Terri Chaires, MSN, RN Director of Patient Services for Obstetrics and NICU for WellSpan Chambersburg Hospital

Lisa Lehett UPMC Horizon

Sarah Cooper RN, Clinical Educator - Family Birth Center St Clair Hospital

Terrie HawkinsReproductive Healthcare Coordinator at Prevention Point Philadelphia

Fran Doyle, DIrector Maternal Child Services, Penn Medicine, Chester County Hospital

Good Morning! Mary Beth Kollar, LPCClinical Case Manager for SUD in pregnancy program at Lehigh Valley Health Network

Dawn Horst-Manager of Women and Children's Community Health at Penn Medicine Lancaster General

Michelle Djevharian CNM

Michelle Joseph, Pediatric Clinical Lead, Doylestown Hospital

Ann Giazzoni Senior Program Manager, BH Integration UPMC Health Plan

Krista Flaherty, LCSWAllegheny Health NetworkManager Perinatal Hope Program

Amy Stauffer, CRNP

Shannon Hittle Manager the Birthplace at Riddle Hospital Media PA

Cathy Henderson, Director of MAT at WellSpan Health

Jami Marks, Director of Health ChoicesGeisinger Health Plan

Amanda Arnold, RN St Clair Health FBC

Amy Cruz, MD, OBGYN physician, Penn State Hershey Medical Center

Michelle Djevharian CNM, Einstein Medical Center Montgomerty

Courtney Lott, Service Coordinator, Crozer Health

Jacqueline Drahos, Quality Manager AHN WPH. Good morning!

Amy Stauffer, Penn State Health, CRNP with Maternal Fetal Medcine

Traci Jennings, NNP Penn State Hershey Medical Center

Ann Torregrossa, Director, PA Health Funders Collaborative

Christina Harris, Early Childhood Lead for ECCS with the Office of Child Development and Early Learning.

Abby Newman, Operations Manger, The Family Place at Geisinger Lewistown Hospital.

Good morning - Debra Bogen, Allegheny County Health Department

Janine Richard, MSN, RN, Clinical Director of Women & Children's Services, WellSpan York Hospital

Erin Redding, LSW Geisinger Free2BMom Behavioral Health Case Manager

Debr Knittle RN

Sarah Worthington, outpatient OBGYN social worker at Temple

Team Coordinator

Kim Costello, DO, CPE, FAAP, Director of Neonatology at St. Luke's University Health Network, Executive Director of NICU Operations at Onsite Neonatal Partners

Geisinger Bloomsburg Hospital

Sharon Register, RN, Project Manager Main Line Health

Hi, Everyone! Bob Cicco, neonatologist from Pittsburgh

Pam O'Donnell, MSN, RN, Programmatic Nurse Specialist, UPMC Altoona

Good Morning! Donna Allen, RN Nurse Home Visitor, Nurse Family Partnership of Schuylkill County

Debra Knittle Geisinger Bloomsburg Hospital Maternity Center

Joanne Balasavage CRS Free2BMom Geisinger Wilkes-Barre, PA

Kim Leonard CRNP Director of Magee WHSL of UPMC Northern Pod

Heather Enright Perinatal Safety RN at Reading Hospital - Tower Health

Eileen Thompson, PA Chapter, American Academy of Pediatrics

Jen Sullivan, OB Nurse Manager at Evangelical Community Hospital

Donna McCarthy, Clinical Registered Nurse Supervisor, Geisinger Women's Health, Scranton, PA.

Julie Rose Thomas, Administrative Team Coordinator at Geisinger Community Medical Center Childbirth Center- Scranton, Pa

Good Morning! Ashley Savage QI Data Coordinator and IBCLC for the ICN at Hospital of the University of Pennsylvania

Good Morning. Norma Bryan, RN BSN Mount Nittany Medical Center

Brittney Bogar, RN, Penn State Health Hershey Medical Center

Franca Dalibor, CRS and CRS Coordinator for the Geisinger Health System

Good Morning All, Leeanne Minihan, Case Manager/Counselo at Williamsport Family Medical (MAT Outpatient )

Good morning. Lisa Murphy, Clinical Practice Nurse Leader at the Women and Babies Center at Penn State Health

Good Morning! Vivian Petticord RNC, Director Womens Health Service Line UPMC Magee-Womens Hospital

Good Morning! Jill Henrich - Safe Care Manager for Northumberland County through Greater Susquehanna Valley United Way

Madie Hartman DO Assistant Professor of Family and Community Medicine Penn State Hershey Medical Center

Good Morning Everyone your virtual packet is here: https://www.whamglobal.org/march-31st-2022-learning-collaborative

PA PQC teams can request trainings via an online form at https://www.whamglobal.org/pa-pqc-initiatives

Can you please comment on your recommendations for breastfeeding when the mother has polysubstance use, specifically marijuana use.

