Midwives seek answers to infant mortality trends

Why does Wisconsin demonstrate some of the best and worst infant mortality rates in the nation?

How can one county – Dane — show virtually no disparities between mortality rates among white and minority infants for five consecutive years, while Wisconsin overall reports the highest African American infant mortality rate in the whole USA?

These are some of the key questions that midwives, nurses, doctors and other health care providers will address at the Midwives Alliance of North America’s Region 4 Conference in Madison July 16-18.  It’s the first time in six years that the alliance, which represents certified-nurse midwives and licensed professional midwives from across the Midwest, will meet to discuss crucial issues affecting maternal and infant health.

The organization was inspired to get together because of recent research by Dr. Thomas Schlenker M.D., according to conference co-chair Jan Wolfenberg, a licensed and certified professional midwife who has a private practice in Menomonee Falls.

As director of public health for Madison and Dane County, Schlenker reported in 2009 that the county’s African American infant mortality rate dropped nearly 70 percent from 1990-2001 and 2002-2007. The gap between African American and white infant mortality rates disappeared over the five-year period: six deaths per 1,000 births for African-American babies and four deaths per 1,000 births for white babies.

Schlenker’s findings received national media coverage and attracted the attention of the U.S. Centers for Disease Control. Schlenker told the CDC that local public health officials couldn’t entirely explain the improved numbers, but one primary reason was a decrease in the number of low-weight, premature births.

Dane County public health officials still don’t know why that happened.

Schlenker’s department has since received a $500,000 grant from the University of Wisconsin School of Medicine and Public Health to further investigate the county’s infant mortality trends, including why the African-American infant mortality rate crept back up in 2008.

Meanwhile, the city of Milwaukee ranks seventh worst for infant mortality among the 53-largest U.S. cities, according to Milwaukee’s Department of Public Health. The gap between the city’s infant mortality rates for African Americans and whites is among the worst nationwide.

In 2007, Milwaukee’s overall infant mortality rate was 9.8 deaths per 1,000 births. For white babies, the rate was 6.2 deaths per 1,000 births; for African American babies, the rate was 14.1 deaths per 1,000 births.

Again, why? And what can be done to improve maternal and infant health in Milwaukee?

Wolfenberg and fellow midwife Jackie Tillett don’t have the answers to those questions, but they firmly believe that midwives can assist in boosting infant and maternal health.

Midwives provide prenatal care, education, labor support and delivery to childbearing women during their pregnancy as well as during the postpartum period. They also help care for the newborn through the first six weeks after birth.

Tillett is a certified-nurse midwife and manager of the Midwifery and Wellness Center at Milwaukee-based Aurora Health Care. The center provides midwifery and wellness care to women at five locations, the primary one being in downtown Milwaukee at Aurora Sinai Medical Center. Another location is expected to open at Aurora’s Midtown Health Center at 58^th and Capitol Drive in Milwaukee in fall.

“What midwives are really about is providing options and choice in health care,” says Tillett. “Every woman should know the path her pregnancy is taking and that she has options, which we explore with her. Clearly, our first goal is a healthy baby and mom, and we’re willing to spend a lot of one-on-one time with her. We like to say we are high-touch care, not high-tech care.”

Because a midwife’s routine visit with an expectant mother lasts about an hour – much longer than an OB/GYN normally has to spend with a patient – the midwife has enough time to go over pertinent health information, Tillett says.

Neither Tillett nor Wolfenberg suggest their services should replace a physician’s care. In fact, some of their clients are under a physician’s care in addition to their services.

As one of the scheduled speakers at the MANA conference, Tillett will discuss how to integrate midwifery services into community settings. Another featured conference speaker from Milwaukee will be Karen Lupa, a certified nurse- midwife at the Sixteenth Street Community Health Center who will give a review of the community health center model of midwifery services for low-income women.

The conference will bring together speakers from 12 states who will describe how midwifery services have been used in their communities to improve the birth experiences and healthiness of mothers and babies. Some speakers have examples of models of care they’ve used to improve outcomes in specific populations, including African American, Amish and Native American, Wolfenberg says.

Wolfenberg hopes the conference will allow providers of all backgrounds to share information on what works to improve maternal and infant health in all populations.

She isn’t sure why MANA Region 4 hasn’t had a conference in six years, but when it comes to finding solutions to saving infants’ lives, there’s no time to waste.