Final Paper
Final Paper
Final Paper
Cali Gialousis
Lucia Petrus
Angela McCue
Taylor Seitz
Summer 2017
Education on the Prevention of Infant Mortality 2
Outline
● Introduction to the Research Study
o Education and Infant Mortality
● Theoretical Framework
o Sister Callista Roy’s Adaptation to Change Theory
● Abstract
● Introduction to Literature Review
o Causes & Prevention of Infant Mortality During 3 Stages of Pregnancy
▪ Prepartum
▪ During Delivery
▪ Postpartum
● Review of Literature Body
o Prepartum/In Utero Education & Prevention
▪ Causes of infant mortality during pregnancy
● Poor sexual hygiene
● Smoking
● Infections
▪ Poor prepartum healthcare & nutrition
● Healthcare visits
● Folic acid
o Education in hospital, during delivery
▪ Bed sharing/co-sleeping in the maternity ward
▪ Infant-safe sleep program
● Evaluating an effective sleep program to prevent SIDS
▪ Maternal characteristics associated with suffocation & strangulation
▪ Improving health outcomes with support groups
● Evaluating the effectiveness of community-based programs
o Postpartum Education & Prevention
▪ Home healthcare to decrease infant mortality
▪ Availability of pediatric care
▪ Follow-up care for high risk infants
● Summary
● Reference Page
Education on the Prevention of Infant Mortality 3
Abstract
Infant mortality continues to be a rising problem, affecting infants from birth to 1 year of age in
the United States. This literature review evaluates the effectiveness of nurse teachings for
prepartum care, education on infant sleep position and newborn assessment, and discharge
teaching for the further prevention of infant death. The studies in this research were conducted in
doctor’s offices, hospitals, and in the community. A convenience literature review of 12 articles
concludes that with proper education provided at the right stage of pregnancy in the correct way,
This study explores the relationship between education and infant mortality. The purpose
expecting and new mothers, as well as their family members, regarding the care of new infants.
Providing proper education to parents and family members of new infants before, during, and
after delivery will significantly reduce infant mortality rates in the U.S.
The theoretical framework for the research is guided by Sister Callista Roy’s theory of
adaptation to change. The emphasis Roy places on adaptive and coping abilities, including the
need for alterations in the person's environment provides a framework for examining the
importance of making changes to better fit the lifestyle of parenthood regarding infant care and
parental decisions that will prevent infant mortality. The need for making these changes is
examined before, during, and after pregnancy for new mothers as well as family members.
Literature Review
This research review looks at 12 articles on the relationship between increased nursing
education and decreased infant mortality. These articles identify the causes of infant mortality
throughout the stages of pregnancy and birth including prepartum, postpartum, and in-hospital
care. By examining the causes of infant mortality throughout these stages, research suggests
ways in which proper nursing interventions can decrease the occurrence of unexplained infant
death. Guided by Sister Callista Roy’s Adaptation to Change Theory, this review is organized by
stages in which education should be implemented to produce change, therefore, preventing infant
Spina bifida and anencephaly are two major birth defects associated with high rates of
Education on the Prevention of Infant Mortality 5
infant mortality and disability (Botto et al., 1999). A 1991 randomized double-blind trial by the
Medical Research Council’s Vitamin Study Group provided evidence that folic acid prevents the
majority of spina bifida and anencephaly. This evidence led to a mandate, in 1998, by the United
States that wheat flour and maize be fortified with folic acid to help prevent these diseases. A
recent study shows that approximately 1300 new cases of spina bifida and anencephaly are
prevented each year in the United States mandated that wheat and maize be fortified with folic
In this study, researchers obtained the annual number of births within each country from
the latest United Nations database of births (2013). Estimates of the prevalence of neural tube
defects were collected from the latest March of Dimes Global Report on Birth Defects.
Researchers only included countries that had mandatory fortification and added at least 1.0 ppm
folic acid to their wheat and maize. This is the first time time that researchers have collected such
data. According to the March of Dimes Global Report on Birth Defects, the average global birth
prevalence of spina bifida and anencephaly was 2.4 per 1000 live births. Based on this statistic,
researchers conclude that mandatory folic acid fortification at 200 mg a day would prevent and
lower the rate of spina bifida and anencephaly to a total of 0.5 per 1000 births.
