A Mother’s Story Kathleen Moline, BSN, MA Policy Analyst Division of Women’s and Infants’ Health 10/21/2009

Key VDH Perinatal Health Data Sources Maternal Mortality Review PRAMS Vital Records Hospital Discharges

How Do WE Listen-PRAMS Collects statewide data on maternal attitudes and experiences before, during, and shortly after pregnancy Data not available from any other source Provides surveillance data essential for planning, implementing and evaluating MCH policies and programs Identify groups at high risk Monitor changes in health status Measure progress towards goals Plan and review programs and policies

Virginia PRAMS Sampling, ,342 eligible live births 1,245 women selected 683 Low BW selected 336 LBW completed 562 Normal BW selected 323 NBW completed  Sampled approx. 100 women per month (50 LBW)  Mail survey with phone follow-up  57% response rate (weighted)

Virginia PRAMS Topics  Preconception Pre-pregnancy BMI Multivitamin use Pregnancy intention Health insurance status  During Pregnancy Content and source of prenatal care Alcohol and tobacco use Attitudes and feelings about pregnancy Health insurance status  Post-pregnancy Labor and delivery Infant health care Postpartum depression Health insurance status Post pregnancy – infant health

How do we listen- FIMR  Fetal and Infant Mortality Reviews  Maternal Interview  Medical Record Abstraction  Case Review Team Analyst  Community Action Team Recommendations

Maternal Interview  Tells the story from the source  Tells of barriers, conflicts, misunderstandings of information, successes  Points a direction for action  Not peer review  Must be tempered with the stages of grief the mother is experiencing

SIDS Mother’s Story  Stories are real  Compiled from actual SIDS cases that occurred from July 1, 2008-June 30, 2009  Quotes from memory of maternal interviewer  Pictures supplied from CPSC  Part of the story told from mothers that reside in West Central Virginia RPC

“She wasn’t sleepy and every time I put her in the crib she cried. I knew I had to get up early for work the next day so I just kept her in the waterbed with me.” (Photo from CPSC files)

About 25% of mothers are co-sleeping with their infant Source: Virginia Department of Health, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007.

“I wish I would have known more about SIDS. They should have more stuff about it on the radio or TV.” (Photo from Child Protective Services files)

About 65% of mothers followed the AAP recommendation for back to sleep Source: Virginia Department of Health, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007.

 “I thought crib death only happened in cribs. That is why I didn’t use the crib.”  “I thought crib death only happened to white babies.” (Photo from CPSC files)

SIDS Rates Virginia Department of Health Division of Health Statistics compiled by the Office of Family Health Services Division of Women’s and Infants’ Health,

 “The baby’s daddy put him down to sleep on his stomach because he always had so much gas and slept better that way.”  “We always had the baby sleep on his back but the babysitter had put him down on his belly in the middle of her bed with a lot of heavy covers.”

“How do you most often lay your baby down to sleep now?” Source: Virginia Department of Health, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007.

 “I do not believe in Back to Sleep. I worry more babies will die from choking from being on their backs. I believe that if my baby would have been on her back since coming home from the hospital, she would have died sooner.”

What are we doing about it?  CJ Foundation Grant  Child Fatality Review focus  Division of Injury and Violence Prevention, Car seat safety pilot  “Grandma’s Campaign for Healthy Grandchildren” program of AARP