Perinatal/Infant Health

Annual Report - FY2022

 

Activities in this domain were carried out by the following MSDH offices, bureaus, or programs during the reporting period:

• Healthy Moms/Healthy Babies of Mississippi (HM/HB)
• Maternal and Infant Health Bureau (MIHB)
• Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
• Lead Poisoning Prevention and Healthy Homes

 

The following section outlines strategies and activities implemented between 10/1/2021-9/30/2022 to meet the objectives and show improvement on the measures related to perinatal and infant health:

 

PRIORITY: Infant Mortality (and associated factors of preterm/low birth weight)

 

NPMs, NOMs, SPM, and ESMs:

• NPM 5 - A) Percent of infants placed to sleep on their backs B) Percent of infants placed to sleep on a separate approved sleep surface C) Percent of infants placed to sleep without soft objects or loose bedding

         SPM 1 - Percentage of women who smoke in the last three months of pregnancy.

• NOM 9.1 - Infant mortality rate per 1,000 live births
• NOM 9.3 - Post neonatal mortality rate per 1,000 live births
• NOM 9.5 - Sudden Unexpected Infant Death (SUID) rate per 100,000 live births
• ESM 1.5 - Promote the use of the Mississippi Quitline and Baby and Me Tobacco Free to assist women in quitting smoking during pregnancy.
• ESM 5.1 - Number of safe sleep educational books and resources distributed to families in all birthing hospitals

 

Objective: By September 30th, 2020, expand safe sleep outreach from 6 to 9 new community partners.

 

Objective: By April 30th, 2020, increase the number of likes and or reactions to the Safe Sleep Mississippi Facebook page from 0 to at least 500.

 

Objective: By September 30th, 2020, increase the number of trainings given to professionals on infant safe sleep guidelines from 2 to 4.

 

Objective: By August 30th, 2021, increase the number of birthing hospitals supporting and participating in the Mississippi Perinatal Quality Collaboratives QI Initiatives from 33 to 37.

 

Objective: By September 30th, 2021, reduce primary cesarean deliveries among low-risk mothers (NTSV) rate by 10% among 5 participating hospitals.

 

Objective: By May 30th, 2022, produce a document that highlights the findings, success, and challenges of the FIMR program regarding reducing infant mortality in a local context.

 

Objective: By September 30th, 2022, increase the number of families educated about infant safe sleep practices from 162 by 50%.

 

Objective: By March 30th, 2020, establish a system for tracking activities and success of FIMR Program.

 

Objective: By August 30th, 2020, create a data tracking system to identify key documents needed for thorough SUID case review.

 

Strategy: Implement a reporting template for Fetal and Infant Mortality Review (FIMR) Coordinator.

 

Strategy: Continue monitoring the FIMR Coordinators through the new reporting template.

 

Activities: The current FIMR program operates to review fetal/infant deaths from the three coastal counties of Mississippi – Harrison, Hancock, and Jackson. The new tracking system for the FIMR program began in March 2019. To date, little to no technical assistance has been required. A new electronic and survey-based tracking system was to be implemented for the 2021-2022 reporting period, which would allow all the information to be generated into an ongoing data collection system. Due to being unable to access the data files of former MIHB staff, a report providing precise information is unavailable. However, a summary of available information follows below.

 

During the reporting period, eight CRT meetings were held with an undeterminable number of cases being reviewed.

 

FIMR Case Review Team Meetings

• 10/14/2021 – hosted by Singing River Hospital – Ocean Springs
• 3/16/2022 – hosted by Singing River Hospital– Pascagoula
• 4/26/2022 – hosted by Highland Community Hospital
• 5/9/2022 – hosted by George Regional Hospital
• 5/10/2022 – hosted by Memorial Health Gulfport
• 6/28/2022 – hosted by Singing River Hospital – Gulfport  
• 7/20/2022 – hosted by Merit Health Biloxi
• 9/20/2022 – hosted by Singing River Hospital – Ocean Springs

 

Upon reviewing fetal and infant deaths, the panel provided recommendations which centered on precipitating or contributing factors and strategies for prevention of future deaths. From the meetings held in the reporting period, recommendations centered on COVID-19, vaccines during pregnancy, vaping, second/third hand smoke, maternal cocaine use, depression after stillbirth, drug use in pregnancy, post-partum hypertension, maternal obesity, maternal age and birth defects, infant sleep safety, syphilis, self-induced abortions, infant car safety, maternal depression screening, preconception and postpartum maternal care, blood clots, and stillbirth prevention. The recommendations were then shared in the context of the FIMR Community Action Team meetings, which allow for a much larger audience of medical professionals, social service organizations, faith-based communities, etc. for programming and implementation at the local level.

