Maryland Babies Born Healthy Initiative

What is the Babies Born Healthy Initiative?

Why is Infant Mortality an Urgent Issue in Maryland?

What Programs are Included in the Babies Born Healthy Initiative?

What Can You Do To Have a Healthy Baby?

Where Else Can I Find Information?

Prematurity Awareness Fact Sheet

What is the Babies Born Healthy Initiative?

Many factors – family history, personal medical history, diet, environment, lifestyle, access to services – all contribute to infant mortality. To reduce infant mortality and eliminate racial disparities in Maryland, the Center for Maternal and Child Health has launched a broad public health initiative, called Babies Born Healthy. The Babies Born Healthy Initiative focuses on prevention services and quality improvement, believing that improving infant health requires a comprehensive multifaceted approach that addresses family, community and systems factors associated with poor pregnancy outcomes.

 

Why is Infant Mortality an Urgent Issue in Maryland?

Infant mortality has long been considered the most sensitive indicator of the overall health of a population because there are many events throughout a woman’s life that may contribute to a loss.  An infant death or pregnancy loss is a signal that there may be broader problems within the community.  While there have been several decades of improvement in infant mortality, progress in Maryland has slowed and Maryland’s infant mortality rate remains higher than the national average.
In Maryland:

• The percent of women receiving prenatal care in the first trimester of pregnancy has been dropping since 2000, reaching a low of 79.5% in 2007. Among white women in the state, 82% received early prenatal care, compared with 73.5% of Black women and only 63% of Hispanic women.

• African-American infants continue to be at greater risk, with a disparity of nearly to 2:1 in prematurity rates, and over 2:1 in infant death rates.  Between 2006 and 2007 the disparity in infant deaths increased to 3:1.

• Preterm births have increased by 6% since 2000. 

• Baltimore City and Prince George’s County infant deaths continue to contribute the greatest proportion (42%) of the infant deaths in Maryland.  While infant mortality has continued a downward trend in Baltimore City, the infant mortality rate in Baltimore (11.3 deaths per 1000 births) and in Prince George’s County (11.7 deaths per 1000 births) remains well above the State’s average of 8 deaths per 1000 births. 

“Tip” of the Iceberg

For every infant death, six infants are born premature -- too small or too soon.  Premature infants are more likely to have disabilities that may have a lifelong impact requiring specialized health services and special education, making the social and economic cost of prematurity substantial.  Families experience loss of work and decreased productivity.   For these reasons, Babies Born Healthy focuses on all Maryland babies being born healthy and preventing infant death.

What Programs are Included in the Babies Born Healthy Initiative?

• MCH-WIC Collaborative projects were launched to increase access to preconception (before pregnancy) and interconception (between pregnancies) health services. The MCH-WIC Collaborative projects link Maternal and Child Health (MCH) services (which include family planning, folic acid distribution, and others women’s health services) to WIC services in order to optimize women’s health. Model MCH-WIC Collaborative projects are in Baltimore City, Baltimore, Charles, and Wicomico Counties.

• The Maryland Patient Safety Center Perinatal Collaborative was launched to improve the safety and quality of care at Maryland birthing hospitals.  Teams from each hospital’s labor and delivery units participated in learning sessions to facilitate communication, patient care and treatment protocols, the use of simulated patient emergencies, and electronic fetal monitoring. The Perinatal Collaborative efforts are focused on improving communication with the goal of reducing preventable adverse outcomes to zero in these hospitals and thus improving patient safety throughout the state. 

• The Maryland Advanced Perinatal Systems and Services Program (MAPPS) was established by the University of Maryland in collaboration with Johns Hopkins University to assure access to high-risk perinatal consultation to community providers. MAPSS uses both telemedicine and on-site high-risk perinatal consultation with local health care providers in under-served communities.  Consultation through MAPSS services have been utilized by providers in Allegany, Calvert, Caroline, Cecil, Garrett, St. Mary’s and Washington Co.  The program strengthens the perinatal system of care in Maryland that has been adversely affected by the shortage of obstetric providers throughout the State. The MAPSS approach not only supports the local health care providers but also allows women to have access to specialized consultative services while remaining in their local communities.

• In January 2009, the Vital Statistics Administration will launch the Electronic Birth Certificate (EBC).  The Electronic Birth Certificate will allow for more complete and timelier reporting and will expand the capacity for data collection. These data will better reflect maternal and infant health outcomes. In addition, the EBC contains new data which include information on prenatal care, fertility therapy, participation in the Women Infants and Children food program, infections, maternal morbidity, source of payment for care, breastfeeding, multiple race selection, smoking, method of delivery, congenital anomalies, and abnormal conditions of the newborn. This information can be used to better develop and implement prevention strategies.

