Community Spotlight: Improving birth outcomes with Project Swaddle

Dec. 8, 2021

Video

Improving birth outcomes with Project Swaddle

Video transcript

Slow piano notes play. A brick wall connects to a fence around a stately building with a clock tower. On the wall, words are carved into stone.

ON SCREEN TEXT: WELCOME TO MONTGOMERY COUNTY Indiana

CITY OF CRAWFORDSVILLE

Storefronts and old-fashioned buildings line a street.

PAUL: A big issue in Montgomery County is ‘cause we’re now an OB desert.

A soft-faced, clean-shaven white man with grey hair and bright eyes sits wearing a white shirt with fire department pins and badges on it. A blue banner with white text comes in from the left.

ON SCREEN TEXT: Paul Miller

Division Chief

Crawfordsville, IN Fire Department

PAUL: So, our Labor and Delivery unit had shut down in 2013, which placed an immense burden on us as firefighter paramedics seeing more deliveries in the field.

A fire engine backs into a red brick fire station. Now a Pakistani-American woman with shoulder-length brown hair sits in front of a truck. A blue banner with white text comes in from the left.

ON SCREEN TEXT: Amnah Anwar

Senior Director

Indiana Rural Health Association

AMNAH: Rural Indiana is already lacking in access to care when it comes to infants and pregnant moms. But there is also that huge issue of substance use disorder and the combination of the two has resulted in a very high infant mortality rate in high-risk pregnancies.

A white paramedic SUV is parked on the station driveway with the words “CRAWFORDSVILLE FIRE DEPT.” printed on the side near the front and “COMMUNITY PARAMEDICS” on the side near the back.

AMNAH: Community paramedicine comes as a solution that can provide the care to the patient and take it to their home.

A balding community paramedic with a horseshoe mustache exits the station wearing a black polo with the Crawford fire department logo over the breast and a shoulder bag. He strolls to the SUV parked on the street. Now the man stands in front of the SUV which is parked on the driveway again. A blue banner with white text comes in from the left and the piano notes picks up into inspirational music.

ON SCREEN TEXT: Darren Forman

Community Paramedic, Director of Project Swaddle

Crawfordsville, IM Fire Department

DARREN: Project Swaddle is wrap services. We see high-risk mothers. We wrap them into social services if needed, we wrap them into SUD or mental health treatment if needed. I’ve helped with housing; I’ve helped with transportation. I’m an extension of the OB provider.

The SUV pulls away from the curb, with “MOBILE INTEGRATED HEALTH” printed across the back. Darren drives with one hand. Now he enters a residence.

DARREN: I usually pick up these patients somewhere in the seven-to-ten-week gestation and I’m with them for the better part of a year.

A young woman with wet brown hair carries a baby into a white kitchen where Darren waits. She smiles at the sleeping baby she cradles.

DARREN: We’re weighing the baby. We wanna make sure that we get to all the benchmarks.

The baby lies on a scale on the kitchen table and the mother helps Darren weigh him. Now she cradles the baby again and a child yells in the background as she speaks. A blue banner with white text comes in from the left.

ON SCREEN TEXT: Brittney

Project Swaddle Participant

BRITTNEY: He’s just encouraging, informative, and it’s reassuring, you know, to just have that extra support, too.

A young boy peers in at the door before stepping out of sight. The sleeping baby stirs as Darren holds a stethoscope to his chest and listens.

DARREN: I know, I know, I’m touching you with that cold thing.

The mother nods as Darren speaks with her and writes notes in a binder. On the scale, the baby screws up his face and sucks its thumb.

Paul speaks in a room.

PAUL: We’re fully integrated into the health system, so everything my paramedics do in the field, it shows in my Physician and Specialty Care notes. We’re able to do referrals from there, order labs, make medication adjustments, and really protect the mom.

Darren speaks with a beaming Brittney as she rocks her baby.

DARREN: He is right on target. He’s picking up weight just like we want him to.

Now Darren carries his bag and a white case as he follows a pregnant, auburn-haired woman into a duplex.

DARREN: Hi buddy. How are you?

Now the woman sits on a couch in a bright living room next to a man in a red t-shirt. Darren takes her temperature, then goes to his bag at the coffee table and writes in his binder.

AMNAH: At Indiana Rural Health Association, we heard about Project Swaddle and we really liked the idea, but at that time, we really did not have the infrastructure. But then we got contacted by UnitedHealthcare.

A clean-shaven white man with peppered hair and hooded eyes sits in a grey room. A blue banner with white text comes in from the left.

