Research has shown that taking .4 milligrams of folic acid daily prior to and in the first few weeks of pregnancy can significantly reduce certain birth defects, including neural tube defects, some cardiac defects, cleft lip and palate, and limb deformities.

However, half of all pregnancies are unplanned, and awareness of the need to take this vitamin prior to pregnancy is limited. The Northern Virginia Perinatal Council and the March of Dimes have embarked upon a public awareness campaign on the need for every woman of childbearing age to take .4 milligrams of folic acid daily. We also need to address the cultural differences of our many immigrants in the area and their need to learn about folic acid and take a multivitamin daily.

With the increase in multiple pregnancies, occurring both naturally and with assisted reproductive technologies, health care providers must remember that twin pregnancies are high-risk pregnancies and must be treated as such.

Several mothers told the home interviewer about suffering from a constant, rhythmic backache but were either "afraid to bother" their physician, thought that backaches were normal in pregnancy, or their physicians did not investigate the seriousness of this symptom.

• Kaiser Permanente has an excellent preterm prevention program, "Tender Loving Care", which has been very successful in reducing preterm births among Kaiser patients. Other providers of prenatal care could explore this type of prevention model.

• Bacterial Vaginosis, Group B strep and other infections in the prenatal period must be treated more effectively, particularly if we are to reduce infant mortality in African American babies.

Several mothers told us that they had symptoms of preterm labor, which they ignored, based on advice from colleagues or relatives. Several others told us they contacted their doctor’s offices with symptoms of preterm labor, but were told by a receptionist over the phone that backache in pregnancy was normal.

• We recognized the need to provide more accurate information to pregnant women about signs and symptoms of preterm labor in addition to educating the office staffs.
• Patient education materials on Preterm Labor from the Virginia Perinatal Association and from the March of Dimes have been distributed to all doctors’ offices and prenatal clinics in Northern Virginia, as well as to libraries and other public places.

On-site workplace education programs like "Babies and You" have proven to decrease costs to employers associated with premature births. The Washington Business Group on Health recommends such programs, and we should encourage businesses to utilize such programs. The Northern Virginia Perinatal Council and the National Capital Area March of Dimes will be working with National March of Dimes in implementing a newly revised "Babies and You" Program to be used in the workplace, or clinics, churches or community centers.

5. Outreach education regarding the need for early prenatal care and risks of birth defects must be provided to the foreign born population, especially Middle Easterners and Latinas. Education and public awareness campaigns must be done in appropriate settings and need to be culturally and linguistically appropriate.

40% of infant deaths in Northern Virginia in 1998 and 34% in 1999 were to foreign-born women. We have been working with the March of dimes for several years in an effort to make women aware of the need to take folic acid prior to pregnancy to prevent birth defects, but we had concerns we were not reaching this vulnerable group of women—the foreign born. We wrote a mini grant to the March of Dimes National Capital Area Chapter, to enable us to purchase folic acid and distribute it to women at risk—the low income foreign born women who use the health department clinics for family planning and well baby care.

We received funding and distributed 650 bottles of folic acid, each one containing an 8 months supply, to Fairfax Resource Mothers, the Naomi Project, Arlington Project Family and Alexandria and Prince William WIC. Loudoun health Department received a separate grant and is distributing folic acid in their family planning clinic. The one on one teaching enhances distribution of the vitamin and encouragement provided through the Resource Mothers and WIC programs.

We have also enlisted the aid of DC United Major League Soccer Team to provide public service announcements and to promote preconception and prenatal care and healthy infant care at their well attended soccer games, and are working with many multicultural organizations to promote preconception care, folic acid, and prenatal care. 

With the Northern Virginia SIDS Alliance, we have been promoting the Back to Sleep and other SIDS risk reduction messages at health fairs, hospitals, clinics and day care centers in Northern Virginia. Sadly, infants in day care are much more at risk for SIDS if they are placed to sleep in a prone position if they had become used to sleeping on their backs.  

The Northern Virginia Perinatal Council and the Northern Virginia SIDS Alliance: 

•   provided SIDS risk reduction training and gift bags for families to all the Healthy Families sites in Northern Virginia.
• produced and distributed 15,000 copies of a brochure aimed at African American Families: "Reducing the Risk of SIDS." It has been extremely well received among African American health professionals and families.
• The Northern Virginia SIDS Alliance and the NVPC provide training on SIDS Risk Reduction for hospital staff, child care providers, and other interested groups. 

7. Families, professionals and employers need to be more aware of bereavement services, and support for families who have suffered perinatal loss must be improved.

The Northern Virginia Perinatal Council works with the Perinatal Loss Committees in the hospitals, sponsors the Resolve Through Sharing Bereavement Counseling Programs in Northern Virginia, and works with the support groups MIS and the Northern Virginia SIDS Alliance to promote bereavement support. The Perinatal Council has developed a list of support groups, counselors and Internet sites specializing in perinatal loss. This resource list is given to  families whose babies die in Northern Virginia, along with the March of Dimes Bereavement kit and the booklet "When Hello Means Goodbye". Bereavement materials are available in Spanish and English. These materials are provided whether the family participates in the FIMR study or not.

The NVPC initiated the formation of the "Infant Mortality Roundtable" a group of people interested in improving care to families who suffer a perinatal loss. The Roundtable meets quarterly and membership is open. 

The NVPC collaborated in the redesign of  the Perinatal Memorial Garden at Inova Fairfax Hospital, and has developed  a Perinatal Loss Library .

The annual Perinatal Loss Memorial Services at Inova Alexandria Hospital and Inova Fairfax Hospital and the annual SIDS Memorial Service in December provide special opportunities for families to come together to mourn and remember their babies.  

Contact Betty Connal for additional information on the FIMR Project or any Perinatal Loss Support Programs

bconnal@aol.com  703-204-6778