Background:
Previous preterm birth is a major risk factor for preterm birth in a subsequent pregnancy. Addressing maternal conditions in the interconception may be an ideal opportunity for prevention of a recurrent adverse event. This project was designed to provide interconception care, beginning in the immediate post partum period, to mothers whose infants were born at 32 weeks gestation or less. Mothers who experienced a fetal/infant demise were also included. The goal of the project is to improve the health of these mothers and reduce their risk for recurring poor birth outcomes.

Objectives:
Test the feasibility of integrating maternal health care and support services into the NICU environment.
Determine the receptivity of women who have experienced a poor pregnancy outcome to initiation of well woman health care.
Record the health needs, risks, and barriers to care of mothers of preemies at the University of North Carolina.


Methods:
A multi-disciplinary advisory counsel provides leadership to the P4 Program. A CNM provides care coordination and interconception health services. Multiple clinical resources and pathways of care are utilized to construct individualized health plans and direct medical management. 225 women will be assessed for risk factors at scheduled intervals for the period of one year following the delivery. Services include: care/referral for immediate postpartum health concerns; health assessment; documentation of health risks/concerns; appointment for postpartum visit; periodic postpartum depression screening, support for mother's expressed mental/physical health care needs; and development of an individualize health and reproductive life plan.

Results:
The program was able to successfully develop the many partnerships it needed to launch a new service line. Providers and women alike were receptive to the program. A series of tools, resources, publicity and a comprehensive evaluation plan were developed and implemented. Mothers continue to be recruited to the program and the project is on target to meet its goals.

Conclusion and implications for practice:
Mothers of high-risk infants have a great need for interconception care services. Organizations seeking to provide this care should work together to share methods, challenges and outcomes.