Student Spotlight: How is Cara Carter Making An Impact On Perinatal Outcome Initiatives in Minnesota?

#UMNMCH student Cara Carter (MPH 2022) wrote this reflection on how her coursework and deployment have bridged her pharmacy career and MCH career in pregnancy hypertension and Covid-19 vaccination work.

Cara Carter, Pharmacy

Background

I enrolled in the Maternal Child Health (MCH) Program as I was beginning my career as a pediatric pharmacist. I had just completed residency training and learned throughout my experience that I needed to know more about MCH to be the most effective health care provider and patient advocate possible. I knew a lot about treating issues in pediatrics and maternal health after they were diagnosed, but not much about preventing issues. While I have had a passion for patient advocacy and aspired to work for the United States Food and Drug Administration (FDA) since I was a teenager, it was this realization in particular that inspired me to pursue a Masters in Public Health (MPH). Prior to my first semester, I began to receive information about the deployment opportunities the University of Minnesota offers students in the MCH Program. Going into my first year, I was a little apprehensive about applying to a deployment, but there was an opportunity in particular that caught my eye. The Minnesota Perinatal Quality Collaborative (MNPQC) was looking for an intern with neonatal and/or maternal health experience to assist with their hypertension initiative and substance use and recovery efforts.

Minnesota Perinatal Quality Collaborative

The MNPQC was co-founded by the Minnesota Perinatal Organization (MPO) and the Minnesota Department of Health (MDH) in 2018. The MNPQC brings together providers of various levels and specialties as well as various types of healthcare organizations across the state of Minnesota to provide optimal perinatal healthcare. MNPQC provides education, tool kits, networking, support, and other resources to healthcare organizations around the state to assist providers in increasing their knowledge and skills. Initiatives at the MNPQC currently include Preterm Birth Prevention, Hypertension in Pregnancy, Mother/Infant Opioid Substance Use Treatment and Recovery Effort (MOSTaRE), and COVID-19 resources

Cara’s Work on the Hypertension Initiative

Treatment of hypertensive urgency in pregnancy is considered a best practice but is often a difficult feat to treat on a consistent basis. In Minnesota and nationally, Black and Native American people are disproportionately affected by hypertensive disorders of pregnancy. There are other risk factors for hypertensive disorders including hypertension diagnosis prior to pregnancy, prior preeclampsia, obesity, advanced maternal age, multiple gestations, and Type 1 or Type 2 Diabetes. This initiative is important because hypertensive disorders of pregnancy have a mortality rate of up to 17% in the United States.

While deployed to the MNPQC, I worked on the Hypertension Initiative. The aim of the hypertension initiative is to “develop reliable processes of recognition and treatment of obstetric hypertension during pregnancy and up to six weeks postpartum to reduce severe pregnancy and up to six weeks postpartum to reduce severe maternal morbidity by 25% and achieve 80% or higher compliance of the hypertension recognition tool and obstetric hypertension emergency pathway.” The aim is to reach this goal by February of 2023. In order to reach this goal, a toolkit was created to provide to partner healthcare organizations to assist them in their efforts.

Since this is an ongoing effort and requires data collection, I was a part of creating the data collection tool. I evaluated the desired outcomes and assisted the faculty group in developing a survey that collects targeted data to evaluate the effect of this effort. This initiative also includes an Emergency Room (ER) poster and ER treatment algorithm. Due to my clinical background in pharmacy, I was able to review the clinical information in these tools for correct medication information.

This experience was groundbreaking for me. While I learned about hypertension in pregnancy, including hypertensive urgency and hypertensive emergency, in both pharmacy school and residency, this was the first time I was able to apply this information in a preventative manner to public health at large versus the care of an individual patient. In my career, I regularly treat birthing and pregnant individuals in hypertensive urgency and hypertensive emergency. I also treat the newborn babies of women who have these conditions and who have been treated for these conditions during the labor and delivery process. It was a very unique experience to be working on a multidisciplinary team to prevent the need for these treatments in the mother and child. The tools created in this experience are something I plan to share with my colleagues as I continue to progress in my field.

Cara’s Current Work on Providing COVID-19 Vaccine Information for Pregnant Individuals

After the emergence of the COVID-19 virus, a vaccine for COVID-19 soon followed. Like with many vaccines, this brought about conversations related to vaccine hesitancy especially in pregnant individuals who were not included in the vaccine’s clinical trials. While many organizations including the American College of Obstetricians and Gynecologists (ACOG), Society of Maternal-Fetal Medicine (SMFM), and the Centers for Disease Control and Prevention (CDC) recommend that pregnant individuals, not all members of this population are at ease receiving the vaccine. This also provides challenges for healthcare providers when encouraging their patients to become vaccinated.

Through my deployment at the MNPQC, I have been afforded the opportunity to work within my personal area of interest: vaccine hesitancy. MNPQC has allowed me to provide education for healthcare providers surrounding vaccine hesitancy and specifically COVID-19 vaccine hesitancy in pregnant individuals. I have authored Twitter messages that highlight recommendations from ACOG, SMFM, and the CDC regarding the COVID-19 vaccine in pregnant individuals. I have also written a newsletter article geared toward healthcare providers to educate them on vaccine hesitancy and ways to combat it. Through this experience, I learned how to use social media as a tool to educate the community. Prior to this, I did not have much experience using social media in a professional setting. It was eye-opening to see how something I use daily, such as social media, could be used for more than just entertainment to reach a different demographic. It was also encouraging to be able to educate others about something I am passionate about and see that information contribute to public health outcomes.

Working on COVID-19 vaccine hesitancy in pregnant individuals has also allowed me to connect my current coursework to my deployment activities. For example, I have been able to apply the Theory of Planned Behavior from PUBH 6020 Social and Behavioral Science to explain why this population may be vaccine-hesitant. I have also been able to use concepts from PUBH 6806 Public Health Research to design and justify a cross-sectional study aimed at understanding vaccine hesitancy in this population. It is my hope that this study can actually be conducted and the results can be used to provide healthcare providers a greater understanding of COVID-19 vaccine hesitancy in pregnant individuals and ways to combat it. 

Biography

Cara is a second-year MCH MPH student. Her background is in pharmacy, mathematics, and engineering. Cara received her BS in Mathematics from Philander Smith College, BS in Chemical Engineering from the University of Arkansas, and Doctor of Pharmacy from Bill Gatton College of Pharmacy at East Tennessee State University. Cara also has a teaching certificate from the University of Missouri-Kansas City School of Pharmacy. She is currently a pediatric pharmacist in West Virginia. In her spare time, she enjoys crafting, playing with her dog, and spending time with friends and family. After graduating, Cara plans to continue advocating for the health and safety of pregnant individuals and children with regards to medications by pursuing employment at the United States Food and Drug Administration (FDA). Ultimately, she aspires to become the FDA Commissioner one day.

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