Click here for several interviews with mothers

Northern Virginia Fetal Infant Mortality Review Project

Fetal Infant Mortality Review (FIMR) is a community process that addresses the concerns of infant mortality from a multidisciplinary point of view.

Communities across the United States have been using FIMR since its development by the American College of Obstetricians and Gynecologists in 1990 to review infant mortality from a multidisciplinary perspective.

The FIMR process allows us to gain insight into the medical, social and environmental factors that contribute to infant mortality. FIMR goes beyond death certificates and statistics to find out what happened during pregnancy, birth and the baby's short life.

FIMR’s objectives are:

To examine the significant social, economic, safety, and health systems factors associated with fetal and infant mortality by reviewing individual cases

To plan a series of interventions and policies that address these factors to improve the service delivery system and community resources

To participate in the implementation of community based interventions and policies

To assess the progress of the interventions

FIMR is:

a method for implementing continuous quality improvement

a warning system that describes changes or gaps in the health care delivery system

designed to utilize existing health networks and improve coordination

emphasizes the public health functions of assessment, assurance and policy development

allows for greater understanding of community needs by viewing the whole picture

utilizes the diverse perspectives that members from various backgrounds bring to the process

mobilizes community action to advocate for change

supported by the Maternal Child Health Bureau, ACOG and the March of Dimes

FIMR also provides important benefits to bereaved families. The home interviewer can help facilitate the grieving process, as well as make appropriate referrals to support groups or counseling programs that may be needed. In addition, the home interviewer may identify medical problems in the mother, and may be able to provide significant information to prevent problems in subsequent pregnancies.

Priorities for FIMR in Northern Virginia

To provide a model for community wide review of fetal and infant mortality, with recommendations for improvement of the health care system when applicable.

To incorporate cultural sensitivity and competence into the FIMR process.

To develop a methodology to ensure that the data that is gathered is used to improve care.

By working together across agency and disciplinary boundaries, FIMR can provide meaningful information to enable the reduction of infant deaths and improvement of pregnancy outcomes in Northern Virginia.

The Northern Virginia FIMR team reviewed 193 cases of fetal and infant deaths from 1998 to 2000.

FIMR is an excellent quality assurance mechanism. We found good evidence of identification of high-risk obstetrical conditions early, with appropriate medical intervention. However, we also found that too many women did not know about folic acid, few women really understood the risks and symptoms of preterm labor, and only about half of the pregnancies were planned.

We discovered a disturbing pattern of women suffering from symptoms of preterm labor who did not understand what those signs indicated, or whose complaints were not heeded by their medical providers.

Contrary to the conventional wisdom that infant mortality is more prevalent among poor, uneducated single mothers, the majority of patients in this study were well educated, middle-class, employed and married. Five percent of the infant deaths occurred to teen mothers, but 54% of the deaths occurred to women older than age 30.

Infant Deaths

The causes of infant deaths fall into two main categories: prematurity, especially less than 24 weeks gestation, and congenital anomalies. The most frequently occurring congenital anomaly was cardiac anomalies, accounting for 9 deaths. In 1999 there were 7 deaths attributed to SIDS in Northern Virginia.

.Infant Mortality Data

Northern Virginia’s overall infant mortality rate in 1999 was 4.8 per 1000 live births, according to the 1998 Virginia Department of Health Vital Statistics.

This compares very favorably to the Virginia statewide infant mortality rate in 1998 of 7.2 per 1000, and the United States Infant mortality Rate of 7.0 per 1000. The Healthy People 2000 Initiative established a goal for infant mortality in the United States of no more than 7 infant deaths per 1000 live births. We have exceeded that goal in Northern Virginia, and by adopting the FIMR model, we hope to gain information to enable us to further reduce the infant mortality rate in our region.