Gone Too Soon: Healthy Babies Need Healthy Communities
A Special Series By Milwaukee Lifecourse Initiative for Healthy Families
The excitement of wondering what favorite color a precious baby will grow to love, what dreams and hopes he’ll have, curiosity about first dates and prom and all the joys of parenting are tragically replaced with life-long grief when an infant dies before its first birthday. African American babies in Milwaukee are three times more likely to die than their white counterparts, and there are several factors fueling this health disparity.
According to the 2010 Fetal Infant Mortality Review (FIMR) Report, the two leading causes of infant deaths among African Americans in Milwaukee are:
• Complications of prematurity1, which accounted for 53.7% of the deaths, were the number one cause;
• And Sudden Infant Death Syndrome (SIDS), overlay, or accidental suffocation, which caused 19% of infant deaths.
The aforementioned statistics are the causes of infant deaths, but environmental factors, or social determinants, drive infant mortality rates. However, behind all statics and rates are families who carry the burden of the issue.
Complications of prematurity
Kimberly Hamilton-Diaz, 25, has experienced two preterm deliveries, which is a delivery before 37 completed weeks of pregnancy.
A seemingly healthy pregnancy took a tragic turn on January 31, 2012. Hamilton-Diaz was 23 weeks and 5 days gestation when she experienced some alarming symptoms. “I actually started bleeding and started cramping and that’s what made me go to the hospital,” she recalled.
When she got to the hospital doctors discovered that her water bag had dropped through her then opened cervix. She was contracting and in preterm labor. Her son was delivered, but doctors said he only had a 25% chance of living.
Hamilton-Diaz’s baby boy succumbed to being born too soon shortly after birth. “For 23 seconds [he lived]. He took two breaths and then they tried to revive him—actually 23 minutes they tried to revive him for—and they were unsuccessful.”
Many babies died in 2012, but to Hamilton-Diaz’s this is personal; her son wasn’t just a number—he was her baby.
Hamilton-Diaz’s second pregnancy brought a fresh set of challenges for doctors, but they, too, revolved around her incompetent cervix or her cervix’s inability to stay closed and remain thickened.
Although doctors performed a cerclage, a medical procedure to sew the cervix closed, Hamilton-Diaz’s pregnancy ended as she endured one week and four days of hospitalized bed rest (because her cervix had opened despite the cerclage) until Alayna Elizabeth Rosa Diaz was delivered at 26 weeks, weighing 2 pounds .5 ounces on September 2, 2012.
“I was kind of scared that Alayna might had ended up like I had my first baby, but she didn’t,” she said. “Like I was scared that she was gonna come out not breathing, but she came out actually crying. It was an amazing moment, but I was still scared, but I was actually happy at the same time, so it came out good.”
Now eight-months-old, Diaz is doing well, but she had to overcome obstacles after being born too soon. She needed help breathing and was tube fed. Doctors had concerns about her eyes and heart, and she had physical therapy and came home from the hospital on caffeine (to help her remember to breath) and a heart monitor.
“Her journey starting out was really rough, and I thought that I was gone lose her, but with a lot of prayer and recognizing that my little girl wasn’t going anywhere, I’m really blessed to have her. I’m glad that she’s healthy now, really big and strong,” Hamilton-Diaz said.
Prematurity is a complex issue, and researchers are still looking for causes. “We don’t have an answer, said Maureen Kartheiser, state director of program services, advocacy, and Govt Affairs, March of Dimes. “In terms of the cause and why prematurity is killing so many babies, we don’t know that yet. That’s just the bare facts. We don’t know why there are so many babies being born too soon, and we certainly don’t know why the disparities are so great. I think there’s some common belief that it is in fact due to stressors in families’ life and that from birth to death, a person’s health is going to impact the next generation,” she said.
Research is critical to finding solutions. “We are starting to put much more money into research for prematurity,” Kartheiser said.
Sudden Infant Death Syndrome (SIDS)
With a husband, a son and pregnant with a baby girl, Sabrina Holland couldn’t ask for more. She was thrilled to be having a daughter.
On March 11, 2007, Sariah Brianna Holland was born at 39 weeks and was placed in Sabrina’s arms, weighing 7.5 pounds. But just six days later, on what Sabrina described as a typical day, her life changed forever.
“It was at night, and my husband had brought her in for me to breastfeed her, and she was unresponsive.” The discovery sent Sabrina’s emotions into distress. “Shock I think more than anything,” she recalled. “When he brought her in the room, I’m like, ‘she not breathing, she not doing nothing.’”
After being taken to St. Joseph’s Hospital, Sariah passed of SIDS. Holland relied on family during initial grief. “I had family and church family [to help cope] and get through the hard time. I just surrounded myself with a lot of family and church family,” she said.
If you don’t have close support, Holland says, “I would say seek professional help.”
