MotherBaby Network

advocacy and commentary with a focus on Lane County, Oregon

Tag Archives: infant-mortality

Part 2: Consumer Advocacy & Evidence-Based Infant Feeding Practices

Here’s the second “installment” for my upcoming presentation at the March 2-3 Breastfeeding Coalition of Oregon’s 5h Annual Meeting. Blue text indicates information that will be placed on PowerPoint slides, black text indicates what will be said. I’d love your feedback either here or via email at motherbabynetwork@gmail.com. Read the first installment

This installment covers consumer demand, consensus spanning breastfeeding research, accountability organizations and national and state governments, and the new Joint Commission “Speak Up!”campaign.

What does consumer demand by the numbers look like?

Click on chart to enlarge

These statistics, taken from the CDC 2011 Breastfeeding Report beautifully illustrate the strong consumer demand on the part of women to breastfeed. Oregon has exceeded the Healthy People 2020 goal for 81.9% initiation of breastfeeding. What this tells us is that most women today plan to breastfeed – more than 91% initiate breastfeeding. This is great news. But within six months we see a dramatic drop-off, especially when we consider breastfeeding exclusivity. Why is this?

Behind these declining rates are the potholes and gaps of an inadequate infrastructure entirely incapable of meeting and supporting women and families in their infant feeding decision to breastfeed. Soon after or right along with the first latch, mothers and babies face multiple threats to breastfeeding from several angles that hound, hobble and thwart them all along the way. Behind these numbers lurk the stories of women and families who are forced into a choice they initially rejected – formula feeding. Who among us doesn’t know first or second hand the details of these unanticipated transitions to formula and the associated loss of maternal and child health benefits?

What these numbers also fail to illustrate are the social and ethnic inequities perpetuated via barriers to breastfeeding. Unacceptable disparities in breastfeeding persist by race/ethnicity, socioeconomic characteristics, and geography. Here in Oregon, only 25% of African-American mothers and babies are breastfeeding at six months, compared to the 62% of Oregonians. (ICTC Black Birth Survey)

Important as data collection is, standard metrics do not capture the emotions, frustrations and isolation women and families experience when faced with the unanticipated and multiple barriers that threaten and frequently succeed in separating babies and mothers from breastfeeding.

In sum, our maternity care system falls woefully short of meeting consumer demand for effective breastfeeding services. Fortunately, consumers (mothers) are beginning to connect the contradictory advice they receive from physicians, nurses, lactation consultants, nurses’ aids and housekeeping staff with the poor outcomes they experience. More women are beginning to see how gaps in standard hospital practice undermine them before they ever go home to struggle alone. The actions and activities of innumerable local and national groups sprouting up are giving voice to the dissatisfaction women and families feel with the standard of care.

Consumers are not alone in connecting the dots…..

Click on chart to enlarge

In the big picture, women are no longer alone in their search for meaningful support. The time for big change in maternity care is here.

Research

  • Health benefits. We are beyond debating the pros and cons of biologically normative infant feeding. Multiple short- and long-term health benefits of breastfeeding for mothers and babies have been firmly established.
  • Hospital practice. Research conclusively demonstrates that evidence-based hospital practices positively influence breastfeeding duration and exclusivity.
  • Cost savings. Thanks to Bartick et al’s 2009 cost analysis (The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis), we also have clear documentation of the massive projected savings in dollars and lives that come with exclusive breastfeeding.
  • SIDS. 2011 research confirms breastfeeding is associated with reduced rates of SIDS. The effect is stronger when breastfeeding is exclusive. This finding has special significance for my community of Lane County. Between July 2007 and June 2010, 23.5% of 85 fetal-infant mortalities are among post-neonates (babies one month or older). Breastfeeding reduces the risk of SIDS.
  • Childhood obesity. Breastfeeding is associated with reduced odds of obesity throughout the life span with greater benefits conferred with exclusive breastfeeding. Breastfeeding promotion and childhood obesity risk reduction go together.

