You know where that smoke goes, through your body to the placenta to the baby. ![]() “You get a group of 10 or 12 women, they’re going to say things, like one woman I remember, ‘I can’t believe that you’re still smoking. The basic principle in CenteringPregnancy, Rising told me in her suburban Washington, D.C., office, is that almost any group of people drawn together in a common health concern will be more motivated to alter their behavior than will a single patient hearing instructions alone in a doctor’s office. But she and Almon had their own conditions: They wanted to locate the oral health study in a new sort of prenatal program at Yale created by nurse-midwife Sharon Rising called CenteringPregnancy. When, in 2006, Todd-Langston got a call from Jeffrey Ebersole proposing to establish a full dental service for pregnant moms, she said it was like a gift from heaven. Forty-seven thousand people reside in Madisonville-Hopkins County. If you had an abscess the size of the palm of your hand you’d get something done about it.”īut generally the women coming to Trover Clinic weren’t doing anything about it, mostly because in Hopkins County there was only one dentist who accepted Medicaid patients - for one half-day a month and only on a walk-in basis. If you calculate gum tissues inside and outside of the teeth it’s an area the size of the palm of your hand. Oral, chronic infection untreated is getting into the bloodstream 24 hours a day, seven days a week, seeding systemic circulation. “Kentucky’s oral health? It’s poor and that’s probably being kind,” Ebersole said in an interview last month in Lexington, “but I can’t say it's that much worse than a lot of the nation. Six years ago Ebersole was looking for a site where he could undertake a program to demonstrate in the field what clinicians were telling him in their practice. Gum infections, decayed teeth that weren't attended to so that by the end of pregnancy they would have full-blown abscesses we would just hope that didn’t put them into premature labor.”įew of the women associated dental cavities and oral disease with pregnancy or prenatal problems, despite mounting medical and dental research showing the linkage, especially in Kentucky, said Jeffrey Ebersole, director of research at the University of Kentucky Dental School’s Oral Health Center. “We saw that our women weren’t getting preventative screening. The problem, they realized, begins in the mouths of their patients. The problem isn’t lack of doctors or even access to standard OB-GYN service. And she expects that number to grow as jobs in the region continue to disappear. “Sixty-five percent of our women are on Kentucky Medicaid,” Todd-Langston, manager of the Trover Center for Women's Health, told me. What’s more, 40 percent of all births are paid for by Medicaid. But the numbers across the rural American South and lower Midwest are worse. Premature births are a growing problem nationwide - now estimated at 10 percent of all deliveries - pushing up the costs of care and the subsequent risk of autism and lifelong illness. ![]() ![]() Upward of a fifth - sometimes a quarter - of the babies they were delivering at the highly regarded Trover Clinic were below weight and premature. Nurse LeAnn Todd-Langston and nurse-midwife Sarah Almon had long known their rural west Kentucky county faced a crisis, but it was getting worse. (This story has been corrected since it was originally published.) And Part 2 explored the link between transportation and healthcare. This is the third and final part of a series on rural health-care challenges.
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