Episode Transcript
[00:00:00] Speaker A: Foreign.
Hi, everybody, and welcome to another edition of the Southern Fried Podcast, a production of the Arkansas Democrat Gazette.
You know, one of the things I like to really feature on this podcast is the brilliant people that work at uams, the University of Arkansas for Medical Sciences. We've had a number of them and this is one of the most high profile of them all. I cannot believe we have not had Dr. Nirvana Manning. You've probably heard her speak, seen her on television, whatever. Dr. Manning, thank you for joining us today.
[00:00:49] Speaker B: Thank you so much for having me.
[00:00:51] Speaker A: Yeah, it's a real pleasure to have you on here. Dr. Manning is the Chair of the Department of Obstetrics and gynecology at UAMS. She's held that position since August of 2020.
Also serves as the service line Director for Women's Health at uams. A year ago, UAMS launched a three tiered initiative through its new program, the Arkansas center for Women and Infants Health. It offers vital resources to new mothers and babies during the critical postpartum period. And it is such an issue in Arkansas. We'll get into it over the next 30 minutes or so. It's becoming a bigger issue is we see our rural hospitals in trouble and many of them cutting back, not offering delivery services, and wide swaths of rural Arkansas. So we'll get into that. But first, I always like to those who listen to our podcast, get them a little background, make them comfortable with our guests. So a little bit on your background and your journey and how you, how you became a medical doctor.
[00:02:03] Speaker B: No, absolutely. Well, thank you so much and I'm so thankful for this opportunity.
[00:02:07] Speaker A: Thank you.
[00:02:08] Speaker B: So I grew up in Little Rock. We moved to Little Rock, Arkansas when I was about two years old. I was a graduate of Central High School.
And then I went and did my undergraduate at Vanderbilt University and then came back here and did medical school at uams.
[00:02:24] Speaker A: Gotcha.
[00:02:25] Speaker B: Met my husband along the way. And now three kids later, we're here, we're engraved and not going anywhere. Anywhere.
[00:02:32] Speaker A: Yeah. Always good to have a good central grad on here and a good man. I got a lot of Vanderbilt friends, so always good to have a Commodore aboard too. So.
Yeah, thank you. So let's talk about maternal health in Arkansas.
I know we've improved, but we've traditionally ranked very low in that category.
[00:02:56] Speaker B: Yes, absolutely. And I think it was really sobering several years ago when the statistics came out and had us at number 50 of the 50 states. And so one of the things I think it's given us the opportunity to do is really Hone in and get a lot of different parties moving in the same direction. This is something close to home. It doesn't matter what side you sit on. Women's health is on the forefront of people's minds. So I think making sure that we have grassroots parties as well as all the way to big industries and big corporations kind of working in the same direction. And I really think our governor kind of set the stage.
You know, she is a young mother. It's very close to her heart.
[00:03:44] Speaker A: Right.
[00:03:45] Speaker B: There were several legislative things that came from the last session, and she really thoughtfully said, we need to put this on hold and we need to put some more thought into this. And we kind of broke into three separate sessions, talked about clinical, talked about research. And then she kind of. That's where healthy moms, healthy babies came to fruition.
[00:04:05] Speaker A: Gotcha.
[00:04:06] Speaker B: And I really think that has set the stage now. I think this work started even earlier than that when Arkansas created its first Arkansas Maternal Mortality Review Committee. And what we do in that committee is we go over every maternal death in the state, and we really have everyone at the table, not only doctors, but social workers, anesthesia cardiologists, the morgue, police department, communities. And so, like, what happened here?
What could we have done if everything went perfectly?
And through that work, we saw that 92% of these could be preventative.
And, you know, that was a sobering statistic.
[00:04:50] Speaker A: Oh, absolutely.
[00:04:51] Speaker B: And so as a doctor, you think, oh, my goodness, what are we failing here? But what you realize is it is a. Is a huge community approach to these. We would like to think a suicide or a homicide could have been preventable if given the resources they needed at different points in time. And so it was really gave us the opportunity to hone in where we can work. And it's not in one place. It's not, you know, it's. It's. It's so many different avenues. And so if you don't start working at all of these simultaneously, you're never really going to move the needle.
[00:05:23] Speaker A: Now, you mentioned when that report came out and had US ranked 50th, and it woke a lot of people up, always like to go back to root causes. So because we're a rural state, because we traditionally a poor state, did we have our priorities wrong from a policy standpoint or as I suspect, a combination of all of those things?
[00:05:45] Speaker B: It really is. And so it's hard to, you know, as we really started breaking this down, yes, we are a very rural state.
