Bureau of Family Health Services Perinatal Division: Working to Improve the Health of Mothers and Infants

Infant and maternal mortality remain persistent problems in our state. The infant mortality rate is 7.6 per 100,000 births in Alabama, which is above the national average of 5.5 deaths per 100,000 births. As of 2017, the maternal mortality rate for Alabama is 17.4 deaths per 100,000 births, compared to the US rate of 11.5. The Perinatal Division has several ongoing initiatives to help combat these problems.

The program manager for the Fetal and Infant Mortality Review Program is Amy McAfee, who supervises at least two perinatal nurses outbased in delivering hospitals in five perinatal regions across the state. They review all infant deaths and most fetal deaths that occur in Alabama. The case summaries are presented to a multi-disciplinary committee in each perinatal region to determine the cause of death and how to prevent future deaths. Recommendations are provided to regional community action teams to develop resources and programs to improve the health of infants and mothers. Initiatives implemented by the perinatal nurses or community action teams in Alabama include:

Providing education related to fetal and infant health to the community, including safe sleep practices, benefits of breastfeeding, shaken baby syndrome, WIC services, and nutrition.
Promoting the Count the Kicks app to measure fetal kicks at the same time each day to monitor fetal activity and recognize early signs of complications.
Educating law enforcement and coroners on completion of the Sudden Unexpected Infant Death Investigation form to increase accuracy in reporting sleep-related deaths.
Organizing candlelight vigils and memorial services for pregnancy and infant loss.
Hosting events to increase awareness of perinatal mood and anxiety disorders.
Providing materials on bereavement support groups to parents and families that have experienced the loss of a pregnancy or infant.
Scheduling regular meetings with labor and delivery nurses at hospitals to provide awareness of ADPH perinatal activities and discuss regional challenges to prenatal and infant health.

At the Central Office, the Perinatal Division provides cribs to families in Alabama who cannot afford to provide a safe place for their infant to sleep. This project is managed by Katrina Cuffey, with assistance from Shacari Choice. In 2023, the division is set to surpass its record for the most cribs given out by providing over 500 cribs as of September 1, 2023. Additionally, Antwan Parker and Jaquana Pierce in the Pregnancy Risk Assessment Monitoring System provide education and outreach related to infant and maternal health at community baby showers, health fairs, and BabyPalooza, focusing on safe sleep, benefits of breastfeeding, counting baby kicks to monitor fetal activity, and good nutrition for moms and babies.

The Maternal Mortality Review Program (MMRP), led by Lindsay Harris, the program coordinator, reviews all deaths for women in prenatal care, during delivery, or postpartum up to a year after delivery. Similar to infant deaths, the MMRP utilizes the Maternal Mortality Review Committee, a multidisciplinary committee, to determine if deaths were preventable and how to prevent the deaths from occurring in the future. The Epidemiology Branch, led by Tim Feuser, analyzes the data collected by the MMRP to help complete the annual report. This report helps the state of Alabama understand the challenges of maternal health in Alabama and the findings and recommendations of the Maternal Mortality Review Committee.

Approximately 50 percent of the women represented in the case reviews by the Maternal Mortality Review Committee did not receive an autopsy. The Maternal Autopsy Program, scheduled to begin in fiscal year 2024, will provide an opportunity for family members of a pregnant or postpartum woman to request an autopsy free of charge at the University of Alabama Birmingham Hospital or the University of South Alabama Women’s and Children’s Hospital at no cost. This will help family members receive answers about their loved one’s death and provide the MMRP with a clearer understanding of the cause of death.

Due to the hard work of the dedicated staff in the Perinatal Health Division, mothers and families are receiving education and resources to improve their health, knowledge is gained in the medical community regarding the deaths of infants and mothers, and resources have been implemented to improve the health of women and infants across our state.

By Carolyn Miller and Amy McAfee