 

FIMR Community Action Team Meetings Dates and Topics:

• 9/17/2021 – Interpersonal Partner Violence
• 11/18/2021 – Internet Safety and Child Exposure
• 2/23/2022 – Preconception Care Services
• 5/11/2022 - Therapeutic Foster Care & Adoption Program; Parent Strong Program (Parenting Classes), Adoption Permanency Program (post adoption services)
• 7/27/2022 – Immigrant Alliance for Justice and Equity
• 8/24/2022 – Child Sexual Abuse

 

After requests to MIHB for support over the course of the reporting period, the FIMR Coordinator worked with the MIHB leadership and the MMRC Informant Interviewer to develop a process for adding a maternal/family interview to the case exploration process. A draft of interview assessment questions was prepared by mid-July 2022, with the first maternal/family interview occurring in August 2022. This has been well-received among the FIMR panel and has added context that has been absent with only records reviews for many years. This effort was supported by non-federal/private funds.

 

Strategy: Assess the quality of the completion of Sudden Unexplained Infant Death Investigation (SUIDI) forms, autopsy reports and death scene investigation of SUID Cases that are reviewed by Child Death Review Panel (CDRP).

 

Strategy: Assist the Mississippi Child Death Review Panel with continuing to develop recommendations for state leaders and other stakeholders

 

Activities: There was no specific activity directed to the strategy concerning SUIDI forms and investigation of SUID cases during the reporting period. However, to follow-up on content shared in the prior MCH Block Grant report, the CDRP produced the annual report on 2018 death case findings and released the report public-facing on May 13, 2022. The report can be reviewed at: https://msdh.ms.gov/page/resources/18967.pdf

 

The recommendations in the annual report were the following:

 

State Leaders:

• Legislation that requires firearms to be traced through the Bureau of Alcohol, Tobacco, and Firearms and Explosives when a child has been injured or fatally injured by a firearm.
• Representative from the Department of Mental Health assigned to the Child Death Review Panel.
• Representative from the District Attorney’s Office assigned to the Child Death Review Panel.

 

Healthcare System and Providers:

• Mass media campaigns discouraging co-sleeping and a realistic approach to helping put babies to sleep.
• Increase awareness about the importance of prenatal visits and support groups. Highlight areas where prenatal support groups exist, their success and where these support groups are not available.

 

School Administrators, Teachers, and Counselors:

• Incorporating a curriculum on risky behaviors for new drivers in high school health courses.

 

Local Leaders, Communities, and Families:

• More calls to the Child Protection Service hotline for infant and child fatalities from accidents, homicides, suicides, or any injury related deaths.
• Public service announcements on water safety, swimming safety, and other safety precautions for residential lakes, ponds, and pools.
• Public Service announcements on fire safety and the importance of smoke alarms in homes.

 

During the reporting period, the Child Death Review Panel (CDRP) held 2 review meetings virtually to complete the review of 2019 infant and child deaths and prepare for the review of 2020 cases. Meetings were held on:

• April 20, 2022 – SUID – 19 cases reviewed
• August 9, 2022 – Fire, drowning, notable deaths – 19 cases reviewed

 

The CDRP also participated in a virtual site visit on October 26-27, 2021, with the National Center for Fatality Review and Prevention (NCFRP). This site visit was facilitated by leadership in MIHB and representatives of the Michigan Public Health Institute/NCFRP. A key takeaway from this meeting was to have the CDRP begin strategic planning for translating CDRP data to action, specifically around prevention efforts and activities. In a debriefing held on November 18, 2021, the CDRP began discussions of instituting a subcommittee focused on prevention and advocacy. 