There is an important need to promote the prevention of folic acid preventable spina
bifida and anencephaly by a global folic acid fortification mandate. Successful interventions will
not only prevent FAPSBA, but will also contribute to reducing perinatal, neonatal, infant, and
There are some limitations in this analysis. Estimates are based on older and modeled
data, and may not be an accurate description of current statistics. Researchers conclude from this
Education on the Prevention of Infant Mortality 6
study that there is an urgent need for all countries to require folic acid fortification. When
implemented and monitored successfully, folic acid fortification is proven to make significant a
contribution toward preventing FAPSBA and reducing rates of infant mortality as well as
Neural tube defects (NTDs) are congenital malformations of the brain and spinal cord.
They are caused when the neural tube fails to close shortly after conception. These diseases are
associated with infant mortality. This article focuses on infants with open neural tubes. A
conservative estimate of incidence of states that there are 300,000 new cases of NTDs a year,
followed by 41,000 deaths. This article looks to discover what effect folic acid has on these
diseases.
Researchers reviewed the published literature to determine studies that looked at the
effects of folic acid take preconceptionally on NTDs. The population studied were infants and
the information looked at was the effect of folic acid supplementation using folic acid tablets
0.36 mg once daily to 5 mg once a week or food that was fortified with folic acid. This group
was compared to infants born from pregnancies without a supplement of folic acid.
The number of neonatal deaths due to congenital causes is estimated using a statistical
model. A major weakness of this approach is that only deaths in newborns with visible
congenital malformations will be attributed to congenital causes. NTDs remain an important yet
potentially preventable cause of neonatal mortality. There is quality evidence showing that
The US infant mortality rate has been steadily decreasing in recent years. It went from
6.75 per 1,000 live births in 2007 to 5.96 per 1,000 live births in 2013 (Matthews, 2015). A
Education on the Prevention of Infant Mortality 7
major contributor to infant mortality is preterm birth. Preterm birth is the cause of two thirds of
infant deaths.The aim of this study is to break down the change in the US infant mortality rate
into that proportion attributable to the change in the distribution of gestational age and the
proportion attributable to gestational age specific mortality for the total, non- Hispanic black,
Centers for Disease Control and Prevention National Vital Statistics System’s provided
data for researchers from period-linked birth and infant death files for 2007 and 2013. Data was
included if the gestational age on the death certificate was greater than 22 weeks. There were
24,633 infant deaths and 4,304,549 live births in 2007 and 19,301 infant deaths and 3,924,071
live births for 2013. 31% of the overall infant mortality decrease is due to changes in the
gestational age distribution and 69% is due to improvements in gestational age-specific survival.
Infant mortality improved between 2007 and 2013 as a result of both improvements in
preterm birth and survival after birth. Decreases in mortality at each week of preterm gestation,
with the exception of a small increase at 33 weeks, contribute to the overall decrease. That being
said, each week a child is in utero their chances of survival increase. Obstetrical practices likely
have impacts in achieving reductions in infant mortality, particularly with regard to improving
the overall gestational age distribution. Reasons for declining preterm birth rates include
changes in risk factors for preterm birth, interventions for prevention, and promulgation of
The strength of this analysis is that 2 full years of national data are used, and it
represents the recent infant mortality experience in the United States. The analysis is based on
Education on the Prevention of Infant Mortality 8
vital records and has limitations imposed by missing and misclassified information.
reduction rate differentials show that the decline in neonatal mortality rate has been lagging
behind those of post-neonates. Each year, approximately 2.8 million children die within their
first 28 days of life. Many of these deaths are caused by preventable complications such as
preterm birth, delivery complications, and infection. Preterm birth causing low birth weight is the
The Every Newborn Action Plan was put in to place based on this evidence to end
newborn deaths and still births by 2035. The main goal of this plan is to reduce the rate of
neonatal death to less than 10 per 1,000. In order to avoid preventable deaths, there must be a life
cycle approach to care including preconception and prenatal. Interventions during pre-partum
include delaying age at first pregnancy, meeting unmet family needs, birth spacing, and
enhancement of nutrition status. All of these factors have been related to improved maternal,
neonatal, and fetal outcomes. Bhutta et al. systematically reviewed interventions across the
continuum of care and various delivery platforms, and then modelled the effect and cost of scale-
up. Approximately 47% of infant death and 64% of still births can be prevented using family
planning services, according to estimates. Prenatal care is important for long term health and
nutrition. Limitations of this study include using estimates to make conclusions based on data as
causes of spontaneous abortion and its contributing factors, there are different considerations
during delivery and directly after birth while still under physician care in the hospital setting.
