Valdosta Daily Times

September 11, 2010

Health officials, mothers battle Lowndes’ high infant mortality rate

Johnna Pinholster
The Valdosta Daily Times

VALDOSTA — For several years, Lowndes County has been known around the country for its award-winning marching bands, its commitment to both the arts and military and its championship athletic programs.

But recently, the county has become known for something else — its high infant mortality rate.

According to the South Health District, the infant mortality rate (IMR) in Lowndes County in 2007 was 16.7. The IMR is measured by the number of deaths that occur per 1,000 live births.

Infant mortality is the death of a baby during the first year of life.

Lowndes County had a total of 30 infant deaths in 2007.

Although the statistics are not in for preceding years, Dr. Lynne Feldman, director of South Health District, said the problem came on their radar well before 2007. Starting in 2004-2005, she said the South Health District realized that the number of babies born at low birth weight or dying within the first year of life was increasing.

When compared with other counties in the state that are of comparable size and demographics, Lowndes County is well above the others, Feldman said. The high rate of infant mortality in Lowndes County does not stem from one issue or cause, she added.

“It really is kind of an indicator of the overall health of a community,” Feldman said. “If you have a really low infant mortality rate, then generally people have good access to health care and other things in their community that make it a healthy community.”

A staggering statistic

“I really do not know why the infant mortality rate in Lowndes (County) is higher than in similar counties,” Feldman said. “It shouldn’t be unique to our area.”

Most of the deaths within Lowndes County are black children, she said.

The South Health District charts the number of deaths and where those deaths occur. Statistically, the highest concentration of deaths occur on the southside of Valdosta, Feldman said.

The issue of infant mortality is not an easy problem to solve, Feldman said.

“You can’t just use a medical model to fix it. It has to be a social model. It has to be something that you do before women get pregnant and actually follow through during pregnancy and then make sure the baby is protected afterwards,” Feldman said.

Low birth weight is usually the result of a baby being born before term, she said.

“A baby is supposed to have nine months to grow in the uterus and then they are done,” Feldman said. “If they come out before they are done, you are going to have problems.”

Nutrient deficiencies will also cause babies to be born too small, even if they are close to term, she said. Poor health choices during pregnancy, such as smoking or ingesting illegal substances, can also contribute to low birth weight.

“I feel, overall, one of the reasons babies are having more trouble is that women are going into their pregnancy with chronic conditions that weren’t there some years ago, like diabetes and heart disease,” Feldman said.

She went on to say that many of the issues facing women today are directly related to obesity.

The health of the mother is just one factor that determines the health of a baby. Outside factors, such as economic status and emotional stability, also play key roles in a pregnancy and a child’s development.

Feldman said low income is a risk factor when assessing the health of a pregnant woman and a baby.

Low income women are under more stress, are usually facing greater social and familial issues, and with little money, their diet is usually not good, Feldman said.

They are also less likely to access preventive health care, she said.

Feldman said some causes of infant mortality can be assessed and prevented while others cannot.

Sudden Infant Death Syndrome/Co-sleeping has been renamed to include co-sleeping as more and more infants are found to be sleeping with their mother, she said.

“We have a couple of those, at least every year,” Feldman said. “We are encouraging women to find a separate sleeping place for the baby.”

The way babies are laid down has changed over the years as well, Feldman said. In the past, babies were placed on their stomachs, but it has been determined that laying babies on their backs makes a huge difference in terms of SIDS, Feldman said.

The change has come within a generation, and it can be hard for people to change habits they were raised with, Feldman said.

Congenital anomalies are another factor in infant mortality, Feldman said, though there is really little that can be done.

Folic acid, Feldman said, has been shown to prevent some defects.

“It’s most important that women begin to take vitamins before they get pregnant. If you wait until you go to see the doctor to take your prenatal vitamins, you are not taking them early enough,” Feldman said.

Most of a baby’s development, she added, is done in those first few months.

People need to think about their health and the health of the baby before they get pregnant, she said.

“I would love to have the answer on how to lower the mortality rate,” Feldman said.