 

Strategy: Work with community partners to disseminate safe sleep education and provide resources to community.

 

Activities: The Lead Poisoning Prevention and Health Homes (LPPHH) program distributed over 11,000 pieces of safe sleep educational materials to hospitals statewide and distributed 2,300 pieces of safe sleep education at community events.

 

During the reporting period, the MIHB partnered with 4 additional subgrantees, in addition to Mom.ME and Six Dimensions, LLC (described in the Women’s/Maternal Health section) to implement a range of activities aimed at improving infant health outcomes.

 

The partnerships and activities were as follows from October 1, 2021 – March 31, 2022. Data is not immediately accessible for the remainder of the reporting period and is being further sought.:

 

• National Council on Alcoholism and Drug Dependence (NCADD)

Infant Mortality- Education/Resource Distribution

• Provided safe sleep education to 30 parents, grandparents, and/or extended care givers
• Screened and distributed 30 pack n’ plays to eligible participants
• Distributed 118 car seats
• Distributed 161 packs of diapers

Maternal Mortality-Mental Health Support

• Assessed 78 pregnant and postpartum mothers for mental health and substance use disorder
• Referred 6 pregnant and postpartum mothers to counselors/therapist for mental health disorders
• Host 6 monthly workshops for pregnant and postpartum mothers on mental health and substance use topics – 163 participants

 

• Memorial Health Gulfport

Infant Mortality- Education/Resource Distribution

• Provided discharge education on post-childbirth, breastfeeding, and parenting to 47 families
• Screen attendees for their needs for pack n plays, sleep sacks, and car seats – distributed 60 sleep sacks and 2 car seats
• Provided follow-up assessment with moms post-delivery (2 weeks-12 months) about safe sleep practices - # unknown.
• Provided referrals for postpartum moms for additional resources - # unknown.

Maternal Mortality- Mental Health Support

• Provided classes on prepared childbirth, breastfeeding, and parenting to expectant mothers
• Educational materials provided on post-partum signs and symptoms – 550 materials distributed
• Provided follow-up call 2 weeks post-delivery to 16 families

 

• North Mississippi Medical Center

Infant Mortality- Education/Resource Distribution

• Through support groups, educate participating women about breastfeeding, infant feeding behavior, breast feeding at work, strategies to address breastfeeding challenges – 8 meetings held, 11 participants total
• Through support groups educate participating women on baby sleep safety, proper use of care seats, postpartum depression, etc. – 8 meetings held, 11 participants total

Maternal Mortality-Enhanced Postpartum Care

• Screened 11 participating women on their needs and infant needs by using the Edinburg Postnatal Depression Scale. None required referral.

 

The MIHB also partnered with the Institute for the Advancement of Minority Health as a subgrantee during the reporting period. A summary of that project follows:

 

Goal 1: Enhance the capacity and efficacy of patients and family to advocate for themselves and their loved ones, engage in shared decision making and informed consent, and escalate concerns in emergency situations.

 

Objective 1: By September 29, 2022, IAMH will conduct four (4) health literacy workshops to provide health literacy information to at least 100 expectant mothers in the target areas that increases their knowledge about pregnancy risk factors and their ability to advocate for themselves.

 

Throughout the course of the project period, IAMH conducted four virtual health literacy workshops via Zoom which provided educational material from a curriculum that was developed entitled, “Mommy Basics.” The four sessions were conducted in partnership with Magnolia Medical Foundation. The curriculum provided educational information about proper prenatal care which included warning signs and symptoms that, if experienced, indicated that a care provider visit was needed. The workshops

were attended by 127 women. Pre-test/post-test scores showed marginal gains in knowledge, highlighting the need for emphasizing the warning signs of preeclampsia and premature labor, the importance of placing an infant to sleep on his/her back, and that too many blankets in the crib is a risk factor for sudden infant death syndrome (SIDS).

 

Goal 2: Improve maternal and child health outcomes by training health care providers about the effects of racism on maternal and child health outcomes.

 

Objective 2: By September 29, 2022, IAMH will implement an evidence-based anti-racism curriculum to increase knowledge and awareness among at least 50 healthcare providers about the effects of racism on maternal and child health outcomes.