And. And though that's something that's such a feather in our cap in so many agricultural ways.
It means that women and families have to travel longer to get care.
[00:06:05] Speaker A: Absolutely.
[00:06:06] Speaker B: And the healthcare literacy and the healthcare access is already poor. So preventatively they're not in great shape when they get pregnant. We have the highest obesity rates, diabetes, hypertension. All these things play into pregnancy in a large degree as well as a large uninsured population. So they don't have access to get that.
Then there's a lack of providers in our state.
We know that we have a very aging obgyn doctor population.
We are actively trying to change that with learners coming up, but we're already behind the eight ball and that's just one piece of it. Primary care, everything else access in these communities in order to get the care they need to be healthier in pregnancy is lacking.
And then you just add, you compound some of the social determinants of health and financial constraints and transportation and it just becomes a perfect storm where women may need care even more frequently but are able to get it even less frequently than the average.
[00:07:10] Speaker A: Yeah. And I need to point out that this program applies to babies born anywhere in the state, not just those born at uams.
[00:07:19] Speaker B: No, absolutely. And you know, I really thank Senator Boseman for championing this as he, you know, presented to us a few years ago and really said infant mortality in the state is terrible. He's like help me fix it. And I said with all due respect, that is not my area of expertise.
But I would argue it starts upwards from that. It starts with the mom, it starts with the family.
[00:07:41] Speaker A: Absolutely.
[00:07:42] Speaker B: Those are doing well. Then we can really change the trajectory of what happens later on.
[00:07:47] Speaker A: And again I always, I like to say, I, as I said earlier in the introduction, I like to shine a light, own UAMs and I know a lot of people that certainly are residents of here of central Arkansas. Their, their vision is, you know, the, the UAMS Medical center as they drive by on 6:30. But UAMS has operations and people working in every county in the state.
[00:08:15] Speaker B: No, absolutely. We are in all four corners of the state and we have graduates even in the areas that we point. Yeah. So we have our regional programs as well as just infilt trading into programs such as this and, and other specialties have very similar things. But I agree you don't think of uams. You think of it as the, the big, the big Hospital on 6:30. But we really are trying to improve the health care of the state in all four corners.
[00:08:43] Speaker A: All right, let's talk about victories since the program began where, where we've made progress, and then we'll go into where we need to go over the next three to five years. But what, what have we accomplished so far?
[00:08:56] Speaker B: No, well, so thank you. So, you know, with this program, with this kind of earmark that we got from Senator BOSEMAN Back in 2024, we created the UAMS Arkansas center for Women's and Infants Health. And under that is kind of a three tiered approach.
My first, you know, idea was that we need to standardize the education that these moms and families get, no matter where they deliver, no matter who is delivering them, whether that be an obgyn, whether that be a family medicine doctor, whether that be a certified nurse midwife. Let's standardize what they're hearing so that we know that they're in the best foot forward.
And so we standardize that, as well as some infant safety education. So all of those kind of warning signs that we really want moms to know about as soon as they leave the hospital. We standardize that. In addition to that, kind of give them an infant supply kit, a kind of a head start, so that they have diapers, they have wipes, they have a swaddle sack, vitamin D drops. There's just a plethora of things in this infant supply kit. And we gift that to every single mom that delivers in our state.
The second part of this was this I gave birth bracelet. And the idea behind this is it's a visual cue that these women are different.
And I always say the example of a patient presents to my emergency department with an elevated blood pressure, if they're not pregnant, I may not care necessarily about that to the degree that I do. If they're postpartum, that could be an emergency. And so it's not only a visual per, you know, visual cue for the, the mom and the family, but also to medical providers like this woman. And so it says, I gave birth still at risk. It's a bright blue bracelet. And on there is a QR code that leads to our website, which is my Arkansasbirth.org and that gives a plethora of information. So if two in the morning, if they have trouble breastfeeding, there's a video that can help them. If they're having chest pain or shortness of breath, they can get on that site and see if this is a normal consequence of pregnancy or is this something that they need to seek care.
And then kind of the third tier, which is probably my favorite part of this right now, is the proactive Postpartum call center.
And the idea is that rather than putting the burden on families to call for help, we are proactively calling every family in our state. But between five and 10 days postpartum, we have a very scripted medical questionnaire. Are you having X, Y and Z bleeding, shortness of breath, but also some social determinants of health. Are you having trouble with formula or breastfeeding? Do you have diapers? Is there other things, housing and security and transportation that we can help you with, with resources that we already have in our state.
