Although the infant and fetal mortality rates declined in Northeast Florida in 2015, a review of the deaths in the region found that too many of our babies die from preventable causes like bedsharing, parental/caregiver substance use and being born too small and too soon. These findings and more from the 2015-2016 Fetal and Infant Mortality Review process were released at the October 20 Coalition community meeting.
FIMR’s Case Review Team (CRT) reviewed 28 cases in 2015-16 utilizing an approach developed by the American College of Obstetrics and Gynecology (ACOG) that pulls information from birth, death, medical, hospital and autopsy records and maternal interviews.
For the first time in eight years, the team reviewed sleep-related deaths. Of the nine abstracted deaths (of 26 total sleep-related deaths in the region), the majority took place at home, while the baby slept with others, in an unsafe sleep location, on soft bedding and with unsafe items in the bed.
A mother’s health prior to pregnancy continued to have a major impact on birth outcomes. Unmanaged medical conditions and high BMIs can lead to maternal complications and prematurity. Substance use before, during and after pregnancy also impacts preconception health; can lead to fetal deaths and babies born with withdrawal issues; and is a factor in a number of sleep-related deaths.
Based on the infant mortality statistics and the FIMR cases, the Case Review Team developed the following recommendations:
Safe sleep education will continued to be a recommendation. More specifically, a Public Service Announcement to include information about bedding, bedsharing and additional teaching regarding skin-to-skin contact while “alert and awake.” We will collaborate with a number of local agencies who partake in the Child Abuse Death Review team.
Address late entry or second trimester entry into care. Referral time for women on Medicaid from the assinged medical home to the obstetrician is causing women to enter into prenatal care late. Work with the four managed care organizations in the region to smooth this transition and avoid causing late entry to OB while the pregnant woman waits for a referral from her medical home, whom she may never visited before.
Centralized location for all obstetrician-related activities in Northeast Florida. Possibly Facebook, but a website is preferred. Links to classes, connections to resources, fast facts, service announcements.
Sue Combs is the Healthy Start coordinator for the Florida Department of Health Baker County. The task force looks at maternal/infant health issues specific to Baker County.
The Baker County Infant Mortality Task Force meets the second Tuesday of every month at 1:15 p.m. at the Baker County Health Department. At present, this task force consist of community members from Healthy Start, Healthy Families, Northeast Florida Healthy Start Coalition, Hubbard House, First Coast Women’s Services, Baker Prevention Coalition, AmeriCorps, WIC, and Responsible Fatherhood.
The purpose of this meeting is to look at maternal/infant health issues specific to this rural community. Some of the issues that were identified through the Florida Healthy Baby Initiative were lack of male influence in the home, preterm deliveries, tobacco use during pregnancy, late entry prenatal and incomplete prenatal care.
At present, the task force is revising the current action plan to address the topics of interest in the community as related to infant mortality. This revision includes looking at the role community partners can play in outreach and education in the community. The first item on our revision agenda is “father/mother involvement”. Stephanie Bechtel, Healthy Start care coordinator will lead this committee and will collaborate with Khalil Talib of the Responsible Fatherhood Initiative to initiate community engagement through a baby shower for dad’s. The task force will focus on child safety at the next meeting which will be held on October 10, 2016.
Sleep-related deaths continue to occur in Northeast Florida, despite national and local campaigns that educate and empower families to follow safe sleep practices. As a result, the Coalition will relaunch the Northeast Florida Safe Sleep Partnership in October 2016 to bring together local agencies and community members to develop strategies and initiatives.
The Coalition recently surveyed more than 600 parents in the region on why they bedshare. The results were discussed at a community meeting in August, and several key messages and strategies were developed by attendees. These will be incorporated into a safe sleep marketing campaign to be implemented in October 2016 with funding from the March of Dimes Florida Chapter.
The momentum of the survey and community meeting will be continued with quarterly Safe Sleep Partnership meeting that will be begin at a date in late October to be announced soon.
In 2015, 18 percent of all infant deaths in Northeast Florida were sleep-related, up from 16.8 percent in 2014 (according to provisional data from the Florida Department of Health). Statewide, sleep-related deaths accounted for 15.9 percent of infant deaths in Florida in 2014 and 14.8 percent in 2015.
Bedsharing is a leading factor identified in sleep-related deaths — in 2015, bedsharing was found in 58 percent of sleep-related deaths by the medical examiner.
The majority of sleep-related deaths can be prevented by following safe sleep practices like:
Putting baby to sleep alone in his or her own sleep surface (a crib, bassinet or pack and play).
Placing baby to sleep on his or her back.
Avoiding bedsharing and napping with baby on a couch or chair, especially if on pain medication, drugs or alcohol.
Keeping items like stuffed animals, blankets and pillows away from baby while sleeping to avoid suffocation.
Carlotta and Dakota are brand new parents, but they were prepared for the challenge with the help of a friend. Bridgers, their Nurse-Family Partnership nurse home visitor, helped them prepare for the birth of their daughter, the joys of parenthood and their next steps in life.
The Nurse-Family Partnership nurses deliver the support that moms need to have a healthy pregnancy; become knowledgeable and responsible parents; and provide their baby with the best possible start in life.
Learn more about the benefits from Carlotta & Dakota:
Every Baby. Every Day. The Northeast Florida Healthy Start Coalition and all of our programs, like the Nurse-Family Partnership, provide women and their families with the support and education they need to make sure every baby has a healthy start.
After remaining stagnant for two years, in 2015 the infant mortality rate dropped in Northeast Florida from 8 deaths per 1000 live births to 7.1 deaths. The fetal death rate also dropped from 2014 to 2015 (from 8.3 deaths per 1000 live births to 7.1 deaths in 2015).
Duval County, the population center of the region, continues to drive the region’s rate with 7.9 deaths per 1000 live births. From 2013- 2015, Baker County had significant fluctuations, while Clay and St. Johns counties had sizeable decreases. Rates in smaller counties can fluctuate significantly from year to year, as a few additional or less deaths impact the rate much more than larger counties.
Significant racial disparities continue to exist: Black mothers are almost twice as likely to experience a fetal death (10.2 deaths per 1000 live births, compared to 5.4 deaths) and almost two and half times as likely to experience an infant death (11.1 deaths compared to 4.8 deaths) as white moms. This trend has been consistent over the past five years.
Infant mortality rates improved in areas of Duval County where it has been historically high, (Health Zone 1), while increasing significantly elsewhere (32210 & 32218).
There were 26 sleep-related deaths in 2015. Sudden Unexpected Infant Deaths (SUIDs) are higher in Northeast Florida than the state. Bedsharing is a leading factor identified in sleep-related deaths — in 2015, bedsharing was found in 58 percent of sleep-related deaths by the medical examiner.