 

Throughout the project period, The Institute held five (5) workshops that implemented an evidence-based anti-racism curriculum. The workshops were facilitated by Dr. Tanya Funchess, Assistant Professor in the College of Nursing and Health Professions at the University of Southern Mississippi. All workshops were held virtually via the Zoom platform. Overall, 44 participants representing 19 organizations attended at least one workshop in the series. All workshops were evaluated by measuring knowledge prior to and after content delivery via online pre- and post-survey.

 

Goal 3: Improve infant mortality rates in the target area by providing safe sleep education to parents, grandparents, and extended caregivers such as childcare providers.

 

Objective 3: By September 29, 2022, IAMH will distribute at least 500 educational materials through community outreach events and in partnership with daycare centers.

 

Throughout the course of the project period, The Institute hosted or attended community outreach events whereby they distributed educational materials (pamphlets, fact sheets, booklets, and brochures), diapers, personal hygiene items, infant formula and other items within the prioritized counties. The Institute hosted five (5) Community Baby Showers. Educational materials were supplied to these partners so that they could be distributed to parents and caregivers. There were 2,625 educational items distributed in the prioritized counties. Partnerships were established with ten (10) daycare providers.

 

Goal 4: Identify the needs of pregnant and postpartum women in Bolivar, Copiah, Hinds, Simpson, Sharkey, Sunflower, Issaquena, and Washington counties.

 

Objective 4: By September 29, 2022, IAMH will distribute and obtain completed peripartum and postpartum assessment forms from at least 80 pregnant and postpartum women in the target counties.

 

During the project period, an assessment survey was developed to be distributed to pregnant and postpartum women within the prioritized counties. The goal of the assessment was to identify women who needed referrals and link them to services or resources. Though the goal was to reach at least 80 women in the prioritized counties, only 46 individuals completed the assessment. Questions were asked around secondhand smoke risk, infant feeding, postpartum depression and anxiety, and awareness of services and resources in the community. Among those who responded, 17.4% reported that someone smoked inside the home. Regarding infant feeding, many respondents reported bottle-feeding their infant (41.3%), almost one-third (30.4%) breast fed, and 26.1% do both. Approximately 15.2% of respondents had concerns or questions around breastfeeding their infant. Almost one-fourth (23.9%) had concerns that they may have postpartum depression or anxiety. About one in ten (10.9%) did not have a pediatrician for their infant, and 13.0% did not have a medical provider for their own primary care. Lastly, when asked about awareness of specific services and resources, almost all (89.1%) were aware of the Women, Infants, and Children (WIC) Program, but only 45.7% were aware of services provided by the Early Periodic Screening, Diagnostic, and Treatment (EPSDT) Program. Findings from the survey indicate that there is a need for resources related to breastfeeding support, and postpartum behavioral health services.

 

Strategy: Implement social marketing strategies to promote safe sleep.

 

Activities: The MIHB maintained the website domain for www.safesleepms.org; however, analytics are not available to address viewer usage and other metrics as the domain subscription has since lapsed. The SafeSleepMS social media pages (Facebook, Twitter, and Instagram) remained live, but very few posts were made in the reporting period. Due to the end of the funding agreement which supported these activities in prior reporting periods, they were largely discontinued. However, there continued to be periodic social media messages on safe sleep posted to the MSDH Facebook. New, deliberate strategies are proposed in the 2024 SAP to optimize the use of social media platforms and websites to promote health, safety, and other messages regardi perinatal/infant health.  

 

Strategy: Facilitate the statewide Perinatal Quality Collaborative to engage obstetrics, neonatal and pediatric stakeholders in applying quality improvement methodologies related to perinatal outcomes.

