Seeking Answers

Doctors throughout Indiana and in the local region of the Southwestern Hospital District (which includes the counties of Vanderburgh, Posey, and Warrick) noticed an alarming trend when health data from 2013 began to arrive. While infant mortality in the state had increased slightly by .04, the spike in the Southwest region of Indiana was enough to cause health officials to take notice and work to become proactive.

“Indiana is consistently worse than the national rate every year,” says Dr. Maria Del Rio Hoover, a neonatologist at St. Mary’s Medical Center. She also has served on several Indiana State Department of Health committees addressing infant deaths. “Our infant mortality rate is the seventh worst in the U.S.”

Infant mortality is defined as the death of a baby before his or her first birthday. The rate is the number of babies who die in the first year of life, per 1,000 live births.

To put in perspective what this means, Hoover says the rate for Indiana in 2013 was 7.1 lives lost while the U.S. rate was 5.96. The rate for the Southwestern region of Indiana, which includes the counties of Knox, Daviess, Martin, Gibson, Pike, Dubois, Posey, Vanderburgh, Warrick, Spencer, and Perry, was 8.9 for 2013, reflecting a jump of 2.1 in infant deaths from 2012.

“The Southwestern Indiana region has the highest mortality rate in the state for 2013,” says Hoover. “Breaking it down more, Vanderburgh County’s rate was 11.”
Hoover says it’s important to know when looking at this data from the Indiana State Department of Health (ISDH) that infant mortality rates are not based on babies who pass away in the region. These rates are based on mothers who claim residence in the county and had an infant who died.

“It’s no reflection on one area hospital versus the other,” she says. “We know that approximately 30 percent of the babies who died and whose mothers lived in Vanderburgh County died outside of our Southwestern Hospital District.”

To understand this data and what it means for the families of Vanderburgh County and the region, Hoover and other officials — including the Vanderburgh County Health Department — began to look at factors and break down what happened to the little lives that were lost in the region. Together with Dr. Ken Spear, the Vanderburgh County health officer, Hoover is digging deeper, finding all the data she can about the mothers and the babies they lost. This information is the most important in their search, she says, and can help families, doctors, and health officials in the region develop programs to become more proactive about the health of infants and preventing future deaths.

“It’s like being a detective. I don’t want to jump in and spend time and energy on programs that aren’t going to make a difference,” she says. “We’re trying to define what we call the root causes.”

Root causes, Hoover explains, are what happened to mothers and babies that could have factored in the infants’ deaths. Low birth weight, babies born prematurely, mothers who did not receive early prenatal care, and mothers who smoked while pregnant are just a few of the areas researched by the health department.

“Our numbers are way too high,” says Spear. “Our smoking rates are up, our obesity rates are up.”

As the work continues, Hoover says they may find the increase in infant deaths in the Southwestern region may not be related to any one factor.

“My feeling is that I don’t think we need to overreact until we have all the facts,” says Hoover. “We need data from 2014 to see if there is a trend. What we currently are doing is gathering all of the facts and determining causes and commonalties so that we can develop and implement programs.”

In 2012, knowing the state was not on goal, the ISDH began to roll out several programs addressing different root causes found to be a factor in infant mortality in Indiana. The Indiana State Department of Health Maternal and Child Health Division developed the Indiana Perinatal Quality Improvement Collaborative (IPQIC) to address the needs of mothers and babies.

The IPQIC initiative has brought about the Perinatal Care Regionalization system, which designates where infants should be born or transferred based on the amount of care they need at birth; the 17P Project, which looks to make sure mothers at risk of delivering early receive the 17P drug, an effective preventive medication; and more.

Hoover says the state also holds a Labor of Love Infant Mortality Summit each year, which is a part of the commitment of the state to lower infant deaths. This year’s summit, held Nov. 6, focused on the race disparities in infant mortality. The event brought in renowned experts to downtown Indianapolis to discuss data, offer solutions, and work on preventative care.

Locally, Hoover says focusing on data and utilizing the FIMR program — Fetal and Infant Mortality Review — to find more information about the deaths that occurred in Vanderburgh, Warrick, Posey, and Gibson counties is key in this stage.

“It takes a while to get complete data. While we wait to get that information from outside our area, we can use local numbers from FIMR to identify root causes,” says Hoover.

The local FIMR program — started in 1997 — is funded by ISDH and works to collect data about fetal and infant deaths from charts and coroner’s offices. Susan Bonhotal, RN/MSN and nursing instructor at the University of Southern Indiana, has been coordinator of the local FIMR Program since 2002. Her job is to gather local data about fetal and infant deaths in Vanderburgh, Warrick, Posey, and Gibson counties then present it to the Southwest Indiana Perinatal Advisory Board, who then can work on implementing proper programs.

“We’re not looking for blame, what we’re looking for is trends,” she says. “And we’ve come up with a number of projects over the years.”

From data collected by FIMR, local campaigns on safe sleep have been implemented, which have provided cribs to mothers in need and education about preventing sleep-related deaths.

FIMR data collected for 2013 has raised concerns about smoking during pregnancy, obesity in mothers who are pregnant, and the lack of mothers receiving early prenatal care.

“We’ve tried to do a lot of work with smoking and pregnancy. That is a terrible factor in our area, along with obesity,” says Bonhotal.

Spear says the Vanderburgh County Health Department has received several grants this year specifically focused on infant mortality. One will look at how to make the FIMR program more helpful. The other is a Baby & Me Tobacco Free grant; mothers who sign up for the program and stay off cigarettes, as measured by nicotine levels, can receive vouchers for free diapers when the child is born. Spear says the health department will pull together a group from local hospitals and clinics to find the best way to roll out the program to the at-risk population in the area.

“This isn’t going to be a quick fix. This is an ongoing effort,” he says. “We’re going to try to be a part of the solution with everybody else. But it’s going to take a lot of different organizations to address this. No one group is going to get this done.”

For more information about Indiana State Department of Health, visit For more information about Vanderburgh County Health Department, visit

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