SIDS is defined by the Centers for Disease Control and Prevention (CDC) as the “sudden death of an infant less than one year of age that cannot be explained after a thorough investigation is conducted, including a complete autopsy, examination of the death scene, and review of the clinical history.”
According to the City of Milwaukee Health Department, the Milwaukee County Medical Examiner uses categories behind the term SIDS, for example, SIDS category 1A or category 1B. There are very few cases in Milwaukee, and nationally, where a baby dies of SIDS category 1A, which means the baby died sleeping on his back, in his crib and with no other risk factors found in the home.
Dr. Tina Mason, MD, MPH, FACOG2, has gained an understanding of Milwaukee’s infant mortality problem during her extensive obstetrical career. “The number one reason why babies are dying is because babies are born too soon,” said Dr. Mason. “So the actual question becomes, ‘why are these babies born too soon?’”
Understanding risk factors is important. Health status, environment, race and family history of preterm birth matter. A college educated African American woman is more likely to experience a worse birth outcome than a white woman who did not graduate from high school.
“I always ask were you born a preemie, and I love it when families come into the office because I’ll talk with the whole family, and the families will tell you; they have a history of having babies being born too soon.”
Preconception and interconception care—or health care plans before and in between pregnancies—are steps women can take to help prevent problems during pregnancy. “When you’re going in for your annual exam, or when you’re talking to your provider, you have to be empowered [to ask questions]. That’s part of interconception care,” said Dr. Mason. “What’s going on in your life? That’s part of interconcpetion care,” she added. Working with your doctor will allow you and your provider to develop a plan to help support a healthy birth outcome.
Social Determinants of Health
The CDC describes social determinants of health as people are born, grow up, live work, and age, as well as the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.”
Nicole Angresano, vice president of community impact at United Way of Greater Milwaukee, served as chair for the social determinants committee for Milwaukee Lifecourse Initiative for Healthy Families (LIHF) and is currently a Milwaukee LIHF Transition Team member. She understands how social determinants drive infant mortality rates.
“It’s just incredibly important to look at health in the context of one’s environment, so you could be eating all the right foods, but if you live in a home with too much lead in it—lead paint for example—your health is still going to be at risk,” said Angresano. “We don’t live in a bubble, and so our environment—whether it’s our workplace, our school, our home—has a direct impact on our wellbeing.”
Stress and racism play a role, too. “If you think about things like stress, and not just the current stress of being pregnant, which can be stressful to anybody, but historical stress, stress of living in poverty, stress of living in a neighborhood that may not be safe, all of those things has impact on our capacity to have healthy babies,” she said.
Major determinants that the social determinants committee was charged with addressing were poverty and racism, according to Angresano.
Other social determinants that drive infant mortality rates are social inequalities and discrimination, lack of family supporting wages, unemployment rates, lack of father involvement and neighborhood conditions. These factors go beyond personal choices such as eating habits and smoking, alcohol or other drug addiction.
Hamiliton-Diaz’s son and Sariah Holland are two of the many babies in Milwaukee who left this world too soon. As individuals and a community we must rally together for prevention so that all babies can blow out their first candle and fill their parents’ lives with memories.
There are warning signs to prematurity and steps families can take to support healthy birth outcomes. According to marchofdimes.com the six signs of pre-term labor are contractions that make your belly tighten like a fist every 10 minutes or more often, change in the color of your vaginal discharge or bleeding from your vagina, the feeling that your baby is pushing down (pelvic pressure), low, dull backache, cramps that feel like your period or belly cramps with or without diarrhea. “We’re saying call your doctor even if you only have one sign of preterm labor,” said Kartheiser.
Healthy birth outcomes can be supported by “healthy eating [and] not smoking while your pregnant. We obviously think it’s important for the family to be engaged with healthy nutrition for whole family and pregnant mom,” Kartheiser said.
Kartheiser added that preconception care is also critical to supporting healthy birth outcomes. Ask your doctor about preconception and interconception care today.
To prevent SIDS babies should always be placed on their backs in their bassinet or crib. There should be no pillows, blankets or sheets, stuffed animals or bumper pads in the sleep environments.
Visit www.jumpatthesunllc.com/LIHF or calling 1-888-726-JUMP to get involved.
1. A pre-term delivery is one that occurs at 36 weeks or sooner. Full-term pregnancies last between 37 and 40 weeks gestation.
2. Dr. Tina Mason, MD, MPH, FACOG serves in many capacities. She earned her masters of public health from Columbia University in New York City and went to medical school at the University of Iowa. She obtained her postgraduate training at the University of Michigan. She is currently consulting for insurance companies, and she is president of the Medical Society of Milwaukee County and president of the Milwaukee Gynecological Society.
The Lifecourse Initiative for Healthy Families (LIHF) is the centerpiece of a multiyear evidence-based program created by the Wisconsin Partnership Program and the University of Wisconsin School of Medicine and Public Health that is investigating and addressing the high incidence of African American infant mortality in the state.