Accountability

Consumer voices and research findings are increasingly making their way to the top of the agenda for major actors in the development and implementation of health care policies. As these bodies move beyond signaling interest to taking action, forward-thinking hospitals will take action to be in position for a time when reimbursement dollars will be tied to breastfeeding outcomes. Action means adopting evidence-based practice for infant feeding.

  • CDC mPINC. A national survey of hospitals to measure infant feeding policies and practices. Facilities receive private analyses outlining their strengths and areas that need improvement. Unfortunately, consumers are not permitted access to facility-level reports.
  • Joint Commission. The nation’s most important hospital-accrediting body recently included exclusive breast milk feeding in its new perinatal core measure set.
  • US Surgeon General Call to Action and Healthy People 2020. Both documents guide national, state and local health policy making. Increasing the number of breastfed infants is a key public health goal.

Nation

  • Healthcare reform. is a major national issue. Promoting and protecting the rights of nursing mothers to pump included in legislation.
  • Let’s Move. The First Lady’s campaign includes breastfeeding as part of the solution to the childhood obesity epidemic.
  • Transforming Maternity Care. Maternity and infant care are the most expensive hospital condition in the United States – $98 billion in 2008. The US spends more than any other industrialized country on maternity and infant care. The outcomes do not support this spending. Any discussion of improving the healthcare delivery service must focus on maternity and infant care.
  • Breastfeeding. Discussion of infant feeding reform thus fits within a larger context spanning the entire perinatal period from conception through an infant’s first birthday.

Oregon

  • WIC. Oregon WIC is one of only 6 states awarded a Breastfeeding Performance Bonus from USDA, tied for the first time to exclusive breastfeeding rates.
  • Oregon Hospitals Partnering for Evidence-based Infant Nutrition. This is a statewide project of the BCO to provide facility-specific technical assistance and encouragement to hospitals adopting evidence-based practices. The May 2011 hospital summit brought hospitals and community groups together to develop plans for next steps. This summit provided my community’s two leading hospitals (McKenzie Willamette Medical Center and Sacred Heart Medical Center) with an opportunity to publicly share their commitment to become Baby Friendly-designated facilities.
  • Oregon Health Insurers Partnering for Prevention (OHIPP). This group of health insurers selected breastfeeding as an evidence-based prevention strategy for reducing obesity. Incentives to hospitals that attain the Baby-Friendly designation are being explored.

The Joint Commission’s message to mothers? Speak Up!

Now that consumers are joined by research scientists and health policy makers at the national and state levels, we are beginning to see efforts to encourage women to seek and insist on excellent infant feeding care. Having recently signaled to US hospitals that exclusive breast milk for infant nutrition is increasingly on the agenda by putting it as an optional perinatal performance measure, the Joint Commission is signaling again. This time, the Joint Commission is speaking directly to consumers. The Joint Commission’s new “Speak Up!” campaign tells mothers they must take action by “speaking up,” if they are to be successful in realizing their preference to breastfeed.

The medium for this latest signal is a brochure. There are several things to like about this campaign’s brochures:

  • It is intended for distribution during the prenatal period when women have the opportunity to think and plan ahead.
  • Breastfeeding, while a biological norm, is presented as a skill to be learned. Learning requires preparation before, during and after birth for mother and baby
  • Women and support people are encouraged to speak up and ADVOCATE for themselves to ensure they are receiving proper, evidence-based care. In other words, being a squeaky wheel is a good thing.
  • Telling women to speak up implies that they ought not assume their hospital’s care is in line with successful outcomes.
  • The information provided is consistent with Baby Friendly Hospital Initiative’s Ten Steps to Successful Breastfeeding and, therefore, is evidence based.

Encouraging personal responsibility is laudable. That said, my reservation with this campaign is that it requires a consumer to have a rather deft capacity to read between the lines. The target audience is unlikely to be able to do this, if they are not first informed that the current and common infant feeding support they are likely to encounter is rife with serious deficits. A more straightforward approach would be great.

