By Tom Wilemon, The Tennessean
The battle against infant mortality in Tennessee is a slow and steady process, akin to rocking a baby.
Without a single panacea to cure all the ills or a silver bullet to eradicate the many threats, health officials have to be consistent and patient. Infant mortality is edging down year by year because of direct engagement with pregnant women, community education efforts and safety initiatives to reduce hospital risks. But progress is not being made on all fronts. More babies are dying because of unsafe sleeping conditions.
Jordan Davis made it past his first birthday - even though he's from a neighborhood where tears often are shed over funeral bouquets adorned with tiny lambs. His mother, Dera Davis of North Nashville, said programs run by Metro Public Health and Meharry Medical College came to her rescue when she was single, pregnant, depressed and unhealthy.
"I had never heard about it," she said. "I didn't know there was a program out there such as this one to help women with different information about how to take care of their children and just be a better parent."
She learned about the Metro initiative, Music City Healthy Start, during a community baby shower at Meharry, which runs the CenteringPregnancy program. She has let others know help is available by going door to door in her neighborhood during the annual North Nashville Community Crusade, held each September, and passing out fliers. Metro also sponsors a Boot Camp for New Dads.
These programs for at-risk neighborhoods show promise. The infant mortality rate among blacks in Davidson County fell 7 percent from 2009 to 2010 - the first year of Healthy Start - which targets North Nashville, where the most babies are dying. Data from 2011 and this year are not yet available.
Statewide, for every 1,000 children born alive, 7.9 died before their first birthdays in 2010, the last year for which numbers are available. That's an improvement from the infant mortality rate of 8.7 in 2006.
But too many deaths are occurring because of unsafe sleeping conditions - babies strangling on toys in their cribs or suffocating under a slumbering parent.
Unsafe sleeping conditions account for 20 percent of all infant deaths, said Dr. Michael Warren, director of family health for the Tennessee Department of Health.
"If we were able in 2010 to carve out 131 infant deaths that were due to sleep-related death, our infant mortality rate would have gone from being ranked in the mid-40s nationally to the national average," Warren said.
Economy a factor
Home foreclosures and joblessness may be contributing to the problem, said Dr. Kimberlee Wyche-Etheridge.
"With the changes in the economy and with the changes in living situations, multiple families may be living in one dwelling or people may be moving in with other people, so space becomes more of an issue," she said.
There may not be room in a crowded apartment for a crib, so babies are sleeping in the same bed as their parents.
"A lot of studies have shown - and have videotaped people in their sleep - how much they actually move," Wyche-Etheridge said.
Of the sleep-related deaths in Davidson County, 69 percent were not sleeping in a crib or bassinet, 51 percent were not sleeping on their backs and 47 percent were sharing a bed.
Babies should sleep alone, on their back and in a crib with only a firm mattress and tight-fitting sheet. A blanket or a stuffed toy can be deadly.
One front where the state has made great strides with improving babies' chances at life is in hospital neonatal intensive care units. The Tennessee Initiative for Perinatal Quality Care, a statewide collaborative, identified central line-associated bloodstream infections as a problem early on. As a result, infections in NICUs decreased faster than in other hospital wards.
This collaborative also is working to reduce elective early inductions - when doctors and mothers decide to bring a baby into the world before the 39th week of pregnancy without a good medical reason. Another of its initiatives is to get more hospitals to promote breastfeeding.
Babies die most often because of conditions related to prematurity, low birth weight and birth defects.
"We know that so much of this is due to Mom's health before she ever gets pregnant," Warren said.
Tennessee's high rates of obesity and women who smoke make them chronically ill with conditions such as asthma, high blood pressure and diabetes.
The color of a woman's skin also is a risk factor. The mortality rate for whites is 6.3 deaths per 1,000 births, compared with 13.8 in blacks. As high as that rate is for African-Americans, it is an improvement from 2009, when it was 16.
Davis, who had an unexpected first pregnancy at age 31, was already obese. Although she consulted with a nutritionist, watched her diet and kept her weight gain to just 30 pounds, she still wound up developing pre-eclampsia - a condition marked by high blood pressure and swelling. But like many pregnant women who get it, she didn't realize she was sick.
"I went to the hospital for an appointment," she said. "The next thing I knew, they had to admit me."
She was admitted on a Monday to Nashville General Hospital and Jordan was delivered by Caesarean section the following Friday. Although he was born a month early, he still weighed an even 6 pounds. Davis had undergone steroid shots to help Jordan develop faster.
Now, he's a healthy toddler who loves Elmo, can drink on his own and tries to talk on the telephone. Davis believes the biggest benefit she got from the program is the emotional support from other pregnant women.
"Some of the same hardships I was going through, they were also going through at the time," Davis said. "They were handling things a little bit better than I was."
She was no longer alone.
"There's always help," she said. "There are always things you can do to better yourself and better your child."
Contact Tom Wilemon at firstname.lastname@example.org or 615-726-5961.