Impacting Perinatal Care in California

An interview with MCCPOP founders Dr. Philip Sunshine and Cecele Quaintance

The Mid-Coastal California Perinatal Outreach Program (MCCPOP) began on the basis of collegial relationships throughout the region from San Mateo County to San Luis Obispo County that have been maintained to this day and impacted countless mother-baby dyads. With our virtual format this year, MCCPOP leadership is delighted to welcome our 2021 attendees who hail from 19 states and 5 countries and represent a variety of medical specialties. To celebrate the 40th annual MCCPOP Perinatal Potpourri, we spoke with two of MCCPOP’s originators. Philip Sunshine, MD—one of the founding fathers of neonatology—and Cecele Quaintance—who wrote the grant that established MCCPOP and secured its initial funding—discuss the program’s history and growth.

The following is an interview between science writer Laura Hedli and Dr. Sunshine and Quaintance. It has been edited for clarity and length.

Dr. Philip Sunshine established the foundation for MCCPOP back in the 1960s and '70s when he started an educational outreach program in the community.

Laura Hedli [LH]: Tell me about MCCPOP’s beginnings.

Philip Sunshine [PS]: What I started to do in 1966 was to try to market our nursery to the community. I would call friends of mine in Modesto, Salinas, Monterey and say: “I want to come down and talk to you about what we’re doing at Stanford.” We also started an educational outreach program, and I told the physicians that if they ever had a sick kid, we would be glad to come down and help them care for the infant.

In 1975 when Jerry Brown became governor, we were able to convince the administration that setting up the perinatal outreach programs would be successful in decreasing neonatal morbidity and mortality. Soon thereafter, the MCCPOP program developed through a grant from the state.

Cecele Quaintance [CQ]: There were 5 regions in California that were going to be funded, and MCCPOP, the Mid-Coastal California Perinatal Outreach Program, was the one for this area. I believe the original grant was $250,000/year through Title V. The grant paid for a coordinator, clerical staff, and some travel. I ended up taking the job.

Cecele Quaintance oversaw the formal establishment and daily operations of MCCPOP as the program's first coordinator. 

LH: What did you do once you received the initial funding?

CQ: We worked closely with the Stanford faculty in pediatrics and OB and with the nursing staff in the NICU and L&D as well as our colleagues in respiratory therapy.  We had a rather special relationship because of Phil, and then his colleagues, in that the nursing and physician teams were really very tight from the very beginning. It was assumed that those relationships were very important and were always maintained. Later we were able to add social work professionals that added to our ability to address so many important issues. So that meant everything that was done, was done in tandem. That sort of team effort was instilled in the culture from the very beginning.

What we did was we really built on what Phil had started before, which was going out and actually providing education in the community. That had been going on at least since the early ’70s.

Once the formal, state-sponsored Regional Perinatal Programs of California (RPPC) had been developed, the original scope of work was we would visit every hospital in our region, which at the time was 22 hospitals. We usually visited each hospital at least 4 times a year, with nurses and physicians, both neonatal and OB. What was a little different about MCCPOP was that we almost always traveled in teams. Somebody was out somewhere, on average, four days a week.

LH: What pieces of education that you brought to these community hospitals have been most transformative in terms of care for moms and babies?

PS: An important aspect of our program was the inclusion of the perinatologists who worked with the community physicians to markedly improve perinatal care. This was also facilitated by the introduction of fetal monitoring, which became universally available.

CQ: Morbidity & Mortality (M&M) conferences were probably our bread and butter in terms of changing practice. The community hospital teams selected and presented their cases and asked the questions that they were concerned about. We didn’t present the cases. They did, and we’d be able to work with them. We were particularly fortunate, I think, that our physician leaders were very skilled collaborators and able to make suggestions without judgment.

From the start, since we had integrated groups of physicians and nurses, everybody was encouraged to participate. The docs never felt they were on the carpet all the time, and the nurses began to take more responsibility for care. There was not only practice change, but I think there was also a lot of team building that would go on in those M&M meetings.

PS: They could trust us. One of the things that changed from the beginning was the hospitals not only wanted us to review the cases, but they also wanted a quick talk. We started to provide 20-30-minute talks about some aspect of care that they were particularly interested in.

CQ: The relationships between our MCCPOP team and the hospitals we partnered with were very, very close. I think those relationships allowed people to ask for help in situations where they often would not.

PS: We occasionally would do outreach programs at hospitals that were outside of our region. I remember one time we actually flew up to Crescent City. We had been invited there by a hospital administrator. Every nurse in Del Norte County came. There must have been 40 or 45 of them.

The smartest decision I ever made was to have our annual conference in the community and not at Stanford. We didn’t want this to be a Stanford-only program or conference.

When I started my talk, one gentleman raised his hand and he said: “Why are you guys here?” He said: “I left practice in San Bernardino to get away from guys like you who were always coming and preaching the gospel.” And I looked at him and I said: “Well, I’m sorry that you didn’t invite us, but we’re here and we’re going to give a talk to tell you about what we’re doing. Those of you who want to stay can stay. And those who don’t want to stay can leave.” I talked about the transport system and a few things about taking care of critically ill kids.

Two weeks later, I got a call from that same physician. And he said: “Were you kidding me about taking care of sick kids? “I’ve got one of the sickest kids I’ve ever had.” So, we flew up to Crescent City, and transferred the baby to Stanford and cared for him. And then the physician asked if he could come down to see what we were doing. I told him yes. He spent several days observing what was going on in our nursery.

LH: Wow, what a testament to outreach education. Did the hospitals you visited compensate you for your time?

CQ: They paid for nursing and administrative time. To my knowledge, our physicians were never paid for the hours they spent. They were reimbursed for mileage, but most of them didn’t even bother to turn in [the paperwork]. I believe we started with [initial contracts of] $5,000/hospital, so the hospitals got value for that money.

LH: In what other ways has MCCPOP impacted perinatal care in California?

CQ: The other thing we did a lot of as time went on is to help with CCS certification. All of the Level II and then, later, Level III nurseries had to be CCS-certified in order to get reimbursed by Medi-Cal. We did huge amounts of consultation getting people up and running, preparing for CCS site visits, and helping them write all their policies and procedures. In fact, we would go to all the site visits and be with them when the state visited. We provided all of that to them. That was MCCPOP.

LH: Based on 2019 numbers, MCCPOP now partners with 9 contracted hospitals serving a total of over 18,000 community members. And, of course, 2021 marks the 40th anniversary of MCCPOP's annual conference.

CQ: I believe we actually held the first conference in Monterey, and I think it was ’81. Much to our surprise, it grew huge. At one point we had 450 people [attendees] for several years in a row. I think one of the most successful parts of that annual conference was the interaction that occurred around the region among people who became colleagues instead of in their own little thing.

PS: The smartest decision I ever made was to have our annual conference in the community and not at Stanford. We didn’t want this to be a Stanford-only program or conference.