I suspect, however, the greatest significance of this campaign is the signal it sends to hospitals rather than to consumers. Brochures are a rather passive form of support that may or not be read by consumers. I am confident, however, that the administrators inside hospitals who make decisions about whether or not to pursue the Baby Friendly designation are able to see this campaign in a larger context – one in which an ever-clearer signal is being sent for hospitals to link doing a better job by consumers with accreditation status. Seen in this light, “Speak Up!” is a very positive development.

— End of installment 2, final installment coming soon. Feedback appreciated!

WP.com Share Button

Share

Lane Co’s High Fetal-Infant Loss = Lost Economic Investment

Recently I was listening to Marketplace’s Kai Ryssdal interview a Russia-based NPR health correspondent about the intersection between health and economic prosperity. Much of their discussion applies nicely to Lane County’s poor perinatal outcomes and our prospects for future economic growth and diversification.

Russia, like Lane County, faces a number of complex public health issues that significantly dampen prospects for attracting investors. Increasingly, Russian policymakers are connecting improved health outcomes across the lifespan with national economic development. Accordingly, issues similar to Lane County’s that diminish prospects for good fetal-infant outcomes are elevated to national priority status. In other words, promoting good health and well being become a compelling potential on-the-ground resource for attracting investment and building economic prosperity.

Regarding bad health outcomes, here’s how the correspondent puts it:

That’s not just bad for Russians, it’s bad for Russia’s economic prospects. International investors use certain health statistics — like infant mortality and life expectancy — to gauge a country’s economic future. So to deal with these troubling statistics, the Russian government announced a plan to build 23 neonatal centers across the country with state-of-the-art Western technology.

Ironically, Russia’s plan to build more neonatal centers comes at a time when the March of Dimes suggests checks on the over-supply of NICUs relative to actual need in this country. This isn’t to say that NICUs are not needed in Russia but rather that what may be needed in one place can be in over supply elsewhere with diminishing returns for that population or community.

As Russia strives to correlate infant mortality rates with attracting investment, Lane County, so far, has not. If we did, we would talk about negative ramifications for our high fetal-infant loss in terms of lost investors and an anemic rate of home-grown innovation. We would connect these losses with the current state of the local economy.

Why are health statistics, including infant and fetal-infant mortality rates, predictive of regional economic success? Tragically, fetal-infant losses are the tip of the public health iceberg. Hidden beneath the surface lies a continuum of sickness and suffering that affects homes, schools, and industry. Investors, who want to know a healthy, creative and innovative workforce is ready to move ideas to the next level, look very closely at these numbers before making a capital commitment.

Were we to move Lane County’s response to a much-too-high rate of fetal and infant loss beyond its current niche lodging among public health, social service, non-profit and community-member focus, how swiftly might we move? Healthy Babies, Healthy Communities coalition members would, no doubt, begin to count among its coalition partners representatives from business, hospital administration and university leaders. It would also garner consistent local coverage in the business section of the newspaper.

Current coalition members have a variety of sound approaches to improving perinatal outcomes throughout the community. Elevating the discussion to action through partnership is needed to carry many of worthy ideas forward. One simple and inexpensive idea with the potential to significantly improve the health of Lane County mothers and babies is printing brief facts on paystubs, church programs, explanation of benefit forms and bank statements, etc. about the importance of the last weeks of pregnancy. Non-medical (elective) induction is a common practice despite the solid research condemning its practice. The March of Dimes has championed the correction of this national practice and would be a source of correct information. Employers, employees / expectant parents, extended family and the community all gain from correcting the unnecessary damage done via unnecessary inductions.

Maternity Act – doing right by pregnant women and babies, everyone benefits

Despite mounting evidence to the contrary, bipartisan efforts aren’t dead in Washington, D.C. Just before Thanksgiving, Congressman Elliot Engel (D-NY) and Congresswoman Sue Myrick (R-NC) filed the Partnering to Improve Maternity Care Quality Act of 2010 (MCQA). This act begins the necessary work to remove the multiple, interlocking barriers separating women and babies from effective care.