Babies Born Healthy Initiatives in Baltimore City

• Baltimore City Health Department implemented a Safe Sleep program to support families at risk for an infant death.  Baltimore City Health Department implemented a public awareness campaign (media and print), distribution of “onesies” with a safe sleep message to new mothers, and distribution of portable cribs to families in need. 

• Baltimore Healthy Start Inc. is being funded to expand services based on the results of the needs assessment conducted in 2007.  Much of the reduction in infant mortality in Baltimore City has been attributed to the Healthy Start approach of aggressive outreach and community-based support services in specific neighborhoods with the highest proportion of poor birth outcomes, including prematurity as well as infant deaths.

• Planned Parenthood Inc. of Maryland will be developing comprehensive women’s health services for clients in Baltimore City.   The new services screen women to determine if they have a previous history of poor birth outcome, genetic or chronic health conditions, obesity, mental health or substance abuse problems, domestic violence, environmental hazards, or infectious disease exposure.  Women are also screened for their  nutrition, exercise, and  immunization status. Counseling and educational services are available to women with identified risk factors and women who need chronic disease management are referred to community health centers or other providers. 

Babies Born Health Initiatives in Prince George’s County

• The Prince George’s County Health Department will be utilizing Babies Born Healthy funding to increase access to primary prevention services through a referral to Greater Baden Medical Services.  In addition, funding will help to re-establish a women’s wellness center at the health department’s Cheverly Health Center.
• Greater Baden Medical Services  provides outreach and serves women at risk of poor pregnancy outcomes with women’s health and family planning services.  In addition, Greater Baden Medical Services work with the Prince George’s County Health Department to assure access to chronic disease management for women of child-bearing age.

Other Programs That Work To Ensure Healthy Babies?

• Teen pregnancy prevention projects beginning in1990;
• Expansion of family planning services statewide in 1994 and 1996;
• Maryland Perinatal System Standards implemented in 1995 and most recently updated in 2008;  
• Crenshaw Perinatal Health Initiative, which addresses the core public health functions of assessment of prenatal services in a community, assurance of adequate prenatal care, and the development of policies relating to these issues, beginning  in 1995; and
• Fetal and Infant Mortality Review (FIMR) is an ongoing program in all Maryland jurisdictions that relies on a confidential and anonymous review of individual cases of fetal and infant loss to identify needs and opportunities for change in community systems that will prevent future deaths.

What Can You Do To Have a Healthy Baby?

Being in the best health possible before becoming pregnant and getting early and consistent care can improve your chances of having a healthy baby.  Preconception care, or healthcare before pregnancy, helps you to be in good health before you become pregnant.  You and your future baby will benefit by identifying any possible medical, genetic, or environmental risks.  Since the baby's major organs are formed during the first 2 months of pregnancy, pregnancy care should start before conception, which requires planning.  Planning your pregnancy is critical in making every child a wanted child and every pregnancy as healthy as possible for both mother and baby.

Once a woman is pregnant, early prenatal care is probably the most important step toward a healthy baby. If you suspect you might be pregnant, get a pregnancy test right away and arrange for a healthcare visit. The earlier you start prenatal care, the earlier you with your provider can start a healthy routine for you and your baby.

Where Else Can I Find Information?

American Academy of Pediatrics  – Information for the public and healthcare professionals on a variety of issues related to child health and development.

American College of Nurse Midwives  -Information for the public on midwifery and tips for a healthy pregnancy.

American College of Obstetricians and Gynecologists– Patient education materials

Centers for Disease Control and Prevention – Information for healthcare professionals and the public on healthy pregnancy, healthy baby, preterm birth and a variety of other issues related to perinatal health.

March of Dimes, Maryland Chapter – Information for the public and healthcare professionals on preventing birth defects, premature birth, and infant mortality. 

Maryland Department of Vital Stats - Vital statistics reports including information on infant mortality.

Maternal and Child Health Bureau, Health and Human Services – Information for the public on how to have a healthy baby

Maryland Department of Health and Mental Hygiene, Local Health Departments – Contact information for your local health department.

Maryland WIC - Information on the WIC Program including how to apply.

For More Information on the Babies Born Healthy Initiative Contact
Ilise D. Marrazzo, RN, BSN, MPH
410-767-6713
revised 01/2009