B1 - Compassionate community-centered approaches to stillbirth prevention

This session will describe the Fetal and Infant Mortality Review (FIMR) methodology and how it serves as an effective system intervention and public health strategy for prevention. It will describe how fatality review findings were used by one community to inform efforts to decrease stillbirth rates. It will highlight the partnership with Healthy Birth Day (Count the Kicks) as an evidence-based strategy for stillbirth reduction.
Stillbirth, or fetal death, affects about 1 in 160 births every year in the United States. Annually, there are about 22,000 stillbirths reported in the US. The stillbirth rate has remained relatively unchanged and unimproved over the years. Stillbirths and infant deaths are sentinel events that reflect the overall health and safety of a community. Fetal and Infant Mortality Review (FIMR) is a community-based, data-driven, action-oriented process aimed at improving services, systems, and resources for women, infants, and families, toward the prevention of fetal and infant deaths. Unique to FIMR is the inclusion of ‘parental/family interviews’ - personal narratives bereaved parents share to provide information about their experiences before, during, and after the death of their babies. These confidential stories are considered by the Review Team in the aggregate; and when combined with clinical reviews of de-identified local cases of fetal and infant deaths, they help inform local findings and recommendations.

In 2017 Healthy Start Coalition of Miami-Dade’s (HSCMD) FIMR findings consistently showed a lack of education and understanding about the importance of fetal movement. Kick count education was not often recorded prenatally and interviews with mothers who experienced a fetal loss described a disconnect between fetal movement and fetal wellbeing. Often mothers who had experienced a loss voiced that they thought it was normal their babies did not move in late pregnancy and that they thought their babies were just sleeping more – when they noticed a significant slowing or lack of movements. Mothers shared that they did not want to bother the doctor or go to the ER and were unsure of what to do. These misconceptions and misleading education led the HSCMD to recommend to the FIMR Community Action Group (CAG) the need to explore ways to educate pregnant women regarding fetal movements and empower them to know when to seek help.
Count the Kicks encourages expectant parents to track their baby’s movements daily during the third trimester of pregnancy and to contact their healthcare provider right away if there is a change in what’s normal for their baby. Research shows a change in a baby’s movement is the earliest and sometimes only indication that something might be wrong with a pregnancy. Count the Kicks is committed to preventing stillbirth and eliminating disparities that persist. Iowa’s stillbirth rate decreased by 32% during the first 10 years of the Count the Kicks campaign. Fetal movement monitoring has been examined as means of assessing fetal health and detecting fetal distress that, left untreated, may result in stillbirth. Recent research indicates that the use of a kick-counting tool has improved birth outcomes. Additionally, partnership with community organizations helps bridge the gap between patient and provider alongside use of a free kick counting app and education on the importance of tracking fetal movement. Partnership between state FIMR groups and Count the Kicks is essential in decreasing the stillbirth rate across the U.S.