Education on the Prevention of Infant Mortality 9
Once a birth occurs, it is a responsibility of the healthcare team involved to ensure the health and
safety of the infant and mother, as well as to provide education that will allow the mother and
other family members to continue this health and safety after departing the hospital. By closely
considering the causes of infant mortality that occur during delivery, within the hospital setting,
and after returning home, a plan for implementing proper education can be determined.
Bed sharing between infants and their parents is known to be risky and yet hospitals
continue to allow mothers and infants to sleep together, especially if the mother chooses to
breastfeed. BT Thach and his group of researchers quantify the risk involved by examining this
behavior related to infant death during the hospital stay. In 2011, email requests were sent to all
the members of the National Association of Medical Examiners for information on infant deaths
that occurred while sharing a bed in the hospital. Information on 15 infant deaths was returned.
The affected infants involved in this study prior to their death were healthy, had no physical
problems, and were delivered without complications. All 15 infant deaths include one or more
identified risk factors of bed sharing, the number of associated deaths shown in parentheses:
Breastfeeding while lying down (8), obesity (2), swaddling (2), infants less than 4 months of age
(15), sedating medication (4), excessive maternal exhaustion (15), and smoking (2).
In concluding the study, Thach and his team confirm that the causes leading to infant
death are preventable and there is a need for education on prevention techniques. With only a
few infant deaths to study, Thach recommends that all infant deaths or near deaths while in the
hospital be reported to state health agencies so that more information will be available for further
research. Thach’s research is limited by the suspected under-reporting of infant deaths during
The educational approaches that are recommended suggest further education be provided
to new mothers including the importance of providing care in a well-lit room. Thach suggests
more education on skin-to-skin and bed-sharing risks, how to assess an infant's breathing, skin
color, and response to stimuli, and the importance of sitting upright when breast feeding should
be presented to new parents directly after delivery. Close supervision during the hospital stay by
a trained person should also be implemented in order to continuously assess both infant and new
mother. Training another family member who will have close contact both during and after the
hospital stay is important in ensuring the continued monitoring of safe practices. With any health
program, infant and new mothers should be continuously monitored for any changes in health
status or adverse effects that may occur, modifying the health plan as needed (Thach, 2014).
According to the Centers for Disease Control and Prevention, there are three commonly
reported infant deaths: SIDS, suffocation or strangulation from bed sharing and “unknown
causes”. As of 2014, SIDS represented 44% of infant deaths, bed sharing represented 25%, and
“unknown causes” represented 31% of all infant deaths. Based on these statistics, a 6 person
This team of researchers consulted other local hospitals, clinics, and examined the current
literature to determine a safer way for babies to sleep. Based on location, they found that
between 2009 and 2010 there were 487 infant deaths. Of these deaths, 89 infants died due to
sudden, unexplained sleep related issues and of these deaths only 10 (11%) of the infants were in
what is considered a fully safe sleep environment. It was also discovered that 34 (38%) of the 89
infant deaths were due to accidental suffocation. Upon further investigation, the team found that
there is inconsistency in how infants are put to sleep while in the NICU.
Education on the Prevention of Infant Mortality 11
Audits from 2014 data of this research show that the nursing staff was following the safe
sleep practices only 20% of the time. This data also showed that the sleep environment was not
safe due to loose blankets or infants were being placed on their sides or stomachs. They also
found that after discharge, unsafe sleep practices are continuing in the home. Based on this
information, the team realized that these behaviors were modifiable with education and modeling
of safe sleep practices while in the hospital. With this in mind, the team implemented the use of
“bundles” to be used by the NICU staff as well as other pediatric hospital floors. These bundles
are prepared care packages for use by clinicians and other medical professionals that include
sleepsacks, clinical guidelines for a safe sleep environment, standardized caregiver discharge
education, and providing outreach education sessions in the community during a woman’s
prenatal visits.