MCQA is a prudent and overdue response to several years’ worth of reports and media coverage of the appalling disparities in access and outcomes for mothers and babies across and within communities in this country. Amnesty International’s Deadly Delivery: The Maternal Health Care Crisis in the USA is the latest report. Inside these reports are the details of our embarrassingly high national maternal mortality and infant maternal mortality rates. The most tragic of outcomes, these mortalities are a “canary in the mind shaft.”

62 Lane County babies lost before first birthday

Lagging behind 40 to 50 nations, including all other industrialized nations, the country’s infant mortality rates are evidence of far too many tragic and suboptimal outcomes for a country of our resources and standing. This is especially true given that US per-capita spending far exceeds that of any other country on the planet. Locally, Lane County’s fetal-infant mortality rate leads the state – 62 babies were lost before their first birthday from July 1, 2007 to June 30, 2009.

We’re talking serious money and not enough to show for it

The federal government has a big interest in seeing better outcomes for mothers and babies. Annually, 4.2 million babies are born in the US. Medicaid pays for more than 40% of all maternal hospital stays. Put another way, over half of hospital discharge bills going to Medicaid are for childbearing women and newborns. This adds up to a $39 billion dollar business. It’s reasonable to expect a better than below 40 ranking for this kind of investment.

MCQA does three things:

1. Develop a maternity care quality measurement program

Specifically, a complete set of national, evidence-based, quality consensus measures to assess processes, outcomes, and the value of maternity care provided to Medicaid and CHIP (Child Health Plus) beneficiaries will be developed.

2. Identify payment mechanism improvements

A national demonstration project to identify and evaluate emerging payment reform mechanisms that actually support high-quality, high-value care will be created. An example would be bundled payment for a complete care provided to women and newborns.

3. Identify essential evidence-based maternity care services

The Institute of Medicine will be authorized to identify a package of essential evidence-based maternity care services for childbearing women and newborns.

Creating and bringing each of these components to bear on our under-performing maternity care system would go a long way toward providing early prenatal care, effective breastfeeding support, stemming the tide of induction-driven preterm births and the cesarean epidemic and so much more.

More than a chit for motherbaby advocates

MCQA is much more than a boon or chit for motherbaby advocates. Rather, it fits part and parcel with all other efforts to move national and local economies beyond recession. Healthier women and babies mean stronger families, workforces and communities. Women now make up a majority of the paid workforce. Never have employers and government had a more obvious reason to support maternity care reform.

Don’t you think DeFazio should co-sponsor?

Let’s encourage Congressman DeFazio to co-sponsor MCQA. Send him a message using his email form. Be sure to refer to MCQA by its bill number: H.R. 6437. Feel free to copy and paste a link to this blog in your message.

Some media coverage please…..

As a final thought and in addition to legislative action, serious and ongoing local Lane County coverage of these bedrock issues affecting the well being of women and babies would be helpful. Despite high fetal-infant mortality rates in Lane County, community-level coverage has been scant at best.

The Sacramento Bee’s recent coverage of its local fetal-infant mortality rate is a positive and productive example of the kind of coverage needed in Lane County. The Bee article gets beyond the numbers to put a human face on the complicated but addressable issues contributing to the unnecessary suffering and loss of life.  Here’s hoping we see better (any?) coverage from, among others, The Register Guard, The Eugene Weekly and KLCC in 2011.

Considering maternal mortality in Lane County

Yesterday, I attended the UO Women’s Law Forum discussion of maternal mortality. Among the invited speakers was certified nurse midwife Hilary Prager from the PeaceHealth Birth Center.

Anyone remotely interested in or familiar with maternal and infant well being knows US rates are significantly higher than those in other developed and developing countries. Recently, Amnesty International issued a report – Deadly Delivery: The Maternal Health Care Crisis in the USAoutlining the total disconnect between US maternal health care spending (more than any other country) and maternity outcomes. Women in this country have a higher risk of dying from pregnancy-related complications than their counterparts in 40 other countries. The report also describes the extreme variations among women. Perhaps the starkest disparity is that African-American women are nearly four times more likely to die of pregnancy-related complications than white women.

