Bethany Vukusic
Babies are precious. The experience of pregnancy, birth, and the first year of an infant’s life can be magical, joyful, and fulfilling — or not. Social determinants, physical health, mental health, and personal relationships all factor into what kind of experience and how good of a start each new family and baby has. Beyond vaccinations and well child check-ups, Michigan’s public health system makes great efforts to ensure that each start is a good start.

Dr. Natasha Bagdasarian“We are protecting the most vulnerable and reducing disparities in health outcomes,” says Dr. Natasha Bagdasarian, chief medical executive for the State of Michigan. “Health outcomes are very different for different groups of people in our country. If you are wealthy or live in certain parts of the country or state, you may have better health outcomes than someone who has a lower income level, who may live in another geographic area, or someone of another race. It's very important to us that we focus on those who are most vulnerable.”

The Michigan Department of Health and Human Services (MDHHS) Division of Maternal and Infant Health addressed these disparities with a new four-year plan launched this year. Advancing Healthy Births: An Equity Plan for Michigan Families & Communities highlights health across the reproductive span; delivering babies at full term with healthy weight; safe infant sleep practices; and mental health and wellbeing.

“We've got some really terrific programs,” Bagdasarian says. “One of the things that I am able to see in my role is the very different ways that we are trying to lift up populations and help them gain access to better health outcomes. When I think about impacts to young children and young families, it really starts before birth.”

A new MDHHS website dedicated to preventing pregnancy-related deaths, Hear Her Michigan, provides information about urgent maternal health warning signs. An MDHHS still-birth prevention program, Count the Kicks, educates expectant parents about the importance of paying attention to baby’s movements in the third trimester of pregnancy.

“Maternal mortality is a big problem in this country as are disparities with maternal and infant outcomes,” Bagdasarian says. “Of the programs that are so beneficial, number one is the Medicaid payments for doulas. We know that doulas improve birth weights, they reduce preterm births, they reduce the rate of C-sections — and those are all problems that impact Black mothers and poor mothers.”

Another health risk that MDHHS is tackling, sexually transmitted infections (STIs) can harm infants. For example, congenital syphilis can result in miscarriage, stillbirth, low birth weight, neurological deficits, and seizure disorders. Identifying pregnant women at risk and treating them can prevent these.

“We don't think about sexually transmitted diseases as being something that impacts babies and young children,” Bagdasarian says. “But there are diseases that can be transmitted in utero, impact the health of a baby, and actually have consequences throughout the life course of that child.”

Rebecca Antaya RD, nutritionist and lactation consultant, Ottawa County Department of Public Health.
MDHHS programs also provide lactation consultants, home visiting, and the Women, Infants, and Children program (WIC), which helps provide adequate nutrition during pregnancy, lactation, and the first years of a child’s life, along with other programs and resources.

“Not only is WIC a resource in terms of the things they provide, but they are also great partners in terms of making sure that we are communicating and providing other really good health information to young families,” Bagdasarian says.

Home visits nurture parents and babies

Through the MDHHS Maternal Infant Health Program (MIHP), Michigan’s local health departments deliver evidence-based supports to Medicaid eligible pregnant mothers and infants up to 12 months of age. The Ottawa County Department of Public Health (OCDPH) is one example of how MIHP works with young families.

“We make a difference on the development of that growing baby and the experience of the pregnancy,” says Bethany Vukusic, OCDPH Maternal Infant Health Program team supervisor. “We help them to understand a little bit about what's happening inside their bodies as that baby's growing, what to expect in labor and delivery, and what to anticipate in the postpartum period.”

Infant clothing is one of many resources that Ottawa County Department of Public Health shares with new parents.
MHIP supports expectant parents by assessing needs, linking them to community resources, and educating on pregnancy, childbirth, and parenting skills. The voluntary program is delivered through a team approach that can include a nurse, dietitian, social worker, community health worker, and lactation consultant. The team also includes infant massage educators who provide families another opportunity to increase bonding and attunement with their baby.

“There are games you can play with your baby as you're doing the different strokes,” Vukusic says. “It's a great way to get face-to-face time and enjoyment both for the baby and the parent in a way that is also helping them to relax the baby.”

Vukusic shares that talking about the basics of diaper changing, bathing, feeding schedules, and sleep patterns helps parents build confidence. The team also assesses the infant’s developmental milestones and social emotional connections.

“We provide families with age-appropriate activities to promote those milestones in development,” Vukusic says. “We also assess for postpartum depression and anxiety and connect the parents with the appropriate resources as needed.”

Vukusic says that the team has encountered families experiencing food insecurity and expectant mothers skipping meals. Connections to WIC and community-based emergency food sources help these moms nourish themselves and their unborn babies.

“While we can't necessarily turn the tide instantly, we can make a difference, and we can help that baby have a better chance,” she says. 

Some of the new parent educational materials used by Ottawa County Department of Public Health.
Public health supports infant and family mental health

Parenting doesn’t come easy for everyone, especially when parents live with mental illness, substance use disorders, or past trauma as a child themselves. A public service mental health provider, Genesee Health System (GHS) implements public health strategies addressing infant and family mental health.

Elizabeth Burtch“Those early years are so critical, and you never get them back,” says Elizabeth Burtch, GHS director of Children’s Services. “The attachment style between a primary caregiver and an 18-month-old can tell you a lot about what will likely happen to that child, like high school graduation, types of relationships, substance abuse.”

GHS works with infants in foster care and awaiting adoption as many have already experienced trauma. The goal is to both help them heal and educate foster and adoptive parents on what to expect and how to deal with behaviors that might arise.

“If they're closer to toddler age, they could be acting out pretty significantly depending on what they've experienced,” Burtch says. “It’s really important to have somebody that's able to give insight into why a child is acting a certain way.”

GHS also implements the MDHHS Infant and Early Childhood Mental Health Consultation program, sending two full-time staff members trained in early childhood to daycare settings and preschools to help caregivers better meet the social and emotional needs of children in their care.

“They can help provide guidance on one specific kiddo. But oftentimes, there's education needed at the programmatic level about things that they could implement that would help not just that one kid, but the whole classroom,” Burtch says. “We know that kids who are expelled from early childcare, their trajectory in life is not good.”

The MDHHS and Michigan’s other local health departments provide these and many more programs aimed at giving the youngest Michiganders a good start.

“If we can support caregivers and babies, we could really change the world,” Vukusic concludes. “In that tricky relationship with a baby. It's not all rainbows and butterflies.”

Estelle Slootmaker is project editor for Yours, Mine, and Ours — Public Health. Contact her at [email protected].

Photos by John Grap.
Dr. Bagdasarian and Elizabeth Burtch photos courtesy subjects.

The Yours, Mine, and Ours — Public Health series highlights how our state's public health agencies keep us healthy, safe, and informed about issues impacting physical and mental health in our communities, homes, workplaces, and schools. The series is made possible with funding from the Michigan Association for Local Public Health.