In November and December 2014, the NICU staff was educated on how to use these
bundles, and in January 2015, the program was fully implemented. Internal audits are still
ongoing and include the monitoring of infants while sleeping in NICU cribs, compliance of the
staff providing caregiver education, including showing the NIH safe sleep video and obtaining
signed documents, and follow up phones calls for two months after discharge to caregivers.
Results within 6 months of implementation show that 90% of NICU nurses and staff are now
modeling safe sleep practices compared to 20% before implementation. Random chart audits of
30 infants show 100% compliance with caregiver education as well as follow ups after discharge
find that most caregivers follow the safe sleep practices at home by not cosleeping with their
infant and using a hard flat sleeping surface. From the start of the intervention in January 2015 to
the end of the year, there were no sleep-related infant deaths among patients discharged from the
NICU.
Education on the Prevention of Infant Mortality 12
This study is limited because of the lack of resources to follow all patients discharged
from the NICU. It is also limited because available infant death statistics in the state of
Pennsylvania take three years to publish. It is further limited by the inability to track all infant
patients at all hospital or clinics local, state and nationwide. In conclusion, it has been found that
standardization of safe sleeping practices, clear guidelines, and increased education among staff
in the NICU and other pediatric floors as well as for caregivers have the potential to dramatically
improve infant care while in the hospital as well as at home (Zachritz, W., Fulmer, M., &
Following in the same pretense of the Philadelphia study, Boston Children’s Hospital
(BCH) also decided to see how they would be able to increase the number of infants being
placed in a safe sleep environment while admitted to the NICU. BCH studied two NICU units
that are affiliated with them. Each NICU unit had a research team that had a neonatologist,
nurses, clinical nurse educator, occupational therapists, and physical therapists. These two teams
were responsible for providing professional input on how this initiative would be implemented.
The teams decided the parameters for this study would be any infant who is older than 34 weeks,
weighs more than 1800 g, and has no acute medical condition. The infants who meet this criteria
were placed into one of two sleep practices: Safe Sleep Practice (SSP) or NICU therapeutic
positioning (NTP) which is what is normally used in the NICU setting. During the time period of
November 2013 through June 2014, nurse educators trained NICU nurses in safe sleeping
practices and provided web based learning modules that all NICU nurses had to complete as a
continuing education program. Once trained, the nurses were then tasked with educating the
families as well as following the safe sleeping practice guidelines. Daily audits were performed
by the nurse educators and other members of the intervention teams to ensure that all staff was
Education on the Prevention of Infant Mortality 13
adhering to the SSP initiative and to measure the benefits of the SSP. The results of this
initiative show that there was significant improvement with SSP compliance (25.9% to 79.7%)
and that SSP can easily be taught and used in the care of infants in NICU’s. Though this
initiative was limited because of the short time period, audits during the day and not at night
when infants are asleep, and the inability to follow up with home SSP compliance, BCH
concludes that SSP can be successfully implemented in the NICU environment and believes that
further implementation of SSP education at the bedside that starts at the time of admission and
continues til discharge will lead to a greater compliance of SSP at home and therefore decrease
Accidental suffocation and strangulation in bed (ASSB) is the most frequently reported
cause of death accounting for nearly 400 deaths annually. ASSB is preventable and it is
important to identify the underlying risk factors however difficult that may be. This study’s
primary focus is to identify the maternal and infant characteristics seen with the increase in
ASSB in the US using secondary objectives that didn’t involve race/ethnicity. Birth and
death certificate data from January 2000 through December 2003 were obtained because these
years contained the most frequent national data however; this data is limited because not all
states use the new birth certificates which allow for more variables to be collected.
Using this data, a population-based study was performed with the primary outcome being
ASSB related deaths. Maternal risk factors available through birth certificate data included:
education, age, race/ethnicity, place of birth, prenatal care, smoking during pregnancy, and the
number of pregnancies. Infant risk factors included: sex, gestational age, birthweight, and
presence of congenital anomalies at birth. Frequency distribution of the risk factors for the
mother and child among ASSB deaths were then compared to survivors and the differences were
Education on the Prevention of Infant Mortality 14
analyzed using the Mantel-Haenszel chi-square tests. Odd ratios were used and any maternal or
infant ratios greater than 2.0 were considered strong predictors of ASSB. Once the parameters
were set, the final population used for this study is 11, 573, 678 infants, of which 1, 064 infants
died of ASSB. The ASSB mortality rate is 9.19 infant deaths per 100,000 live births during this
study period.