I don’t know what Lane County’s maternal mortality rate is but I do know its fetal-infant mortality rate tops Oregon counties and hovers around or above national rates. Despite being home to a major university and hospital system in the developed world, Lane County’s fetal-infant mortality rate is more in line with developing world outcomes. It would be useful to know what local rates for maternal mortality are, too. At the UO Women’s Law Forum I asked if maternal and infant mortality rates tend to track similarly and was told they do not. That said, where there is a poor maternal mortality rate, there will also be a poor infant mortality rate (or vice versa). ). In other words, our maternal mortality rate probably isn’t so great.

Mother and baby mortality rates are the gold standard report card for local and national entities. They are a significant metric for overall public wellbeing because pregnancy often happens to women who otherwise would not interface with the healthcare system. As pregnancies progress, the capacity for a community to provide adequate care is revealed. Bad outcomes suggest systemic, community-wide problems made apparent by but reaching beyond women and babies. Maternal and fetal-infant mortality are among the most extreme of negative outcomes euphemistically described as the “tip of the iceberg.” They frequently occur where access to healthcare and social service systems is inadequate or limited.

According to the latest Lane County data for fetal-infant mortality, 62 women suffered a fetal or infant mortality between July 2007 and June 2009. Barely two-thirds of these women accessed prenatal care during the first trimester. Among candidates for the Oregon Health Plan, many no doubt delayed or skipped coverage due to the OHP requirement of a certified birth certificate at application time.

Bureaucratic barriers are not limited to OHP-eligible pregnant women. These kinds of barriers plus significant financial obstacles, as reported on NPR’s health blog, make it extremely difficult for pregnant women to purchase individual policies, too. At the same time, recent coverage by the Washington Post connects a healthy nation with healthy pregnancies:

“Investing in maternal health would return larger and longer-lasting dividends than almost any other comparable public health investment.”


Share

Lane Co. Fetal-Infant Mortality Coalition Coordinator Leaving

Healthy Babies, Healthy Communities, Lane County’s coalition to reduce fetal and infant mortality rate, recently learned its coordinator, Sandy Moses, has taken another position within Lane County Public Health. Coalition members have been assured of a replacement to continue in Moses’ place. This and continued staff and funding resources for the Fetal Infant Mortality Review are critical to improving the health of local families and babies.

Background

In 2007, Lane County Public Health (LCPH) reported an unacceptably high local fetal-infant mortality rate.  Lane County’s rate is the most serious in the state and among the most serious in the nation. The national rate is also high.

Lane County local government and community have responded with the Healthy Babies, Healthy Communities Initiative (HBHC) and, more specifically, the Fetal Infant Mortality Review (FIMR). FIMR is a framework for gathering and analyzing information to develop community-specific responses. Read more about HBHC and the most recent information garnered through FIMR.

September is Infant Mortality Awareness Month

HBHC will host the second annual Healthy Babies award reception on September 30th from 5 to 6:30pm at Valley River Inn. This event celebrates and recognizes organizations, providers and individuals who make significant contributions toward the improved health and well being of babies and families.

Sponsors for the 2010 Healthy Babies Award Reception are welcome. To become a sponsor or reserve tickets contact: Sandy Moses, 541-682-3650, Sandy.Moses@co.lane.or.us


Latest Lane Co. Fetal-Infant Mortality Data

Lane County has an unacceptably high rate of fetal-infant mortality. The overall rate is higher than the state rate and higher than comparable counties and metropolitan areas. Until recently, it was also higher than the national average. See a rate comparison graph here. Improving on the national rate is a positive development but it should be noted that 29 nations have lower infant mortality.

A community’s rate of fetal and infant mortality reflects its health and socio-economic wellbeing. It indicates the capacity and effectiveness with which government, health and social welfare services deploy resources. Accordingly, Lane County’s fetal-infant mortality rate sends a strong distress signal. Simple explanations or straightforward solutions are elusive. Rates vary within and across population groups due to numerous variables including geography, education, ethnicity, age, socioeconomic status as well as physical and mental health. Access to health care and social services are also important factors. Against this backdrop, our local responses are constrained by the current economic climate and shaped by state and federal healthcare legislation.

