. However, the legislation that passed the committee is essentially the same as what was outlined in the leaked draft. 

The Senate proposal would:

  • Cover working Mississippians up to 99% of the federal poverty level. For an individual, that would be an annual income up to $15,060. For a of four, that would be an annual income up to $31,200.
  • Not cover those making between 100% and 138% of the federal poverty threshold — not even through a private-care option. A plan that doesn't cover people making up to 138% is not considered “expansion” under the Affordable Care Act, meaning Mississippi wouldn't qualify for the 90% federal match rate that the Affordable Care Act grants to new expansion states, nor the additional, two-year 5% increase in match rate the federal government provides to newly-expanded states under pandemic relief spending passed by Congress. Instead, as was the case with Georgia, Mississippi would only get its regular federal Medicaid rate of about 77%.
  • Leave the insurance exchange, the online marketplace that offers federally subsidized plans to people who make between 100% and 138% of the federal poverty level, intact. The Senate plan, unlike Arkansas' Medicaid expansion, would not provide extra subsidies from the state's federal Medicaid money available from the ACA.
  • Include a work requirement mandating at least 120 hours of employment a month in a position for which health insurance is not paid for by the employer. That's more stringent than Georgia's plan, which mandates 80 hours a month. There are several exemptions, such as for full-time students or parents who are the primary caregiver of a child under six years old.
  • Go into effect 30 days after the federal Centers for Medicare and Medicaid Services approves a waiver necessary for the work requirement. That's unlikely to happen under the Biden administration, which has rescinded work requirements previously approved for other states during the Trump administration and has not approved new ones. If the federal government denies the waiver, Mississippi would have to wait until a new administration took office, or sue the Biden administration. Georgia remains in litigation with the federal government over the work requirement issue, and has suffered low enrollment and missed out on millions in federal funds by not fully expanding coverage.
  • Require anyone who voluntarily dropped private insurance to wait 12 months before applying for Medicaid coverage.

Senate Democrats voiced several concerns about the administrative burden of the work requirement and the 120 hour a month minimum, which is even stricter than Georgia's plan – currently the strictest expansion plan in the country. 

Sen. David Blount, D-Jackson

Sen. David Blount, D-Jackson, asked Blackwell about the enhanced match from the federal government.

“So the federal government paying our match for two years and 90% after the two years – we would not qualify for that?” Blount asked.

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Blackwell said that is correct, and they would leave that money on the table.

Sen. John Horhn, D-Jackson, introduced two amendments: one to decrease the recertification requirements from four times a year to twice a year, and the other to reduce the work requirement hours from 120 hours a month to 80 hours a month. 

Both amendments were voted down by Republicans, who make up a majority of the committee's membership. Despite their amendments getting shot down, the Democrats still voted in favor of the bill. Only three Republican senators in the committee voted against the plan. 

When asked about the administrative burden of enforcing the work requirement, Blackwell said he is not worried and believes the Division of Medicaid has enough employees for its implementation. 

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But Georgia, the only state currently with a work requirement in its expansion plan, has spent $26 million taxpayer dollars to ensure a mere 3,500 people to date. More than 90% of that has gone to administrative and consulting costs. 

The bill is expected to be taken to a floor vote as early as Thursday, with a deadline of April 10. 

Since the Senate plan is drastically different than the House proposal – which is a mostly-traditional expansion plan insuring those who make up to 138% of the federal poverty level and would go into effect whether or not the federal government approves a work requirement waiver – a final version will likely be hammered out later in the in a conference committee.

Any final plan would realistically need a two-thirds majority from both chambers to show it has the potential to override a potential veto from Republican Gov. Tate Reeves, who has privately told lawmakers he plans to veto any Medicaid expansion bill.

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Reeves on Tuesday night hosted around 20 state senators at the Governor's Mansion in Jackson where he, again, reiterated his opposition to any form of Medicaid expansion, according to multiple people familiar with the situation. 

At the Tuesday night , Reeves said he would veto the Senate's expansion plan if it reached his desk, though he reportedly said he approved the Senate's work requirement provisions. 

Shortly after the committee passed the expansion legislation, Reeves posted on social that the Senate plan is “still bad policy” and he will oppose it.

“And so I will continue to do what I told the voters I would do – fight Obamacare Medicaid Expansion with every ounce of my being,” Reeves said.  

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This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

Michael Guidry named Mississippi Today managing editor

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is pleased to announce Michael Guidry as managing editor.

Guidry, who joined the Mississippi staff in February 2024, manages the newsroom's day-to-day and plans broader editorial strategy.

He previously served as managing editor at Mississippi Public Broadcasting, where he developed skills in audio storytelling as a producer, writer and editor.

“Michael is a perfect fit for what we're building at Mississippi Today,” said Adam Ganucheau, Mississippi Today's editor-in-chief. “He's a proven newsroom leader, and he knows Mississippi. He also brings us a lot of digital and audio skills that can expect to see more of pretty quickly.”

A native of Destrehan, , Guidry moved to Mississippi to attend Millsaps College, where he earned a dual Bachelor of Arts in History and Theatre. After graduating, he worked as a public school teacher for more than a decade.

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Michael Guidry

While at MPB, Guidry helped a team that received recognitions from the Radio Television Digital News Association, the Mississippi Association of Broadcasters and the Public Journalists Association.

MPB's special feature on Confederate – which he co-produced and co-narrated – received the 2023 Region 9 Edward R Murrow Award for Excellence in Diversity, Equity and Inclusion.

Guidry continues to host MPB's weekly politics show @Issue.

“As someone who spent years in a adjacent to Mississippi Today, it became evident the newsroom was quickly becoming a leader in local, nonprofit news,” Guidry said. “I could not be more to join a publication dedicated to elevating the voices of Mississippians while holding power to account.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

Geoff Pender named Mississippi Today politics editor

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is pleased to announce Geoff Pender as and Editor.

Pender, who first joined the Mississippi Today staff as senior political reporter in May 2020, will oversee the day-to-day reporting of Mississippi Today's politics team.

He brings more than 30 years of experience covering Mississippi politics to the new role.

“If you follow Mississippi politics, you know Geoff Pender,” said Adam Ganucheau, Mississippi Today's editor-in-chief. “He's been a vital member of our politics team since 2020, and we couldn't be more for him to now lead it. He's been a mentor to so many of our reporters, and he's led several impactful investigations for us. can expect more of that from him in this new job— and if you're wondering, you'll also continue to see plenty of his analysis of the state's biggest stories.”

Geoff Pender

Before joining Mississippi Today, Pender was political and investigative editor at the , where he also penned a popular political column. He previously served as an investigative reporter and political editor at the Sun Herald, where he was a member of the Pulitzer Prize-winning team for Hurricane Katrina coverage.

A native of Florence, Pender is a journalism graduate of the of Southern Mississippi and has received numerous throughout his career for reporting, columns and of information efforts.

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“I truly appreciate this opportunity and appreciate being able to continue working with the great team of journalists at Mississippi Today providing in-depth coverage at such a crucial time for the state,” Pender said.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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