 

Activities: During the reporting period, the MIHB scaled back its involvement in activities related to neonatal/pediatric quality improvement initiatives to prioritize maternal health work. However, MIHB staff continued to participate in and push announcements of educational opportunities sponsored by the National Institute for Children’s Health Quality (NICHQ), the National Network for Perinatal Quality Collaboratives (NNPQC), and other stakeholders to the MSPQC listserv, notably related to maternal opioid use and neonatal effects, trauma informed care, postpartum transitions for mother and baby, and reducing inequities for Black birthing people. MSPQC did not launch a new neonatal initiative at the April 2022 MSPQC conference, however, did offer a full-day neonatal track that covered the following:

• Patient-Family Partnership Workshop
• Eat Sleep Console and Wrap Up of Neonatal Abstinence Syndrome (NAS) Project
• Express Yourself: Human Milk Initiative Training
• Necrotizing Enterocolitis- Best Practices

 

The MIHB/MSPQC Neonatal Team continued partnering with the “Express Yourself: Human Milk Initiative” to promote and encourage exclusive breastfeeding. “Express Yourself” is a statewide quality improvement project funded by the Kellogg Foundation and in partnership with MSPQC to educate on Quality Improvement methodology and increase the availability of breast milk to very low birthweight (VLBW) babies in NICUs across Mississippi. Express Yourself meetings with hospital staff were held as follows:

• October 12, 2021 – “COVID-19 in the NICU: Impact on Pregnancy, Breastmilk, and Breastfeeding” (virtual)
• April 21, 2022 – MSPQC Conference (virtual and in-person)

 

MSPQC partnered with the Mississippi Public Health Association (MPHA) and national Count the Kicks (CTK) organization to distribute communications materials free to hospitals for a stillbirth awareness and prevention campaign. MSPQC supplied CTK with a listserv of participating hospitals. An introductory letter was sent to each facility explaining the program. Also, an introductory webinar was scheduled for July 19, 2022, that explained the Count the Kicks campaign and instructed hospitals on how to order materials for distribution to patients. In just two months, CTK had received 67 orders for materials, distributed over 10,000 pieces of literature, had 53 mobile App users from Mississippi, and over 500 views to its website from Mississippi viewers. This initiative was put on hold with the exit of the MIHB staff who had launched it. However, the effort will once again be carried out and on a larger scale starting in July 2023.

 

Objective: By September 30th, 2021, continue to work with partners to reduce the prevalence of tobacco/alternative tobacco products among women ages 18-44.

 

Objective: By September 30th, 2021, continue to empower the MS Tobacco-Free Coalitions and other partners to provide education to local municipalities and counties on the importance of a smoke-free environment.

 

Strategy: Increase cessation among women of childbearing age to promote better birth weights and infant health.

 

Activities: The Office of Tobacco Control provided technical assistance and training to participating Community Health Clinics. Increased awareness of Baby & Me Tobacco-Free through health fairs, table displays on site at CHCs, posting posters in targeted businesses in the community, digital media, community events (drive through baby showers and by sharing program brochures/flyers with stakeholders, providers, and community partners. The MS Quitline provided cessation services to 17 pregnant participants while Baby and Me Tobacco Free Program provided cessation services to 47 pregnant participants. There were 1,010 referrals to the Quitline in FY 2022. This number is down significantly due to a limited number of cessation training courses provided by OTC statewide subgrantees due to competing clinic priorities.

 

Demographics: Tobacco Users by Pregnancy Status

• 10 = total number of current pregnant women who utilized the Quitline pregnancy program.
• 2 = total number of not pregnant women who utilized the QL pregnancy program.
• 11 = total number of women planning to become pregnant who utilized the QL pregnancy program.
• 3 = total number of women currently breastfeeding who utilized the QL pregnancy program.
• Overall total of 26 women who utilized the QL pregnancy program from October 1, 2021-September 30,2022.

 

PRIORITY: Breastfeeding

 

NPMs, NOMs, SPM, and ESMs:

• NPM 4: A) Percent of infants who are ever breastfed B) Percent of infants breastfed exclusively through 6 months.
• NOM 9.1: Infant mortality rate per 1,000 live births
• NOM 9.3: Post neonatal mortality rate per 1,000 live births
• NOM 9.5: Sudden Unexpected Infant Death (SUID) rate per 100,000 live births
• ESM 4.1: Number of hospitals certified as Baby Friendly to increase the percent of births occurring in Baby Friendly hospitals

 

Objective: By September 30th, 2021, increase enrollment and participation in the WIC Program by 5% via partnerships and evidence- based initiatives.

