Fetal Infant Mortality Review Program
The Fetal Infant Mortality Review (FIMR) Program is a community-based, action-oriented program designed to enhance the health and well being of women, infants, and families through the review of individual cases of fetal and infant death. The purpose of the FIMR Program is to understand how a wide array of social, economic, health, educational, environmental and safety issues relate to infant loss on a local level and in turn utilize that information to improve community resources and systems of care to reduce fetal and infant mortality.
FIMR has been operating in Contra Costa County since 1991 and is implemented by the Family, Maternal and Child Health Programs of Contra Costa Health Services.
How FIMR Works
The FIMR process consists of five components: grief and bereavement support, maternal interview, records review, case review and community action. The process begins when the program is notified that a fetal or infant death has occurred. The FIMR Program receives referrals from hospitals, clinics, the Office of Vital Registry, case management programs and other perinatal providers. The five components are described below:
FIMR staff contact parents through phone calls and home visits soon after the pregnancy loss or infant death. Staff provides emotional support, information, and referrals to other services that assist parents and families.
After family support has been initiated, the mother may participate in an interview. The maternal interview is the heart of the FIMR Program and makes FIMR unique among other case review processes. The interview allows the mother's voice to be heard and provides her with the opportunity to share her experiences before, during and after pregnancy.
The FIMR Program reviews information from a variety of sources, including medical records, birth and death certificates, coroner's reports, and records from health and social service agencies.
A case summary is prepared using information from the maternal interview and records review. The summary is de-identified to assure the confidentiality of patients, providers and health care facilities. The case summary is then presented to the Case Review Team (CRT) for review. This team represents a range of professional organizations and public and private agencies that provide services and resources for women, infants and families. The CRT reviews the summaries, examines the circumstances related to each case and identifies social, economic, health, educational, environmental, and safety factors associated with those deaths. The CRT then identifies problems with the health care system that require change and makes recommendations for how to improve policies and services that affect families.
The next step in the FIMR process is to turn CRT recommendations into action. Issue-specific task force groups are assembled to implement interventions designed to address the problems identified by the CRT. Task force members include those who are in a position to direct change at the community level.
For additional information on the FIMR process, visit the National Fetal Infant Mortality Review website.
Examples of FIMR's Community Actions
The FIMR Program has sponsored several community interventions based on findings from the case review process. Examples of these include:
- A prenatal health card carried by women that provides any potential provider with her essential health information when her prenatal records are not available,
- A folic acid public education campaign,
- Provider and client resources on preterm labor and danger signs of pregnancy,
- A strategic planning event for 23 local agencies and programs to institutionalize comprehensive SIDS education
- Grief and bereavement guidelines for use by providers with clients that have experienced a fetal or infant loss, and
- A crib exchange project to assure that low-income families have safe sleeping environments for their infants.
Frequently Asked Questions
Q: How does FIMR differ from other case review programs?
A: FIMR is the only process that:
- involves a multidisciplinary team,
- invites community participation,
- interviews the mother, and
- reviews de-identified cases
Q: What is FIMR's relationship to other programs?
A: FIMR's comprehensive approach complements all other efforts to understand and quantify fetal and infant deaths, and invites collaboration with many programs dealing with similar issues.
Q: How do I refer a client to FIMR?
A: You can refer clients who have experienced a pregnancy loss at 20 weeks gestation or greater or the death of an infant up to 1 year old. To refer a client to FIMR, call the FIMR Program at 925-313-6254.
Q: Who is involved in the FIMR case review process?
A: The FIMR Case Review Team consists of approximately 20 members that conduct the case review process. This interdisciplinary team has included representatives from obstetrics, pediatrics, social work, public health nursing, law enforcement, and community health staff. Team representatives come from a variety of public health, regional, and community-based organizations.
Q: What happens after a case is reviewed?
A: Following the case review, the resulting findings and recommendations are documented. FIMR staff establish issue-specific task force groups to develop and implement interventions and projects to address case review recommendations.
Q: How many cases does the FIMR Program review?
A: On average, there are approximately 140 fetal and infant deaths that occur to Contra Costa residents every year. The FIMR program reviews only a small portion of these cases, approximately 25 to 30 cases per year.
Benefits of FIMR
- Empowers and inspires communities to create local solutions
- Identifies opportunities for interagency partnerships
- Facilitates the grieving process for families and connects them with support agencies
- Enhances understanding of community needs by presenting the whole picture
- Expands available services through cooperative programming and joint funding
- Improves existing service delivery system and the quality of services provided by individual professionals, health and related social service agencies, community-based organizations and local health units
- Reduces gaps in care
- Ultimately, reduces fetal and infant mortality
- Fetal Infant Mortality Review Program: Findings and Accomplishments, 1998-2004
- Fetal Infant Mortality Program Brochure
- Referral Form
- Client Brochure
English | Spanish
- Preterm Labor Fact Sheet
English | Spanish
- Danger Signs of Pregnancy Fact Sheet
English | Spanish
- Folic Acid Educational Materials
- Prenatal Health Card
Contra Costa FIMR Program
Family, Maternal and Child Health Programs
597 Center Avenue, Suite 365
Martinez, CA 94553 [Map & Directions]