One of the things the South Health District had hoped to do, through Healthy Start, was to make young women aware of the things they can do to enter a pregnancy in the healthiest way possible, she said.

A healthy baby should weigh about 2,500 grams or about 5 pounds, 5 ounces at birth, Feldman said.

Monitoring the number of deaths each year is a slow process as birth certificates have to be matched with death certificates, Feldman said.

Of the 30 infant deaths recorded in 2007, 36.7 percent were due to premature births, 13 percent were from SIDS. Fifty percent of those deaths were black, 36 percent were white, and about 7 percent were Hispanic, Feldman said.

Analysis of the issue was conducted and the South Health District applied for a grant. At the same time, the economy began shrinking and state and federal funds began to be cut.

In the end, the South Health District ended up not getting a grant through Healthy Start to attack the issue, but the Lowndes County Board of Health did get a smaller grant through the March of Dimes to start a program called Baby Luv.

Baby Luv

Baby Luv (Lowndes Unique Victories) has been in operation for three years. Through the March of Dimes, Lowndes County Board of Health gets $50,000 a year to administer the program.

Baby Luv has 80 women in the program, though program leaders typically try to reach 120 women each year.

Any pregnant woman who is determined to be at high risk of having a problem pregnancy or birth are admitted into the program. So are any black women.

“Wherever you live, African-American mothers have a higher chance of having a baby that dies in the first year of life,” Feldman said, “and nobody really understands totally why that is.”

There are theories — some highly controversial — but none display any concrete answers as to why the infant mortality rate is higher for black babies.

“One big reason is that African-American women are more likely to have a low birth weight baby and low birth weight babies are more likely to die in the first year of life,” Feldman said.

The goal of Baby Luv is to reduce the rate of infant mortality by 20 percent and the rate of low birth weight by 10 percent by this year.

The program offers intensive case management and involvement with the mother during pregnancy and during the first year of the baby’s life. The program provides a comprehensive education system that covers issues such as early labor, immunizations, pediatrician visits, proper bedding for cribs, car-seat safety, nutrition and other maternal issues.

Women are expected to participate in educational sessions, keep all doctor’s appointments, and to be available for home nurse visits and phone calls.

The program is voluntary and women that are referred do not have to participate.

During the program’s three years, Baby Luv has accepted 120 women who have given birth to 120 babies, Feldman said.

None of those babies have died, Feldman said, but some of them have been low birth weight.

The mothers within the Baby Luv program can be both first-time mothers or those that already have children, said Lisa Jones, registered nurse and case management staff member for Baby Luv.

If it is the first pregnancy, the mother is usually deemed high risk through pre-existing medical conditions such as high blood pressure or diabetes or has suffered from a miscarriage.

Expectant mothers are referred to Baby Luv through Prenatal Case Management. If a pregnant woman falls into one of the categories that is deemed high risk, she is referred to Baby Luv and, if there is space, taken in, Jones said.

Charisma Myers, 28, is six months into her third pregnancy.

Myers was referred to Baby Luv as she suffers from asthma and cervical cancer cells were found during the first months of her third pregnancy.

At the time, Myers said she had no idea that her asthma could affect the baby’s health. Since becoming a part of Baby Luv, she said she has learned that not only is it hereditary but the drugs she takes to manage the asthma can affect the child growing inside of her.

Jones conducts home visits every three months. The visits, Jones said, are a personal touch, a way to reach out and remind the mother that someone is here for them.

The home visits allow the women to discuss whatever issue they are having, be it emotional or medical, she said.

“We tell them at the beginning (that) we are not going to hound you. We are not going to hunt you down,” Jones said. “We never go into the home looking for things that are bad or looking for situations to make her life worse. If there is a situation, we are there to help her.”

A staff member calls once a month to get information regarding doctors visits as well, she said.

Though Feldman is excited about the good results Baby Luv is producing, she is worried that the program reaches only a portion of the population in need.

With the future of the Baby Luv program uncertain, funds are renewed each year, donations and volunteers are always welcome, Jones said.

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