In 1996, Maine lost around four babies for every thousand born. As of 2014, that number is around seven. With medical advances and policy changes, the United States as a whole steadily lowered its infant mortality rate in the same timeframe, but Maine’s rate climbed.
The chart above is based on data from the National Center for Health Statistics.
No one has a good handle on the circumstances that led to these deaths or how families could have been better supported. The group established to examine trends in maternal, fetal and infant mortality is not doing so because of shortcomings in the legislation that created it.
Maine lawmakers need to make granting this panel expanded authority a priority in the upcoming legislative session so policymakers can begin to understand why the state’s mortality rate has increased and, hopefully, work to reverse the trend.
The Maine Maternal, Fetal and Infant Mortality Review panel is restricted by two main things: It needs a family’s consent before viewing any state or medical records, and it has to wait four months after the death of the infant to contact the family for that permission or an interview.
Four months after an infant dies, the Maine Center for Disease Control and Prevention is supposed to send a letter to the family offering support services, such as grief groups, and asking if they would like to participate in a review, to potentially help prevent future infant deaths or improve available resources for families.
Since the creation of the panel, no deaths have been reviewed as a result of that letter from the Maine CDC, according to the 2015 report to the Legislature. The few deaths it has reviewed have come to the panel either from a family reaching out directly, or a medical professional making a referral.
The panel did not meet in 2015 and was only able to review two of the 85 deaths in 2014.
Clearly, this system is not working.
Meanwhile, the number of drug-affected babies has increased 500 percen t from 2005 to 2015; about 20 percent of Maine women smoke cigarettes in their last three months of pregnancy; and there were five infant deaths in 2015 from preventable unsafe sleeping arrangements.
However, it’s impossible to know whether anything specific is causing Maine’s infant mortality rate to increase by looking at the numbers alone. Are there any gaps in care for people living in a certain area of the state? Did parents encounter health care professionals who couldn’t help?
Because Maine has such small birth and death numbers, the National Maternal, Fetal and Infant Mortality Review Program recommends that Maine examine every death of a baby and talk directly with surviving family members. Without rights to view hospital records and the ability to reach out to families sooner, the panel can’t begin to do this.
The panel has not asked for expanded powers yet out of fear it would be canceled altogether, but it would be negligent not to attempt to understand why Maine’s babies are dying more often than they used to. Not only is the infant mortality rate saddening, it’s also an indicator of the health of Maine’s entire population.
Legislators should grant Ellie Mulcahy, coordinator of the Maine Maternal, Fetal and Infant Mortality Review Panel, full access to medical and state documents should she request them, not to assign blame but to understand the problem.
This way, the panel coordinator can aggregate information to identify trends. Before she presents information to the panel as a whole, identifying information must be taken out of the documents. Then, if more information is needed, the panel coordinator can reach out to the family, perhaps through a health care provider, for an interview.
We don’t want the state meddling unnecessarily in the life of a family experiencing an unimaginably difficult time, but understanding this issue is crucial to preventing more deaths. Before Maine can fix this problem, it has to know what’s going on.
