Food As Medicine for Healthier Pregnancies

Credit and Courtesy Ms. Marcia Sweet, Purdue Extension Nutrition and Education Program, Purdue University

TERRE HAUTE – Walk into the Chances and Services for Youth (CASY) kitchen on a Wednesday morning and you will find a flurry of activity.

Dairy crates are filled with food carefully selected by Indiana State University Instructor Casey Strawser. In another area, recipes are reviewed and ingredients assembled by Purdue Extension Nutrition Program Advisors Judith Barnes and Amanda Shook. In a corner, lesson plans are whispered between Union Health Navigators Michelle Arnold and Sarah Fagg.

When it is discovered that there is only one can of cream of mushroom soup, a call is made to Terre Haute Terre Haute Catholic Charities Foodbank and 10 minutes later Assistant Agency Director Jennifer Buell delivers a case of Campbell’s soup.

Moving from one group to the other is Community Wellness Coordinator Allison Finzel. She was the one who heard the story on NPR about the impact of nutrition on reducing infant mortality rates and decided that was what her community needed. After 18 months of planning, her vision launched this year.

When the four young expecting parents – three moms and a dad – arrive, everything is ready.

They are greeted like old friends and fall into place around the table like family. After watching Barnes and Shook prepare Baked Turkey Meatball Stroganoff, they move into a classroom for a lesson about post-partum depression – a chief fear of all of the participants. Arnold and Fagg are still sharing warning signs and coping tips when lunch is served.

“We want to be supermom,” Fagg warned. “We want to keep the dishes clean and do the laundry. But when the baby sleeps, get the rest.”

What started six years ago as the Union Health’s All Babies and Healthy Start Initiative has evolved into a comprehensive approach to maternal and fetal health.

“Our moms were getting the obstetrics care, but they didn’t have the supports they needed,” said Arnold, who works with families in eight counties in her roles as a navigator and community health worker at Union Health. “(Here) they get a cooking lesson, lunch together, a nutrition class, prenatal information, groceries to take home, childcare, and emotional support. Everything they need for a healthy pregnancy can be found here.”

Just as it takes a team to deliver a baby, it has taken a coalition working towards one goal – preventing infant mortality – to make this program possible.

In 2020, the most current year available, the Centers of Disease Control and Prevention reported that Indiana was ninth of the top 10 states for infant mortality, losing 6.5 babies out of every 1,000 live births. Add to that number stillbirths and miscarriages, and the heartbreak becomes a community problem.

According to the Wabash Valley Fetal-Infant Mortality Review, 9.5 babies out of every 1,000 died in 2019 during their first year in Central Southwest Indiana. Of those 23 deaths, 18 were found to have “preventable factors,” the report stated.

As a result of Finzel’s maternal food prescription pilot program being incorporated into the All Babies Healthy Start Initiative, Union Health’s clients now receive:

· weekly food baskets donated by Terre Haute Catholic Charities FoodbankTerre Haute Foodbank,

· cooking classes from Purdue Extension,

· nutrition education classes from Indiana State University,

· personalized health classes from Union Health’s nurse navigators,

· child care offered by the Yigo County YMCA, and

· transportation to classes if needed.

CASY provides the kitchen and classroom space.

Thanks to various grants, every foreseeable barrier to a healthy pregnancy, successful delivery, and triumphant first year of life has been removed. The free program is open to participants in Parke, Vermillion, and Vigo counties, as well as collar counties in the Wabash Valley. Of the 10 who started the program in January, four participants have proven consistent.

“This program began with a conversation I had with Dr. Jim Turner about the idea for a food prescription program,” Finzel said. “He talked to me about a maternal health program he had. We talked about the nutrition side of that that had never been included in the maternal health program. That’s where it began - on a yoga mat. ”

Dr. Turner, Medical Director of the Richard G. Lugar Center for Rural Health, is Finzel’s neighbor and attends the same yoga program. Union Health and the Lugar Center for Rural Health have been working to reduce infant mortality rates for years. In 2020, the hospital earned the inaugural INspire Hospital of Distinction honor.

