1. Maternal-Infant Health Issues Joan Corder-Mabe, R.N.C., M.S., W.H.N.P. Director Perinatal Nurse Consultant Division of Women’s and Infants’ Health Virginia Department of Health November 19, 2001

2. Major Issues Regarding Maternal-Infant Health <Maternal Mortality <Infant Mortality <Low Birth Weight <Access to Care

3. Maternal Deaths by Race Virginia Residents, 1991-1999

4. The Year 2000 goal (3.3 maternal deaths per 100,000 live births) was not reached nationally or in Virginia.

5. Reasons for reduction in maternal mortality PSulfa and antibiotic drugs PDecrease infections secondary to illicit abortions PAvailability of banked blood PSafer surgical procedures, including Cesarean

6. The 3 leading causes of maternal death in the United States and Virginia THemorrhage, including ectopic pregnancy TPregnancy-Induced Hypertension TPulmonary Embolism

7. Most obstetric complications which lead to maternal deaths are difficult to predict, but some could be prevented.

8. Maternal mortality is not reduced through general improvement in nutrition, education, or elevation in social status.

9. Components of maternal death reviews 3Investigation of individual maternal death 3Multidisciplinary discussion of each case 3Recommendations to prevent future deaths

10. Maternal mortality is reduced by: gQuality intrapartum care gAccess to emergency obstetric care

11. Infant mortality is a health status variable which is widely recognized as a measure of a nation’s, as well as a state’s, maternal and child health status.

12. The United States ranks 22nd in the world in infant mortality.

13. Countries with lower infant mortality rates than the U.S. have comprehensive medical care systems that provide virtually all pregnancy and infant health care visits.

14. African-American babies are more likely to die in America than their white counterparts when born with the same medical risks.

15. Social standing in a community is linked to favorable outcomes in perinatal care even when access to services is constant.

16. The improvement in infant mortality rates is not an indicator that babies are healthier, but medical technology is enabling sicker babies to survive.

17. Regionalization of perinatal care was successful in the 1970s and 1980s by concentrating the births of very low birth weight infants to the tertiary centers.

18. RPC The Regional Perinatal Councils (RPCs) are public/private coalitions charged with the goal to improve the system by which perinatal health care is provided within Virginia.

19. Strategies to reduce infant mortality: RExpand Medicaid eligibility RSimplify and shorten eligibility requirements RProvide “wrap-around” services

20. Provision of family planning services to those men and women who would otherwise not be able to access such services.

21. Baby Care - case management services after completion of a “risk assessment” with coordination, follow-up and monitoring.

22. Resource Mothers - home visiting mentors for pregnant teens and their families.

23. Virginia Healthy Start Initiative - mentoring services for pregnant women; nutrition services for prenatal patients and infants; male support services for fathers; and community-based death reviews.

24. Role of men and families in pregnancy and childbirth: WEncourage reduction of risky behaviors such as smoking, drug and alcohol use WFollow healthy nutrition WPromote early and regular prenatal care WIncrease assistance with household and daily chores WObserve for complications of pregnancy

25. Quality of Care  Guidelines for Perinatal Care - ACOG/AAP  Toward Improving the Outcomes of Pregnancy - March of Dimes  National Fetal and Infant Mortality Review

26. National Fetal-Infant Mortality Review (NFIMR) Program cEstablished in 1990 cPublic-private partnership American College of Obstetricians and Gynecologists (ACOG) Maternal and Child Health Bureau March of Dimes Birth Defects Foundation

27. FIMR is: 8Community-based, action-oriented process 8Early warning system that describes health care 8Method of continuous quality improvement 8Means to implement core public health functions

28. Objectives: 3Initiate an interdisciplinary review of fetal and infant death from medical and social records and maternal interview. 3Describe significant social, economic, cultural and systems factors that contribute to mortality. 3Design and participate in implementing community-based interventions determined from review findings.

29. Low Weight Births:  7.8% of all Virginia Births (1999)  Has not significantly changed since 1970s  Single most important contributor to infant death

30. The etiology of preterm labor and premature birth is unknown.

31. Low Birth Weight is associated with multiple factors: !Medical Risk Factors  High parity  Chronic diseases  Previous Low Birth Weight infant  Genetic factors  Multiple gestation  Poor weight gain  Infection  Placental problems  Premature rupture of membranes  Fetal anomalies  Maternal stress

32. Low Birth Weight (continued) !Demographic Risk Factors  Age 34 years  African-American race  Low socioeconomic status  Unmarried  Low education !Behavioral Risk Factors  Smoking  Poor nutrition  Toxic exposures  Inadequate prenatal care  Substance abuse

33. Long-term effects of Low Birth Weight uNeurologic disorders uLearning disabilities uDelayed development

34. Prevention of low birth weight infants is related to effective family planning.

35. Early and regular use of prenatal care is a strong predictor of positive pregnancy outcomes.

36. Access to Care In Virginia, 15.6% of women (ages 15-44) did not have health insurance during 1996-98, compared to more than 19% of women in the U.S.

37. Provision of culturally competent care

38. Conclusion aStudies of underlying factors that contribute to morbidity and mortality are needed aReview of quality of health care and access to care for all women and infants is needed. aRacial/ethnic disparities need to be eliminated.