A Mother’s Story
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A Mothers StoryKathleen Moline, BSN, MAPolicy AnalystDivision of Womens and Infants Health10/21/2009
Key VDH Perinatal Health Data SourcesMaternal Mortality Review
How Do WE Listen-PRAMSCollects statewide data on maternal attitudes and experiences before, during, and shortly after pregnancyData not available from any other sourceProvides surveillance data essential for planning, implementing and evaluating MCH policies and programsIdentify groups at high riskMonitor changes in health statusMeasure progress towards goalsPlan and review programs and policies
Virginia PRAMS Sampling, 2007Sampled approx. 100 women per month (50 LBW)Mail survey with phone follow-up57% response rate (weighted)
Virginia PRAMS TopicsPreconceptionPre-pregnancy BMIMultivitamin usePregnancy intentionHealth insurance statusDuring PregnancyContent and source of prenatal careAlcohol and tobacco useAttitudes and feelings about pregnancyHealth insurance statusPost-pregnancy Labor and deliveryInfant health carePostpartum depressionHealth insurance statusPost pregnancy infant health
How do we listen- FIMRFetal and Infant Mortality ReviewsMaternal InterviewMedical Record AbstractionCase Review Team AnalystCommunity Action Team Recommendations
Maternal InterviewTells the story from the sourceTells of barriers, conflicts, misunderstandings of information, successesPoints a direction for actionNot peer reviewMust be tempered with the stages of grief the mother is experiencing
SIDS Mothers StoryStories are real Compiled from actual SIDS cases that occurred from July 1, 2008-June 30, 2009Quotes from memory of maternal interviewer Pictures supplied from CPSC Part of the story told from mothers that reside in West Central Virginia RPC
She wasnt 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)
About 25% of mothers are co-sleeping with their infant Source: Virginia Department of Health, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007.
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)
About 65% of mothers followed the AAP recommendation for back to sleep Source: Virginia Department of Health, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007.
I thought crib death only happened in cribs. That is why I didnt use the crib.I thought crib death only happened to white babies.(Photo from CPSC files)
SIDS Rates 2005-2007Virginia Department of Health Division of Health Statistics compiled by the Office of Family Health Services Division of Womens and Infants Health, 2005-2007
Rate per 100,000 live births
White RateBlack Rate
SIDS Rates by Race 2005-2007
The babys 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.
How do you most often lay your baby down to sleep now? Source: Virginia Department of Health, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007.
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.
What are we doing about it?CJ Foundation GrantChild Fatality Review focusDivision of Injury and Violence Prevention, Car seat safety pilotGrandmas Campaign for Healthy Grandchildren program of AARP
1st point out PRAMS is a very important piece of a bigger picture.
One of missing piece of a puzzle which helps us get the complete picturethere are other data sources--clustering by geography; social determinants of health inequity (poverty; race); societal determinants of the social determinants (racism)this is OFHS key data for now.
In other audiencesFamily planning in IM talk? sure not a concern here as you all know no mortality picture is complete without family planning data.--1/2 pregnancies unintended; of those end in abortion; other half increased risk for preterm (poor birth spacing), late PNC, more smoke and drink
At one level we have the births and deaths from vital records and hospital discharge data total population data but lacking in details in some regards (what and the where but not the why or how). Some questions can only be answered with large population data.
The why and how comes from our FIMR and MMR albeit for a smaller number of casescant review all births or even all infant deaths; but these groups will uncover things that would never have been learned just from a death certificate or hospital discharge data (e.g., social factors and contexts)
PRAMS is a nice piece because its source is the voice of the mother herself, has a medium level of depth (compliments/enhances the birth certificate data), but still is a statewide dataset
Collects statewide data--Findings can be applied to states entire population of women who recently delivered a live-born infantEnhances birth certificates/fills critical gaps:--Collects data not available from any other statewide source--birth certs obviously do not contain any information after birth (e.g., infant sleep position; breastfeeding)--other gaps filled include content of prenatal care; pregnancy intention, maternal mental health Provide Surveillance Data--Identify groups of women and infants at high risk for health problems--monitor changes in health status--measure progress towards goals
PRAMS data are used by researchers to investigate emerging issues in the field of maternal and child health. --Plan and review programs and policies aimed at reducing health problems among mothers and babies.--Identify other agencies that have important contributions to make in planning maternal and infant health programs and to develop partnerships with those agencies.
Sampling criteria--Use the birth certificate to randomly select moms who have recently given birth. --Mothers must be a VA resident and her infant must be born in VA.--Infants must be between 2 and 6 months old to be eligible. --Only one infant is sampled from a twin or triplet set.
LBW Oversample--Split sample into BW groups and then oversample LBW --LBW most likely to be born preterm, --die before 1 yr of age --have greater proportion of disadvantaged & underserved populations--Random draw would expect to yield about 8.4% (about 100/1245) but we sampled 6XX
Mode of data collection--PRAMS combines two modes of data collection; a survey conducted by mailed questionnaire with multiple follow-up attempts, and a survey by telephone. --Series of 3 mailings commences 2 to 4 months after delivery. --phone follow-up if no response to the mailings--max about 90 days total from preletter to final phone call
PRAMS allows us to monitor a number of maternal experiences and behaviors before, during and shortly after pregnancy.
PRAMS enhances birth certificate and hospital discharge data--e.g., insurance status before, during, and after pregnancy; intendedness/contraceptive use--content of prenatal care (aware of benefits of folic acid, risk of HIV, adverse effects of smoking/alcohol--post partum topics (e.g., breastfeeding, infant sleep position, mental health; well-baby visits) West Central RPC has 29 White SIDS, 14 Black SIDS or Black infants are 2.69 times more likely to die of SIDSVirginias rate is 72.7 for White infants and 137.1 for Blacks or1.88 times more likely to die