And also, you know, it, Arkansas is the only state that has not extended Medicaid postpartum for 12 months. So one of the questions we ask is, do you have Medicaid and do you want help with the reapplication process? And so we are actively helping them ensure that after 60 days when Medicaid kind of has lapsed out, that they have some sort of payer source to get that preventative care, that they need to talk about contraception, to talk about all these important things so that the next pregnancy can go according to plan.
[00:12:11] Speaker A: Yeah, yeah, that, that is, that is so important.
To lighten the mood for just a second. I smiled for just a second when you mentioned a call line because my wife and I were just. Our sons are 33 and 29 now. But when the oldest one was born, we were just remembering this the other day. And you know how this is with that first child. You're just a nervous wreck.
And born at Baptist Health here in Little Rock. Of course they give her the number to call and she called it, but it's for right after you leave the hospital. She called it so much. After about a week, they said, ma', am, you really need to start calling your pediatrician at this point.
She just wore about. We were laughing about that again the other day. And then that second one comes along, you kind of toss him in the car seat and take off when you leave the hospital.
[00:13:02] Speaker B: 100%. And I love that. Again, hope. I hope more people call.
[00:13:07] Speaker A: Oh, absolutely.
[00:13:07] Speaker B: I think that is where a lot of people just don't know what they have. They don't know that what they're. They're experiencing may or may not be normal. And so just like you said with that first. And sometimes they're so different.
[00:13:20] Speaker A: You just, as we say in journalism, there is no such thing as a stupid question.
[00:13:25] Speaker B: No. And especially when it comes to your health care or your infant's health care, where you feel very isolated during that period of time.
[00:13:32] Speaker A: Yeah. Yeah. You really really do now. Now we were talking about the problems of a rural state, and we know. I've been writing somewhat from a statewide perspective about some of the problems of rural Arkansas, including the chance that we could be losing a number of our rural hospitals. Reimbursement rates are low. I'm not going to get you into all these policy and political issues, but we all know what they are, and it is creating a problem. And I would think that that, frankly, puts a lot more pressure on those of you at UAMS who are taking the statewide perspective to healthcare.
[00:14:14] Speaker B: Well, it really has made us focus a little differently. You know, initially when I got into this role and had the ability to kind of advocate on this level, I think my thinking was, how can we support these hospitals to stay sovereign, to stay open? And while that still is a huge element of this, I think I have pivoted somewhat to think, how can we at UAMS help support them when they need it and. And help them get the resources they do need when UAMS doesn't necessarily need to be the end destination? You know, the smallest, sickest babies certainly need to come to UAMs. We have the resources, we have all of the things in place, but some of those could stay closer to home and really help those families and those community hospitals by keeping those patients. But how can we create kind of a phone, a friend, when they feel as though either their knowledge base is outside of what they can take care of or their hospital is outside of what they can take care of? How can we help bridge those gaps to give them the resources they need to be able to take care of those patients closer to home? And so I think a lot of the work that what we're doing now is how can we create more of these hub and spoke models throughout our state? And maybe we have eight of those, maybe we have 10 of those. I don't know what that number is, but how can we create what that looks like so that those hospitals get additional resources and help, but also have a seamless line to us when they need it?
[00:15:52] Speaker A: I would think that not only in your specialty, but in all specialties, that again, with a lack of rural medical care and perhaps more hospitals closing, with a largely rural state like Arkansas, that telehealth continues to become more and more important.
[00:16:12] Speaker B: It really does. And you know, we do have limitations in obstetrics just because some of it really does involve touching the patient and listening to that baby. But to bridge those gaps in between, I really think it's helpful, and it's helpful even if you know, one of the unique things about our state is that we have a health department in every 75 counties. So that is unique. And there is a provider in those health departments all the time. So how can we potentially train up some of those health department providers and, and then they can do telemedicine to us if they need help so patients can travel maybe close to get that care. We've trained them up to kind of handle the things within these bumpers, and then when it gets outside of that, they have a seamless route to us. I just think we have to start thinking outside of the box on how care is delivered and who potentially is delivering that care, but with the resources and the support to back them up so they don't feel like they're on an island in a desert.
[00:17:16] Speaker A: Yeah. How do we, how do we better educate the expectant mothers and get them really plugged in from the start of their pregnancy?
[00:17:26] Speaker B: Yeah, I think, I think one part of it is before they even get pregnant. You know, I do think that is a lost opportunity. And we know that unintended pregnancies are upwards of 50%.
[00:17:38] Speaker A: Right.
[00:17:38] Speaker B: So how can we educate? You know, there's so much now with AI, we can target people based on what they are, um, watching on social media and educate in different ways. Now, I always joke because I have three kids and TikTok is, you know, social media, all of that, and please do not trust everything you see on that.