Background

In 2007, Lane County Public Health (LCPH) staff observed a high rate of infant mortality. Using the Perinatal Periods of Risk (PPOR) methodology to analyze local fetal-infant birth and death data, LCPH confirmed initial suspicions. PPOR is an evidence-based and internationally respected data analysis tool that looks at fetal and infant deaths in relation to birth weight and age at death.

PPOR established Lane County’s rate of fetal-infant mortality as widespread and statistically significant in all population groups regardless of economic, educational, geographic, age, and cultural status. The highest rate of excess fetal-infant deaths occurs in the post-neonatal period from one month to one year of age. Ill-defined causes (includes SIDS) and external causes (includes accidents) are often cited in these deaths. Many successful prevention models exist to reduce these mortalities.

Community Response

The community responded to the PPOR results with the Healthy Babies, Healthy Communities Initiative (HBHC), a coalition of community partners committed to reducing local fetal-infant loss. HBHC members have identified and employed the Fetal Infant Mortality Review (FIMR) as its best instrument for effective problem solving. Developed by the Maternal Child Health Bureau and the American College of Obstetricians and Gynecologists, FIMR is a well-regarded, evidence-based approach used successfully by other communities. See an explanation of the FIMR process here.

When a fetal or infant death occurs, the FIMR case review team collects information from medical records and conducts a voluntary maternal home interview. De-indentified information is compiled and reviewed to identify critical community strengths and weaknesses, as well as unique health and social issues associated with the losses. Recommendations for new policies, practices, and/or programs are developed and shared with the broader community known as the community action team. The first FIMR report was issued in 2007.

The latest Lane Co. Fetal-Infant Mortality Data

In June, HBHC received the 2010 FIMR report for the period of July 1, 2007 to June 30, 2009. During this period, Lane County families suffered 62 fetal and infant mortalities. Twenty-five percent of mothers consented to an interview with the case review team. Hopefully, in the future more women and families will share their stories. Increasing their participation will provide a more powerful understanding of their experiences and means to identify and bridge gaps in support.

The 2010 FIMR report describes levels of first-trimester prenatal care, payment for care and poverty and homelessness for this group.

Prenatal Care

Inadequate prenatal care is linked to increased risk for low birth weight, prematurity and infant and maternal mortality. Barely 66% of the 62 Lane County women in this group received prenatal care in the first trimester.

LANE FIMR Lane 2007 Births OR PRAMS 2007 Births US 2004 Births
First Trimester Care 66.1% 71.6% 78.4% 83.9%

Payment for care

Health insurance coverage determines access to prenatal care for most women. Oregon Health Plan (Medicaid) offers coverage for pregnant women. In 2008, OHP began requiring a certified birth certificate for application. This is a major barrier to women accessing prenatal care.

Poverty and Homelessness

  • 54.8% of the FIMR cohort were at or below the Federal Poverty Level
  • 21% had no stable housing during pregnancy or at birth

Increasing access to prenatal care and reducing poverty and homelessness would, no doubt, have the greatest impact on reducing local losses. While community partners can speak to the importance of these issues, predicating improved outcomes on removing them would quickly lead to inaction. Legislation to improve maternal and infant outcomes and an economic recovery fall well beyond HBHC’s reach. FIMR provides the tools by which communities can move beyond seemingly impossible obstacles to identify goals and resources that are within reach. Based on the most recent FIMR case review process, five specific areas are recommended for community action. Of the following five, HBHC selected two issues for immediate focus – they are obesity/overweight and smoking.

1. Maternity overweight and obesity

Both overweight and obesity pose risks for women and babies. Overweight and obese women are at greater risk for infertility, hypertension, gestational diabetes, preeclampsia and large-for-gestational-age babies. Babies are at greater risk for birth defects and fetal and neonatal death.