ON SCREEN TEXT: Keith Mason

Director of Advocacy and Engagement

UnitedHealthcare Community and State

KEITH: We’ve invested into both project management as well as startup funds for the expansion sites, and they make sure we’re capturing all those learnings so we can replicate and scale this otherwise. So we can have healthier moms, healthier babies, in all those places.

In the living room, Darren wraps a blood pressure cuff around the pregnant woman’s upper arm. He holds the stethoscope to her arm and listens as he squeezes the pump with his other hand.

Now the woman speaks while sitting on the couch. A blue banner with white text comes in from the left.

ON SCREEN TEXT: Calli

Project Swaddle Participant

CALLI: Being at-risk, like I’ve been, any time of day or night, I can pick up the phone, call Darren if I’m panicking or if something is truly wrong. Gives me a lot of peace of mind.

Darren takes another note in his binder on the table. He straightens and talks with the couple on the couch.

DARREN: If you think about what we’re doing here, it is so basic and so simple, but yet it is profoundly effective.

A slow-motion clip shows Calli walking to her couch. Another shows Brittney’s baby on the scale, with his eyes half-open. A hand strokes the baby’s head as the music crescendos.

KEITH: If we’re successful in helping amplifying other community paramedicine programs in Indiana, no matter who your parasource is, it’s all gonna provide better outcomes, it’s gonna deliver care to the right people, at the right place, at the right time. And if we can be part of that, that’s something that UnitedHealthcare’s excited to do.

A blue u-shaped logo appears against a white background, followed by text.

ON SCREEN TEXT: UnitedHealthcare

Crawfordsville, Indiana, a city of about 16,000 in the west central part of the state, is part of a desert — a maternity care desert, to be exact. This means there is limited or no access to maternal health care.

After the labor and delivery unit closed in 2013, firefighter paramedics saw a dramatic uptick in deliveries in the field — especially concerning in such a high-risk population, where few women had the support they needed.

“Rural Indiana is already lacking in the access to care when it comes to infants and pregnant moms, but there is also that huge issue of substance use disorder,” said Amnah Anwar, senior director of Indiana Rural Health Association. “The culmination of the two has resulted in a very high infant mortality rate and high-risk pregnancies.”

Indiana currently ranks among the highest in the U.S. for infant mortality rates — 20% higher than the national average. The situation was dire, and a solution was needed.

Enter Project Swaddle — a prenatal and postpartum care program offering in-home treatment or transportation services for in-clinic visits, for at-risk mothers and their babies. The program, which began in 2018, links local Crawfordsville paramedics, physicians and community resources with expectant mothers and follows their journey up to 16 weeks after giving birth. With the help of a UnitedHealthcare investment, the program is being replicated throughout Indiana.

“Project Swaddle is wrapped services,” said Darren Forman, director of Project Swaddle with the Crawfordsville Fire Department. “We see high-risk mothers, we wrap them into social services or mental health treatment, if needed. I’ve helped with housing; I’ve helped with transportation. I’m an extension of the OB provider.”

Having a dedicated community paramedic for program participants helps provide a long-term relationship for a new mother — including 24/7 access for questions or emergencies — and also creates a first point of contact that extends all the way into getting care by an OB/GYN. As the main community paramedic with Project Swaddle, Darren usually connects with mothers at 7 to 10 weeks of gestation — with an emphasis on the earlier, the better.

Calli, a mother-to-be and participant of Project Swaddle, receives regular check-ins to ensure she’s maintaining a healthy pregnancy.

“Being at-risk like I’ve been, anytime of day — day or night — I can pick up the phone and call Darren if I’m panicking or if something is truly wrong,” she said. “It gives me a lot of peace of mind.”

To qualify for the program, the mother must be referred by a social service agency or a phyisican. Over 200 women have taken part in the program with more than 99% of expectant mothers achieving full-term delivery — with appropriate birth weights, according to the Crawfordsville Fire Department.

UnitedHealthcare, seeing the success of Project Swaddle, worked with the Indiana Rural Health Association to see how the program could reach more mothers in need throughout the state.

“We’ve invested about $240,000 into both project management as well as startup funds for the expansion sites,” said Keith Mason, director of Advocacy and Engagement at UnitedHealthcare and a Crawfordsville resident. “And we’re making sure we’re capturing all those learnings so we can replicate and scale this otherwise. So, we can have healthier moms and healthier babies in all those places.”

With the program now launching in three other communities, the hope is that Project Swaddle will help not only with full-term pregnancies, but also help set up a lifetime of improved health for the children receiving care.

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