Studies have demonstrated the lower breastfeeding rate in this population and postulate it is related to stigmata of the health care team, less available resources, guilt, and Mom's ability to take the time to breast feed between support groups/meetings/dosing. How do you combat some of these hurdles?

link to this resource on our website:https://www.whamglobal.org/list-documents/557-breastfeeding-traffic-light-tool/file

Yes, please address marijuana use and breastfeeding or even breastmilk feeding as recent studies are showing poor and continued neurologic issues.

excellent thanks for the links to resources!

Agree. I am interested in counseling in relation to polysubstance use, specifically marijuana use.

Thanks

is Dr Bogen's slides available on the PQC website?

Yes, we will be posting Dr. Bogen's slides to the website shortly

thanks Pauline!

Yes thank you, will be nice to share with our pediatricians!

Its remarkable that just by moving from Finnegan scoring to ESC, we can decrease LOS by 18 days, not have to wean babies off Morphine, have parents as primary caregivers in their baby's care, and promote breastfeeding. And it just costs us the price of a boarder room and a hospital meal we provide to parents. Plus it's just the right thing to do!

Also wondering about THC and methamphetamine use and breastfeeding...

I think it becomes more an education for nursing about biases at times with SUD moms

ESC is more about opiates

Subutex methadone

WE have not had moms positive meth and BF.

I think many of us are seeing more polysubstance abuse and are just wondering if the same principles apply.

I worked in WA state docs would caution about THC and BF as its legal

continued active poly substance abuse would rule out ESC

Helpful! So your experience would suggest that we can continue to encourage breastfeeding in our OUD moms provided they meet some of the discussed criteria but discourage if any other substance is on board?

How does polysubstance use rule out ESC?

Link to Dr. Bogen's slides: https://www.whamglobal.org/list-documents/580-overview-of-breastmilk-feeding-guidelines-for-substance-usel/file

We've been focused on optimizing non pharmacologic management. And, really "ESC" is more of the scoring tool, and it is used for all infants that are being evaluated for withdraw.

Does this mean that you use a different scoring tool for polysubstance use? And, how do you define polysubstance use?

As Celina said ESC is used as a scoring tool; is the baby eating, sleeping and consolable? It is used with babies exposed to methadone, Subutex/suboxone, as with those drugs moms can usually breastfeed. For our criteria, these moms must be in a recovery program and their UDS only positive for those drugs, no illicit drugs such as meth,etc...non prescribed drugs.

Can’t hear

I also try to approach THC reduction counseling similar to alcohol and nicotine/cigarettes. Yes, it's legal. But, we discourage use during BF.

I can hear now

Will they allow me to ask a questionRobert is introducing other guests to share

Thanks

Thanks

yes - love that traffic light which is why I included it in the slides!

Thanks! We think it's really helped!

No problem

Terrie is a Reproductive Healthcare Coordinator from Prevention Point Philadelphia

Thanks for bringing that up Terrie. It's a great point!

And will keep me aware of the need to keep up to date with CDC recommendations.

Here are some resources for medications and lactation National Library of Medicine Website​LactMed (APP – free) ​https://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm​Motherisk (Toronto Sick Kids)​http://www.motherisk.org/women/index.jsp​877-439-2744 Motherisk Helpline​

Organization of Teratology Information Specialists​http://mothertobaby.org/ ​866-626-6847

This is greatThank you

In my position, I am most times having a discussion and then leaving space and making myself accessible. In the days following, I normally hear from the mother after she has had time to process our conversation. This is so important!

Are Antiracial tools available that you had at end of presentation?

thank you

excellent talk it is very enlightening

Loved this - Thank you!

Wonderful presentation on such an important topic!

Dr. Mittal - your presentation was fantastic. Thank you for sharing

Thank you for joining us, Dr. Mittal! Appreciate your insights

Thank you Dr. Mittal. Great presentation.

Thk you Dr Mittal, very helpful presentation.

I think that understanding how the birth experience itself can be traumatizing even in someone without a history of PTSD. any unexpected outcome should be explored post delivery even if it is just not meeting the expectation of a vaginal delivery

Very true. Not only the birth experience but the prenatal care.

Dr. Mittal's email is lmittal@bwh.harvard.edu if you would like to follow-up with her.

Elissa Concini (speaking) is Women's Health Quality and Safety RN at Geisinger

or the fear and trauma of an emergency c/s

Thank you for submitting your Quarterly QI updates! As a reminder, information from these documents are compiled and posted for peer to peer sharing: https://www.whamglobal.org/list-documents/581-pa-pqc-team-qi-key-interventions-and-peer-learning-3-31-22-learning-session/file