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A Mother’s Story
Kathleen Moline, BSN, MAPolicy Analyst
Division of Women’s and Infants’ Health
10/21/2009
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Key VDH Perinatal Health Data Sources
Maternal Mortality Review
PRAMS
VA PRAMS
Vital Records
Hospital Discharges
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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
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Virginia PRAMS Sampling, 2007
102,342 eligible live births
1,245 women selected
683 Low BW selected
562 Normal BWselected
336 LBW completed
323 NBWcompleted
Sampled approx. 100 women per month (50 LBW)
Mail survey with phone follow-up
57% response rate (weighted)
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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
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How do we listen- FIMR Fetal and Infant Mortality Reviews Maternal Interview Medical Record Abstraction Case Review Team Analyst Community Action Team
Recommendations
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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
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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
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“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)
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About 25% of mothers are co-sleeping with their infant
Source: Virginia Department of Health, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007.
23.325.4
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
West Central Virginia
Pe
rce
nt
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“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)
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About 65% of mothers followed the AAP recommendation for back to sleep
Source: Virginia Department of Health, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007.
57.1
65.1
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
West Central Virginia
Pe
rce
nt
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“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)
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SIDS Rates 2005-2007
0
50
100
150
200
250
White Rate Black Rate
Rat
e p
er 1
00,0
00 l
ive
bir
ths
West Central
Virginia
Virginia Department of Health Division of Health Statistics compiled by the Office of Family Health Services Division of Women’s and Infants’ Health, 2005-2007
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“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.”
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“How do you most often lay your baby down to sleep now?”
Source: Virginia Department of Health, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007.
16.9
57.1
17.8
8.1
12.7
65.2
17.2
4.9
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
SIDE BACK STOMACH COMBO
Pe
rce
nt West Central
Virginia
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“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.”
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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