[00:17:57] Speaker A: Exactly.
[00:17:58] Speaker B: But we infiltrate that with good medical knowledge and we're looking at ways that we could do that.
But in the early stages, we really want everyone to get early prenatal care. I think that is the key. And how can we get them in the system early? Now, I do think so many things with healthy moms, healthy babies, has helped that with presumptive eligibility, where now they don't have to have Medicaid in order to present. And those, those clinics and those health departments know that they will get paid for those first three visits and the lab work needed, even if they don't get Medicaid. That makes a huge difference in people getting prenatal care early. And it's been proven that if the sooner you get them on a regimen, get the medication that they need, get that care, the trajectory for that pregnancy goes so much better.
[00:18:47] Speaker A: So with our problem cases, what, what is our biggest problem? Is it poor nutrition? Continued smoking, Substance abuse?
[00:18:56] Speaker B: So it's so hard because again, it's kind of, it's, it's so many things. But if I had to simplify it, I'd say it falls into three big buckets.
[00:19:04] Speaker A: Okay.
[00:19:04] Speaker B: And one of those buckets is in that first, is in that hospital stay, is in right around that delivery before they get discharged. And those are things like infection and sepsis, blood pressure issues that really are affecting that mom and that. That infant. The second bucket, I would say, is in those first six weeks postpartum, and that's our cardiomyopathy. Those are the heart conditions, the shortness of breath, the things that are killing our moms, but even more so causing, like, maternal morbidity, which is a lifelong thing that they're dealing with. And those are going largely unnoticed because they don't understand that some of the things that they're feeling are abnormal. And then that last bucket, I think, gets into our mental health, and it's our substance abuse and mental health. And so each of those buckets deserves different attention.
And so that's where I think a lot of the work is being done, is how can we target each of these differently when, while still collectively making a difference in what that outcome looks like?
[00:20:06] Speaker A: So you're a year into your program. We talked about some of what you were doing already. I told you we would look to the future. So let's talk about the things you would like to see happen, maybe added to the program, maybe get better at over the next three to five years, let's say.
[00:20:22] Speaker B: So we're. We're now at a year of the proactive postpartum call center. And, you know, one of the.
If someone calls you now, I mean, the chances of you picking up that phone if you didn't know what that number is, is really small.
[00:20:34] Speaker A: No, I never do.
[00:20:36] Speaker B: Well, we have.
[00:20:37] Speaker A: I will never answer my phone if it doesn't have a name connected to it. You can leave a voicemail for those who have my cell number. Just know that if I hadn't got your name in there.
[00:20:46] Speaker B: But what's been so interesting with this call center is that upwards of 65 to 70% of these moms are answering this phone call. Now, we are working diligently on the front end to prepar.
But what it shows me is they're eager to tell what's going on, and many of them need help that would not have necessarily reached out proactively.
[00:21:08] Speaker A: Right, Right.
[00:21:09] Speaker B: So we have 25 of our 31 hospitals on board, and we're actively getting the rest of that on board. It's amazing. It's been so fun to see this. And the team that has worked on this is so dedicated. I just cannot brag on it enough. But the things that we have found and the screening processes that have uncovered, and again, these are resources we have in our state. And so we are able to maximize what we're doing in our state. But what I think will be real telling going into next session is what do we not have in our state? And we will have data to show. We wish we could have referred people to X, Y and Z, but we didn't have that in this part of the state. Or we've now maximized the resources in this, like let's put more legislative dollars or let's see ways that we can do public private partnerships to help address this corner of the state. Because here's the data that shows that women needed this and were not able to get it. So I'm super thankful. Again, I am super data driven. It's so easy to say anecdotally, women in this part of the state need xyz, but when you see the numbers, when you are able to actively touch those families, I think it brings a different light to it.
[00:22:21] Speaker A: So do you think we're going to see and because we're not the only state that are doing things, thankfully. I mean, I want all Americans to be healthy, but do you think in when we look at those rankings, and I know different studies are subjective, but will we start to see that needle move in Arkansas move up in those rankings?
[00:22:44] Speaker B: You know, I really do think so. And again, not just my optimism and all of this, there was a CNN report that came out and it showed data up through 2024 and we were one of six states on that report that showed improvement in early prenatal care.
[00:23:01] Speaker A: Oh, that's great.
[00:23:02] Speaker B: Which is, which is a huge early marker and that is before healthy moms and healthy babies came to fruition. So I can only hope that with some of these efforts that we are going to start to see the pendulum change.