It is found that infants with ASSB mortality are more likely to have mothers who had
more than one child, are less educated, are either African-American or Native
American/Alaskan Native, and are US born; who had no prenatal care, and who smoked during
pregnancy. This study also shows that infants with the highest ASSB mortality rates are male and
are born between 20 and 33 weeks gestation. It also shows that most ASSB mortalities (71%)
occur before 4 months of age. Based on this study it is important to understand sleep practices
and caregiver behaviors. With this knowledge of risk factors, health care providers and health
educators need to develop specific educational strategies that target the populations containing
This study recommends the education of caregivers with children under the age of 4
months be educated on safe sleeping practices. The sample size of this study lends validity
however this study is still limited by the data collected. Death certificates do not always report
specific cause of suffocation. It is also limited because of the modifiable factors associated with
ASSB mortality. It also does not take into effect the infant's sleeping position or sleeping
environment at the time of death. In conclusion, this study finds it is best to perform a risk
assessment on each individual mother at the time of admission and then perform an infant risk
assessment upon birth in order to tailor the education of safe sleeping practices unique to that
specific family (Carlberg, M. M., Shapiro-Mendoza, C. K., & Goodman, M., 2011).
Education on the Prevention of Infant Mortality 15
In the article of “Infant Mortality in the United States (1998),” a study is conducted on
how participation in the Special Supplemental Nutrition Program for Women, Infants, and
Children (WIC) and Medicaid impacts infant mortality in the United States. It is believed that
participating in either program helps less privileged mothers and their babies by providing
money for nutrition, care products, and health care. Even before this study, it is proven that better
nutrition for both the mother and infant can reduce the risk of infant mortality within the first
Poverty continues to be a growing problem in the US, and programs like WIC allow
women to properly nourish their newborns despite a low socioeconomic status. This study
suggests that with proper nourishment of both mother and infant, occurrences of infant mortality
within the US can be reduced. While poverty causes a lack of access to proper nourishment,
many low-income families also lack health insurance, making it difficult to access proper
postpartum education after leaving the hospital. Programs like Medicaid help low-income
mothers afford health care for themselves and their infants when private insurance is not
accessible. By being in the Medicaid program, women can continue to seek proper care and
education after leaving the hospital. Infant survival among low-income families can be affected
differently based on participation in WIC or Medicaid as well as what stage of pregnancy the
infant and mother enter into either program (Moss, Carver. 1998). This study looks at both
endogenous deaths, which occur during pregnancy and delivery, and exogenous deaths, which
occur during infancy. It is concluded that WIC and Medicaid participation reduce both
women whose household incomes are 185% below the poverty line. Samples from 9,953 live
Education on the Prevention of Infant Mortality 16
births and 5,332 infant deaths from NYC and the District of Columbia are utilized. A limitation
of this study is that certain ethnicities are not used. The response rate is 74% among mothers who
experienced a live birth and 68% from those who went through an infant death. Another aspect
of the study includes the mother's age and educational level. Most mothers participating in the
study are more than 30 years old, white, married, and had at least a high school education. The
final sample consists of 5,019 survivors, 860 exogenous deaths, and 1,917 endogenous deaths.