She said they often share information they find compelling, like the story she heard on the radio. As Finzel discussed the value of a food prescription program, she said Dr. Turner replied, “We’ve never added nutrition, what a great idea! Let’s screen for food insecurity.”

Finzel and Dr. Turner began inviting people to join the conversation. Finzel told Community Wellness Coordinator Melinda Duckett, who serves Parke County – which has only one grocery store in the entire county. Dr. Turner contacted partners at Union Health. Both continued to reach out to community agencies until the team consisted of representatives from Purdue Extension, Union Health, Indiana State University, Terre Haute Catholic Charities Foodbank, Chances and Services for Youth, Vigo County YMCA, and the Union Health Foundation.

“We have learned that there are all kinds of wonderful partners in our communities just waiting for something to do,” Finzel said. “You bring an idea to them and most of the time I’ve always had people just jump onboard and want to know how they could help.”

For Terre Haute Catholic Charities Foodbank, this program fits into the agency’s growing awareness that supplying food is just the beginning of meeting the community’s needs, Buell said. Every week they donate the food for the baskets participants receive. Those baskets include meat, fresh and canned produce, grains, dairy, and the occasional treat like chocolate-covered fortune cookies.

“It really has been a good thing,” Buell said. “We have moved beyond what we have traditionally done to meet the needs of our community. One of the things we have recognized is that food banking is changing.

“We want to do more than just provide food. Good nutrition equates to good health. If we are not receiving the foods our communities need, we are purchasing it because it is a long-term investment in our community.”

Buell said providing the food to the program gives participants the opportunity to learn what to expect from food pantries, should they ever need to visit one.

“What we are realizing is that all of that donated food does no good if our clients don’t know how to use it,” Buell said.

A few days before each class, Finzel calls Barnes and Shook with a list of the item participants will receive and they create meals around the ingredients. The goal: demonstrate all of the ingredients can be used to make a nutritious meal.

Shook, a former executive chef who developed recipes and menus at Clabber Girl before joining Purdue Extension’s Nutrition Education Program, relied on her past experience and creativity. Starting with USDA’s MyPlate.gov, she adapted recipes to accommodate the featured items.

“One of the things I tried to do is share concepts, not just recipes, so they could use those concepts to prepare a nutritious meal,” Shook said.

“I love the program and I think it is amazing to show them how easy it is to make a meal with the food they get. I think they get a lot of out it, too. (During) one of the lessons I asked has anybody made any of these recipes and one made enchiladas. Then they started saying what all they had made. I felt good that they are using these.”

Barnes, who works with Shook doing the food demos, taught the lesson on food labels. For her the best part is at the end, when everyone is sitting around the table answering questions and sharing experiences.

“The group we have is just wonderful!” Barnes said. “They have all gained knowledge from it. They have been very grateful. They let us know that they appreciate it. They enjoy the comradery. They enjoy being together and they enjoy being with us. We’ve all been moms, we’ve all breastfed, we’ve all been through it. So, we all understand.”

Nutrition education is provided by Strawser, a registered dietitian. She said the moms have commented most on the amount of food they have received and the cooking demos, but they are hoping that over the long-run, the program helps moms improve their nutritional intake.

“We want to teach moms how to cook better, how to eat better,” Strawser said. “Nutrition education is an integral part of a healthy pregnancy. We are also hoping to increase their access to the food banks in the area, particularly Terre Haute Catholic Charities Foodbank, so they will know where their resources are for nutritious, healthy food.”

For participant Tori Clampitt, of Rosedale, the program has been invaluable. At 31 weeks, she has not missed one of the seven classes. Clampitt said her husband, Scott, attends the classes with her when he is not working. At one of the classes he attended, he learned how to read nutrition facts labels. Now, he checks the labels when deciding what brands to buy.

“It has been really helpful for me and my friends,” Clampitt said. “This is my first kid, so I thought it might be a lot of new information I might need. I have a lot of friends that are pregnant or have young kids, so I tell them about classes. I have a few friends who want to come when they start the next one.”

“This is really good if you are a new mom and not sure about some things.”