C4 - Learning From Each Other: Maternal Mortality Review and Fetal/Infant Mortality Review Collaboration

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Full Description: Maternal Mortality Review (MMR) and Fetal/Infant Mortality Review (FIMR) Committees have been evaluating contributors to the deaths of mothers and infants for decades. Understanding the medical and social complexities that influence these deaths can be enhanced by sharing the lessons learned from both processes. This can support a new paradigm of review for the future.
The review of fetal/infant and pregnancy-associated deaths is conducted by states and jurisdictions and supported by national organizations. The goals of FIMR and MMR are similar and include:
• to examine and identify significant health, social, economic, cultural, safety, and educational factors that may contribute to mortality;
• to plan and implement interventions that address these contributing factors;
• to identify and address disparities in pregnancy outcomes; and
• to recommend improvements to care that may reduce excess mortality.

Delaware has reviewed fetal/infant and pregnancy-associated deaths for several years. One epidemiologist has conducted data analyses on both programs for over ten years. This allows a steady lens to oversee the variations and trends in contributing factors identified. It has become evident that many FIMR cases involve maternal health morbidities only one or two steps before maternal mortality in severity. Specifically, in the last few years of FIMR, 14-18% of cases have met CDC criteria for severe maternal morbidity.
In both FIMR and MMR, committee members employ a life course approach to assess the persons’ social, cultural, and structural contexts. By using life events and stories, the reviews attempt to learn the effect that a person’s experiences with health care, community services, mental health, and life stressors may have had on the death.
Another tool of shared learning has been the informant interview conducted by the same person for fetal/infant and maternal deaths. Interviews include queries about adverse childhood events, trauma, and exposure to racism and discrimination. Here too, FIMR maternal interviews add an important dimension to the findings coming out of MMR itself as FIMR first-person narratives represent the lived experience of patients with complex physical and behavioral health conditions trying to navigate systems of care.
Delaware has also conducted a joint review of FIMR/MMR findings to identify areas of intersectionality. By looking at the findings from both processes, the group can develop recommendations that holistically span the mother-child dyad.
This presentation will demonstrate how state MMR and FIMR teams can address the intersection of systems and processes that result in maternal and fetal/infant deaths and incorporate different perspectives on the spectrum of poor maternal and child health outcomes to advance a common agenda.

Abbreviated Description: Maternal Mortality and Fetal/Infant Mortality Review Committees have been evaluating the contributors to the deaths of mothers and infants for decades. Understanding the medical and social complexities that influence these deaths can be enhanced by sharing the lessons being learned from both processes. This can support a new paradigm of review for the future.
This presentation will demonstrate how state MMR and FIMR teams can address the intersection of systems and processes that result in maternal and fetal/infant deaths.