Pre-pregnancy Lane FIMR (58 of 62)* Oregon PRAMS 2007**
Overweight & Obesity 55.2% 46.9%
Overweight (BMI 25-29.9) 17.2% 27.6%
Obesity (BMO > or = 30) 37.9% 19.3%

* BMI and/or height and weight was not recorded in 4 of 62 records

** PRAMS refers to Pregnancy Risk Assessment Monitoring System

2. Tobacco consumption

If all pregnant women stopped smoking there would be an 11% reduction in fetal deaths and a 5% reduction in infant deaths. (March of Dimes)

Tobacco Use Lane FIMR OR PRAMS 2007 US PRAMS 2005
During 3 mos. before pregnancy 32.3% 21.2% 21.5%
During pregnancy 22.6% 10.4% 13.8%
During 3 mos. after pregnancy 22.6% 13.2% 16.4%

3. Maternal mental health

Because screening and referral for mental health is inconsistent the true prevalence of depression during and after pregnancy is unknown. Depression during and/or after pregnancy can make it difficult for a woman to care for herself and to bond with her unborn/born child.

Maternal Depression Prenatal Postpartum
Lane FIMR Cohort 6.5% 14.5%
2007 OR PRAMS Cohort
Always 2.1% 1.6%
Often 8.4% 8.9%
Sometimes 25.0% 25.5%
Rarely 32.7% 33.7%
Never 31.9% 30.4%

4. Reproductive health planning

Women for whom pregnancies are not planned are less likely to discover their pregnancies early, and less likely to adopt healthy behaviors, and begin prenatal care.

Pregnancy Lane FIMR (43 of 62) OR PRAMS 2007
Intended 41.9% 52.4%
Unintended 58.1% 47.6%

5. Sudden Infant Death Syndrome (SIDS)

SIDS is the leading cause of post-neonatal death in the US. The Lane FIMR review process identified one neonatal and five post neonatal instances of potentially unsafe sleep practices based on medical examiner findings.

Moving toward community action….. While sufficient county funds are unlikely to materialize in the current economic climate, it is imperative that we maintain the groundwork laid by Lane County Public Health and HBHC. Specifically, maintaining funding and staff time for PPOR and FIMR are a necessity for tracking and responding to the unacceptable rate of fetal-infant mortality in our community.

PPOR and FIMR are the backbone for HBHC coalition building and action. Meetings are well attended by local and state government agencies and county-based non-profits. Additional participation from the business community, citizenry and media outlets would further strengthen current efforts. The following are three HBHC-inspired action items, three ways in which we can start working on solutions:

Screening & Referral

Lane County providers lack effective tools to screen for, address and reduce health, psychosocial, and other risk factors to improve maternal and infant outcomes. The current screening tool is paper-based and outdated. The UO FEAT and Health Policy Research Northwest, HBHC coalition members, are working to address this gap in care. The goal is electronic screening and referral kiosks in provider offices.

Home Visiting

Home visits improve mother and infant outcomes. HBHC’s Home Visiting Project is identifying and coordinating across local home-visiting programs to collaborate on and support consistent messaging and outreach in line with community action items.

Breastfeeding Coalition

A local breastfeeding coalition recently formed to support increased access to evidence-based breastfeeding services. With regard to SIDS, a 2009 study in the journal Pediatrics shows that breastfeeding reduced the risk of SIDS by 50% at all ages throughout infancy.

Share

Lane County’s unnecessarily high fetal-infant mortality rate

“Infant mortality is the most sensitive index we possess of social welfare.”

— Julia Lathrop, Children’s Bureau, 1913

Why are so many Lane County babies dying?

In 2007, the Lane County Public Health Department issued a special report devoted to this question. Soon, additional fetal-infant mortality data will be reported to the Healthy Babies, Healthy Communities Initiative‘s Perinatal Health Team (PHT). (HBHC fact sheet) I have participated with HBHC’s PHT over the past year. The Register-Guard recently published my opinion piece on the need for civic engagement with the work of HBHC.

In anticipation of the new data, I outline here my understanding of the problem we face, key 2007 findings and the local response thus far. With this post, I hope to stimulate sensitive and productive community-wide discussion focused on ending avoidable fetal-infant mortality in Lane County.