 

Objective: By September 30th, 2021, increase breastfeeding initiation and duration rates through prenatal breastfeeding education and post discharge support.

 

Strategy: Assist in the creation and maintenance of Mississippi MILC League across the state of Mississippi.

 

Activities: COVID-19 has crippled in-person Baby Café’ support group meetings. Due to the cost associated with maintaining licenses for Baby Cafés, the model is being phased out in Mississippi. The Mississippi Breastfeeding Coalition has created Mississippi MILC (Making an Impact in the Lactation Community) Leagues. MILC Leagues are breastfeeding support groups. They aim to improve breastfeeding rates in Mississippi by offering access to equitable lactation support statewide. Support groups are facilitated by certified lactation professionals with most leagues meeting weekly. 

 

Strategy: Increase breastfeeding initiation and duration rates through prenatal breastfeeding, education, and post- discharge support.

 

Activities: The MSDH WIC Program established a Memorandum of Understanding (MOU) to provide support for prenatal breastfeeding education and post-discharge breastfeeding support of the Baby Friendly Hospital Initiative. The MOU has been signed by 26 of the 41 delivery hospitals in the state. Several of the MOU agreements are set to expire in FFY 24; however, MSDH WIC plans to work with these hospitals to renew agreements during this time period. One of the important strategies in the agreement is the referral partnership between the hospitals and MSDH WIC. WIC staff provide support in teaching prenatal breastfeeding education classes onsite at partnering hospitals. These efforts were paused in March 2020. Beginning April 1, 2023, MSDH WIC transitioned to hybrid operations which has allowed staff to begin rebuilding these relationships and assisting partnering hospitals during FFY 24. WIC staff promote MILC Leagues to mothers for access to post-discharge breastfeeding support. The COVID -19 pandemic adversely impacted Baby Café’ operations in Mississippi with many locations choosing to close. Lactation leaders in the state to include: the WIC State Breastfeeding Coordinator, the Mississippi Breastfeeding Coalition and Baby Café’ facilitators joined together to establish the Mississippi MILC League. The Mississippi MILC League stands for Making an Impact in the Lactation Community. The MILC League offers free peer support groups for new and expectant mothers virtually or in-person in communities throughout Mississippi. The vision of the Mississippi MILC League is to improve breastfeeding rates in Mississippi by offering access to equitable lactation support statewide. We will continue the establishment of MILC League locations and further develop promotion efforts of this new initiative during FY 24.

 

MSDH WIC will continue to maintain partnerships with other support groups such as the Mississippi Breastfeeding Coalition, Le Leche’ League, Mothers Milk Bank of MS, Delta Health Alliance, REACH Program and Healthy Moms Healthy Babies for additional referrals to the MSDH WIC Program.

 

Breastfeeding peer counselors will rebuild in-person breastfeeding group classes within MSDH WIC while continuing to provide education through individual telephone counseling sessions and virtual platforms when applicable. MSDH WIC has rolled out a mandatory breastfeeding training program for staff. This curriculum is designed to build competencies among all levels of WIC staff in breastfeeding promotion and support strategies in the WIC Program. It relies on recent science, as well as best practices adopted by State and local WIC agencies across the country. WIC Breastfeeding Curriculum training will be provided to new hires through the agency learning management system in FFY 24. WIC participants will have continued access to the Pacify Mobile App for assistance and real time education when breastfeeding issues and questions arise.

 

The Mississippi Breastfeeding Coalition and The Mississippi Public Health Institute have partnered to implement an International Board-Certified Lactation Consultant (IBCLC) Mentorship and Scholarship program to benefit approximately 28 WIC peer counselors and/or registered dieticians. Participants have received assistance with training courses, study materials, mentorship, and exam fees. To date we have 8 new IBCLCs from participating peer counselors. Six additional peer counselors are awaiting test results from the exam administered in March 2023. We have 5 WIC registered dieticians and 4 breastfeeding peer counselors who should be eligible to sit for the exam in September 2023. All other participants must be eligible to sit for the Spring 2024 exam to successfully complete the program.