INDIANAPOLIS - The number of children who die in Indiana before their first birthday represents a grim reality.
Indiana’s infant mortality rate is among the worst in the nation, ranking 45th in the country in 2011. Statistics show a baby dies approximately every 13 hours in Indiana.
In hopes of driving down the rate of infant deaths, the state has instituted a series of new policies. Health officials acknowledge handling the broad causes and issues surrounding infant death take a multifaceted approach.
Infant mortality and low birth weight babies are linked to mothers who smoke during pregnancy, and Indiana has a higher rate than the national average of mothers who use tobacco while pregnant. The state is working to promote breast-feeding, which is known to reduce the risk of infant death, and warning parents against practicing unsafe sleeping habits with their newborns. A new public information campaign, “Labor of Love,” is set to launch in November.
“You just got to go at every single thing you possibly can. Use every arrow in your quiver to get at the issue. There’s no other way to get at it,” said Arthur Logsdon, assistant commissioner of the Indiana State Department of Health. “That’s pretty much what we are doing.”
As of July, a pregnant mother can no longer use Indiana Medicaid to cover the cost of delivery if she elects to have her baby before 39 weeks, unless there’s a medical need. Even before the mandate, St. Mary's Medical Center had set up criteria for women delivering babies before 39 weeks of pregnancy. Because of the policy, elective births dropped “precipitously,” though they weren’t high beforehand, said Dr. Christine Riley with St. Mary’s Medical Center.
Next up: The state wants hospitals to prove they’re meeting the level of care for infants and mothers that they claim.
Effort to reduce infant mortality focuses on hospitals
Historically, hospitals in Indiana have self-declared their level of care in their obstetrics and neonatal units, which range from 1 through 4, with a Level 4 hospital being prepped to care for the most critical of infants. Indiana has two Level 4 hospitals and both are located in Indianapolis — Riley Hospital for Children and Peyton Manning Children's Hospital. Locally, St. Mary’s Medical Center and Deaconess Health System have Level 3 neonatal intensive care units.
“The premise is babies need to be born in risk appropriate settings, so as you might imagine some hospitals are more able to deal with higher risk pregnancy than others,” Logsdon said.
The state is writing rules to bring consistency to the levels of care and conduct quality assurance inspections to ensure hospitals have the programs and standards that coincide with the level of care they promote to the public. Logsdon said even with the changes, the program is voluntary, and there’s no requirement for a hospital to reach a certain level.
Riley said the program will help St. Mary’s reach out to hospitals at a lower level and help care for babies and offer resources if needed.
“We’re trying to make sure it’s being done in the same way everywhere and make sure everyone is consistent and their care is consistent and the quality is good,” Riley said.
Southwestern Indiana on track
Even before talks of Indiana’s infant mortality rate gained more prominence statewide, Southwestern Indiana had set up a review process where local leaders, community agencies and hospital representatives review every case of fetal death to see if trends arise.
In 2007, the work by the Southwest Indiana Regional Perinatal Advisory Board was influential in the state reinstating Medicaid representatives to help guide participants when the state transferred the delivery of the program to an online system, said Susan Bonhotal, coordinator of the board.
“We noticed access to care went down and infant mortality was going up because people didn’t know how to use computers,” Bonhotal said.
When Vanderburgh County Coroner Annie Groves started to see a rise in accidental deaths because of unsafe sleeping habits, she played an active role in promoting the safest way for babies to sleep. St. Mary’s and Deaconess hospitals now have safe sleep programs where parents are shown a video about the dangers of co-sleeping and that babies should be placed on their backs in a crib alone without pillows, comforters or stuffed animals.
“The only trend I see is that everyone thinks it’s not going to happen to them,” Groves said of accidental suffocation.
Deaconess has worked to reduce the number of early elective deliveries both locally and across the state. Doctors from the hospital served on a committee that helped Indiana Medicaid set its policy on deliveries prior to 39 weeks. The committee worked to set criteria of when an early delivery would be required for the health of a mother and her baby, said Lori Grimm, quality and patient safety officer with the hospital.
“There is a danger that hard stops are put in place to meet the guidelines and what is best for a particular mom is ignored. The results can be devastating. Therefore it is important for there to be a process for the healthcare team to discuss cases and decide what is best for the patient and her baby even if it does not meet the established criteria,” Grimm said in an emailed statement.
The region likely fares better in infant mortality than the rest of the state because of access to care, said Dr. Maria Del Rio Hoover with St. Mary’s Medical Center. A larger percentage of women receive early prenatal care in Southwestern Indiana compared to the rest of the state. In Indiana, 31 percent of pregnant woman don’t receive care in their first trimester, but in Vanderburgh County the rate is lower at 27 percent, according to state numbers.
However, more mothers smoke during pregnancy in the region compared to the state’s percentage of 16.5 percent. In Vanderburgh County, 19.9 percent of expectant mothers smoke, along with 33 percent in Pike County. Fewer mothers also leave the hospital breast-feeding compared to the state. In Southwestern Indiana, 26 percent of mothers are discharged without breast-feeding. The state’s rate is 24 percent.
“We have to educate the public,” Del Rio Hoover said. “I just think a lot of women don’t realize how serious smoking can be a harm to a baby. A lot of women don’t realize they need to go to prenatal care early. A lot of it is education too, if you get women early prenatal care problems can be identified and premature delivery prevented.”