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Rock County team to analyze fetal, infant deaths

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Gina Duwe
June 29, 2014

JANESVILLE—A new team of area health professionals will begin reviewing all fetal and infant deaths in Rock County to look for commonalities and gaps in service.

The health department started the Fetal and Infant Mortality Review Team to identify policies, programs and services that reduce infant mortality and racial disparities in birth outcomes, said Janet Zoellner, nursing director at the Rock County Health Department.

The purpose is not to determine causes of death or whether certain deaths could have been prevented, she said.

“What we're really after are: What kinds of things did we learn about our community? Are there gaps in service? Could we as a community have filled the needs of this family better?” she said.

The team will meet quarterly to review all fetal and infant deaths, defined as deaths after 20 weeks of gestation through age 1, in Rock County starting in 2013.

Rock County averages 20 to 25 of those deaths annually, according to state data. Of those deaths, about nine to 12 are stillbirths.

“The first thing is we don't know what we don't know,” she said. “We kind of have to go into it with a bit of an open mind.”

FIMR teams have been in place nationally for decades, often in bigger areas, including Milwaukee and Dane counties.

“It's a very well-regulated process. There are very strict guidelines around it,” Zoellner said. “We're not making that part of the process up.”

The team includes representatives from all labor and delivery hospitals in the county; the county health department, human services department and coroner's office; Lifecourse Initiative for Healthy Families in Beloit; Children's Health Alliance of Wisconsin; and a retired physician.

A nurse from the health department will interview all willing mothers and fathers about their losses. For full disclosure, a nurse interviewed my husband and me about our daughter's stillbirth in preparation for starting the team; our data will not be used in the review because the death occurred in 2012.

“We really feel like that's a super important part,” Zoellner said of the parent interviews. “What we want them to know is we're not only there to gather information. We're actually there to see if there's any kind of support we can offer. We're nurses, so we're always going to look toward that person's best health. We're not just filling out a form.”

The team will collect and analyze medical records from all fetal and infant deaths. Because public health officials are leading the effort, parent permission is not needed to look at the records, Zoellner said.

Confidentiality is key, she said, and all data and identifying information will be removed before reports are given to the review team.

“We wipe it clean of all identifying factors,” she said.

The team is a commendable effort to identify trends and gather data from all hospitals, said Gretchen Finley, director of maternity services at Mercy New Generations Birthing Center in Janesville.

She previously served on the Milwaukee County FIMR team, where education focuses on the dangers of co-sleeping, she said.

“This is the first step in trying to determine what the trends are in our community,” she said.

The conclusions of a FIMR team can be frustrating from a medical standpoint, said Dr. Brian Stafeil, a maternal fetal medicine specialist with Dean Health System, who is a member of the Dane County FIMR team.

Many Dane County deaths are from co-sleeping, SIDS or complications from smoking, he said.

“The solutions are really bigger than pregnancy management,” he said.

“It definitely focuses on the bigger picture, which I think is good,” he said of FIMR teams. “It's not always evident in the medical chart where (the deficiencies are).”

Rock County received a $150,000 implementation grant from the Wisconsin Partnership Program last July, and officials have spent the past year getting the approvals needed to access medical records.

The effort also includes the formation of a Beloit African-American Services Advisory Team to reflect on the team's conclusions and help provide cultural knowledge relating to health disparities and infant loss in Beloit's African-American community.

In 2010, a grassroots coalition in Beloit focused on African-American infant mortality issues received funding to take a more interdisciplinary approach, Zoellner said. One strategy that resulted from the effort was the idea of a FIMR team, and Zoellner wrote a grant request that ultimately was approved.

Rock County already has a team that reviews all child and young adult deaths from 2 weeks old to age 25. The age range, however, precludes the team from looking at stillbirths and babies that die inside a hospital, Zoellner said.

That team primarily looks at accidents—drowning, sleeping, vehicle and farm safety—to find preventative solutions, she said.

The new team will have some overlap, but the child and young adult team does not do parent interviews, she said.



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