You know, the one step forward and one step back are we continue to have rural hospitals, floods. And so access continues to be an issue. And until we, we really start to aggressively address the pipeline of our providers providing the safe prenatal care. You know, we started a family medicine OB fellowship. We have a new certified nurse midwife school at uams. These are people that can provide safe prenatal care and have the ability to phone a friend or have that specialty service when and if they need it. But we need more providers in all corners of the state providing the safe prenatal care. And I'm also, you Know, super curious as to see we are the first state to do a proactive paw center for the entire state. Oh, wow.
[00:24:03] Speaker A: I did not realize that.
[00:24:04] Speaker B: And so it's, it's going to be real fun to see where this data leads us. And does this become kind of a feather in our cap where other states can follow suit and get this information and then we compare that in a much more coagulative way.
[00:24:20] Speaker A: Yeah, yeah. Before we run out of time and we gonna run out pretty quickly, I'm gonna have to get you back. It always happens. But I wanted to expand this just a little bit because you not only work at uams, but as you mentioned, you're a UAMS graduate. And I said I have. Why I like to have people because it is such a gem for a small state offering, you know, in certain specialties, truly world class services that bring people here from all over the world. And then you look at the thousands of people involved and the intellectual capital that it brings to our state, the people working there, and you realize for a state of just 3.1 million people, we've, we've really got a gem in UAM.
[00:25:12] Speaker B: Oh, absolutely. I mean it has been kind of the joy of my career to have stayed on there and having the opportunity to now represent UAMS throughout the state with this important work. I mean, I will look back on and be so thankful for those opportunities.
But the work that UAMS does throughout the state often goes unnoticed.
[00:25:35] Speaker A: It does.
[00:25:36] Speaker B: And I think we are not our own best marketers, but we touch lives in so many different ways. Not only with our, with our graduates that now go out into the communities, but with the innovation, the constant cutting edge and the ability to take care of patients that other parts of the state just would not have the ability to take care of.
[00:25:59] Speaker A: Absolutely.
And I will tell, and you will like this because you grew up in Arkansas. So you realize, as I always tell people from outside our state, that there's only two degrees of separation here. We're such a small state, we either all know each other or we know all the same people. So Lowry Barnes and I graduated from high school the same year, the new UAMS chancellor and he was at Pine Bluff High School. I was at Arkadelphia High School. I'll tell off on our age. It was the 77, 78 school year. I love it.
And so he was the state lieutenant governor for something called Key Clubs, which Kiwanis club sponsor. And I was the Arkadelphia chapter president. So we have literally known each other since the 1970s and that's now chancellor here and that's Arkansas. But you know, with him coming from Pine Bluff, I know that he has a real heart, you know, not only for southeast Arkansas, but for delivering those rural services we were talking about.
[00:27:04] Speaker B: No, I mean the commitment from. From Lowry Barnes and just the love of our state, I think will just take us.
[00:27:13] Speaker A: Yeah, there is really nobody who loves Arkansas or I can tell you. Yeah, agree there, there really is. So, so a big, A big future there and you're playing a big role in it. So I think I'll let you close by giving me a wish list. It can be. These are the extra things we need. I wish we had the funding for X, Y and Z and, you know, I wish these things will happen in Arkansas. So what's your wish list over this next few years?
[00:27:42] Speaker B: Oh, gosh, this is so good. This is like a candy store.
I hope that with the data that we get from the Proactive Pulse center, we find sustainability funding to be able to do this into the indefinite future.
I hope that we can crack the egg or the code on how to help our rural hospitals in new and different ways. And I hope that we really start to infiltrate what access and providers and how that care is delivered in all corners of our state.
And you know, it's been so nice to have just bipartisan support in all of this and having the governor's support in women's health just made so much of a difference.
[00:28:32] Speaker A: Absolutely, absolutely. We.
As you know, I'm very pro Arkansas too, as a native, and I tell people we, we live in the most beautiful state, I think, in the country and we've got the friendliest people in the country.
Now we just need to take better care of them from a, from a healthcare standpoint.
[00:28:52] Speaker B: Yeah, yeah, I think we're getting there.
[00:28:54] Speaker A: All right, Dr. Manning, thank you so much. This has been very, very fun. I always, always enjoy visits with people from uams, and I may give it about a year and then I'll have you back. And since this was a one year report, so to speak, and we'll let you get the two year report and that works out.
[00:29:12] Speaker B: All right, thank you.
[00:29:13] Speaker A: All right, Dr. Nirvana Manning from the University of Arkansas for Medical Sciences, our guest today.
Thank you for joining us. You've been listening to the Southern Fried Podcast, a production of the Arkansas Democrat Gazette.
