The goal of the Fetal and Infant Mortality Review (FIMR) Program is to prevent infant mortality and morbidity through the review of fetal and infant deaths in Maryland. The FIMR process is used as a "warning system" and method for improving birth outcomes and systems of care surrounding pregnancy, childbirth and infancy. FIMR assesses how infant morbidity and mortality occurs in specific local communities and creates an action-oriented process for change. FIMR offers communities a way to discover unmet needs to improve the health of mothers and infants. FIMR is an action-oriented community process that continually assesses, monitors, and works to improve service systems and community resources for women, infants, and families. A fetal or infant death to a community resident is the event that begins the process.
The National Fetal and Infant Mortality Review Program (NFIMR) is a collaborative effort between the American College of Obstetricians and Gynecologists and the Maternal and Child Health Bureau, Health Resources and Services Administration. The Fetal and Infant Mortality Review Program began in Maryland in 1997.
- Fetal death*: Death before the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy; the death is indicated by the fact that after such separation, the fetus does not breathe or show any evidence of life, such as beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles.
- Fetal mortality rate*: Number of reportable* fetal deaths per 1,000 total births. Total births include live births plus fetal deaths of twenty or more weeks' gestation.
- Infant death: Death occurring to a person under one year of age.
- Infant mortality rate: Number of infant deaths per 1,000 live births.
*The definitions of live birth and fetal death are set by law in Section 14 (a) of Article 43 of the Maryland Code, 1957 Edition - Supplement. Fetal deaths are reportable for filing purposes only if the death occurs after a period of gestation of twenty or more completed weeks (Section 21 (a) of Article 43 supra). (Source DHMH Vital Statistics Administration)
NFIMR Glossary of Terms
Key Steps in the FIMR process
- Information about the infant death is gathered. Sources include public health (vital statistics) and medical records. An interview with the mother who has suffered the loss is conducted, if the mother agrees. Professionals with training in grief counseling assess the needs of the family and refer to bereavement support and community resources.
- The Case Review Team composed of health, social service and other experts from the community review this summary of case information and the maternal interview, identify issues and make recommendations for community change, if appropriate.
- The Community Action Team, a diverse group of community leaders, review Case Review Team recommendations, prioritize identified issues, then design and implement interventions to improve service systems and resources.
Confidentiality of all information is strictly maintained. That means that names of the mother, provider and institution are removed.
NFIMR Manual for FIMR Leaders
The Department of Health and Mental Hygiene's Maternal and Child Health Bureau is the lead agency for Maryland's FIMR Program. There are 18 FIMR projects in the state which represent all 24 Maryland jurisdictions. There are 16 jurisdiction level programs (Allegany, Anne Arundel, Baltimore, Calvert, Caroline, Carroll, Charles, Dorchester, Frederick, Garrett, Harford, Howard, Prince George's, Montgomery, Washington and Baltimore City) and two regional FIMR programs: the Lower Eastern Shore Regional FIMR (Somerset, Wicomico, and Worcester County); and the Midshore Perinatal Advisory Committee (Caroline, Dorchester, Kent, Queen Anne's, and Talbot).
Maryland has initiated and maintained the FIMR process in every jurisdiction in the state. FIMR teams have identified numerous findings, recommendations and actions steps for improving systems of care for pregnant women and infants. Recommendations have included improving access to prenatal care, family planning, bereavement services, substance abuse services; increasing screening for domestic violence, safe infant sleep practices, and improving case management. Maryland's FIMR Program is supported by Title V - MCH Block Grant funds.
For information about the State Fetal and Infant Mortality Review Program, please contact Joan Patterson, State Fetal and Infant Mortality Review Coordinator, at the Department of Health and Mental Hygiene's Maternal and Child Health Bureau at telephone number 410 767 6713 or email Joan.Patterson@maryland.gov.
Maryland FIMR Coordinator Training Slides
Preparing Cases for Review
Program Planning and Evaluation