Understanding the problem

The fetal-infant mortality rate includes both fetal (24 weeks gestation and 500 grams) and infant deaths through the first year of life. It is a sensitive gauge of a community’s health as well as of its social and economic wellbeing. Why? Because, tragically, these losses can be just the tip of an “iceberg.” Beneath the surface there can be a near-miss continuum of sickness and suffering. Sickness and loss among a community’s families makes for troubled homes, schools, and industry.

Lane County’s fetal-infant mortality and infant mortality rates are significantly higher than those of comparable counties as well as of the state and nation as a whole. Regarding fetal-infant mortality, Lane County Public Health reports:

“At 9.5 deaths per 1,000 live births for 1999-2003, Lane County’s fetal-infant mortality rate was 20 percent higher than the rate for Oregon (7.9) and 28 percent higher than Multnomah County (7.4). For the same period, at 7.3 deaths per 1,000 live births, the Lane County infant mortality rate was 30 percent higher than the rate for Oregon (5.6) and 40 percent higher than Multnomah (5.2).” See graphic 1. (Page 2, 2007 report)

At 6.9 deaths per 1,000 live births, the national infant mortality rate trails 29 nations, including many with far fewer resources. High rates of prematurity drive national infant mortality. Prematurity’s causes are many, including poor maternal health, lack of access to prenatal and postpartum care as well as overuse of induction and cesarean section. Based on 2006 data, Lane County Public Health reports:

“At 7.0 deaths per 1,000 live births, the county’s infant mortality rate was 27 percent higher than Oregon’s rate (5.5) and 35 percent higher than Multnomah’s (5.2).”

Not an isolated problem

All Lane County women experience higher rates of fetal-infant mortality rates. There are three findings in the 2007 report foundational to understanding and reducing local rates. I expect them to remain central even as new data are made public.

Key Finding #1: All socio-economic, age, and education-level groups have unacceptably high rates of fetal-infant mortality. See graphic 2. (Page 2, 2007 report)

Key Finding #2: Lane County women with characteristics associated with optimal pregnancy outcomes experience higher rates of fetal-infant mortality than the nation’s women as a whole with these same characteristics. Characteristics include being non-Hispanic white with 20 or more years of age and 13 or more years of education.

  • Lane County reference group rate: 8.5 deaths per 1,000 live births
  • National reference group rate: 5.8 deaths per 1,000 live births

Key Finding #3: Lane County has a statistically significant higher rate of post-neonatal infant mortality than the rest of Oregon. “Post-neonatal” refers to 29 days to one year. Ill-defined causes (includes SIDS) and external causes (includes accidents) were responsible for more than half of post-neonatal mortalities. This is important because SIDS and accidents are potentially preventable causes of mortality. (page 3, 2007 report)

Local Response

The HBHC Perinatal Health Team members support and are actively engaged with two strategies for addressing fetal-infant mortality locally:

1. Fetal-Infant Mortality Review (FIMR)

FIMR reduces infant-mortality through (1) identifying community-level factors (social, economic, health) through case review; (2) planning and implementing community-based interventions to change harmful practices and policies; and (3) regularly evaluating progress and effectiveness of interventions. The forthcoming data, mentioned at the beginning of this post, is a result of the FIMR process having been initiated four years ago. See graphic 3 for a description of the FIMR process.

2. Home Visiting Work Group

Mother and infant outcomes are positively influenced when social, economic and health (mental and physical) factors influences overall wellbeing are addressed. HBHC’s Home Visiting Project is identifying and coordinating across local home-visiting programs to collaborate on and support consistent messaging and outreach supportive of optimal mother-baby practice.

What’s next?

The HBHC Perinatal Health Team anticipates receiving FIMR data in May. Based on findings, recommendations for community action will be discussed. These suggested actions will be shared at community-wide meeting on Friday, June 11th from 8-10 am at Lane County Mental Health. Please attend to learn about and participate in developing a community action plan for improving the health and wellbeing of mothers and babies in our community.

Share