For the purpose of this study, a woman is considered a program participant based on the
following: Receipt of WIC food for herself during the pregnancy, receipt of WIC food for herself
and the infant after birth, utilization of WIC or Medicaid as the source of prenatal care, or
utilization of WIC or Medicaid for payment toward any infant illness, and for general care of the
infant after birth. Multiple factors affecting the birth of an infant are examined, including
The following results were concluded: Mothers in the WIC program are more likely to
have health problems than nonparticipants, infants involved in WIC participation are less likely
to die of endogenous causes, and mothers without any health insurance are at a higher risk for
death. In conclusion, being a part of WIC during pregnancy reduces both endogenous and
exogenous infant deaths; however, being a part of Medicaid has no varying effect of infant
programs and health insurance better enables mothers to care for their infants, thus leading to a
In an article by Texas A&M, infant mortality is defined as the death of babies under the
age of one. Unlike some countries, the United States includes the deaths of prematurely born
Education on the Prevention of Infant Mortality 17
infants in this analysis, causing a spike in the number of deaths per year of babies born at full
term. This article defines controllable risk factors as the use of tobacco, alcohol, cocaine, and
other drugs, as well as the lack of access to quality prenatal care. The research conducted
suggests that infants born to wealthier and better educated families have better survival rates for
their newborns compared to new mothers without proper education or financial means to get
According to research, more than 20 percent of babies in the United States are not being
put on their backs, which is the safest way for them to sleep. A key finding in this article is about
the benefits of home nurse visits. Home visits after a mother gives birth to an infant allow a
nurse to provide and teach proper care in the home. This includes checkups, prevention of SIDS,
and inspection of the home for possible hazards. "We have considerable research evidence of the
beneficial effects of home nurse visits for new moms, with special emphasis on the health
benefits to their children," said Lisako McKyer, PhD, associate dean for climate and diversity
and associate professor at the Texas A&M School of Public Health. For example, research
reveals that regular visits from nurses and similar paraprofessionals lead to better psychological
outcomes for both mother and infant, which means lower health care costs over the course of
Home nurse visits also help teen mothers or mothers who are addicts by providing
teaching that these mothers might not otherwise receive. In the end, these home visits allow
mothers to learn what they didn’t learn in the hospital to care for their infant and prevent infant
mortality. These visits are essential in giving proper health care to newborn families who need it.
The safer home translates to less money spent on treating sick and injured infants, which is
especially important considering the cost of care for the rest of the baby's life.
Education on the Prevention of Infant Mortality 18
This article encourages mothers to allow for home health visits as a necessary step in
providing the best possible care for their infant. While home health visits are an investment, it is
argued that they are an important investment toward a healthy life of the baby, reducing future
medical expenses. It is also suggested that home health visits reduce emergency room visits
within the first week of a newborn's life. The literature proves that proper access to health care
can help reduce infant mortality and enhance an infant’s overall health.
In the article, “First steps for Mommy and Me: A pilot intervention to improve nutrition
and physical activity behaviors of postpartum mothers and their infants”, a study is conducted to
assess the feasibility of pediatric care based intervention to promote healthful behaviors among
0-6 month old babies and their mothers. This article advocates for proper nutrition and healthy
lifestyles of both the mother and the infant to help reduce infant mortality.
Having proper nutrition helps nourish the infant, ensuring that he or she is healthy,
lowering the risk of low-weight infant deaths. In the study, a group of 60 mother-infant pairs are
studied, with 24 of those pairs being controlled. Visits and interviews of 95% of the pairs are
multiple parenting workshops. These encounters occur at birth and then again 6 months later,
focusing on the effects any intervention has on infant feeding, sleep duration, watching TV, and
Throughout the study, researchers focus on the mother’s postpartum diet, exercise, TV,
and sleep. Health educators hired by the researchers interviewed mothers at 3 weeks, 6 weeks, 3
and 5 months postpartum. In each subject interview, healthy eating behaviors, exercise, sleep,
and TV are discussed to evaluate how mothers care for their infants after leaving the hospital.
These subject interviews also look at the infant's breastfeeding duration, introduction of solid
Education on the Prevention of Infant Mortality 19
foods, sleep, TV, and safety measures. The interviewers encourage the mothers to care for their
infants in a way that promotes better health. If the researcher feels the mother needs to change
her method of caring, education is provided on how to make necessary changes, including the
use of informative posters and handouts. After 6 months, the researchers returned to assess how
the education during the initial interview has affected health status and caring behaviors
including infant sleep, and breastfeeding durations, infant weight, and introduction to solid
foods.
The study concludes that there is no drastic difference in the outcomes of the mothers
who participated in the study versus nonparticipants; however, mothers do benefit from receiving
education. Having access to health educators and parenting workshops ensures that parents care
for their infants the proper way. Mothers are “somewhat or very” satisfied with this study and
feel benefited by it. The researchers feel that this study helps progress the care of infants, but
does not impact the mother’s own health behaviors. One limitation to this study is that it did not
focus on differences amongst lower income families and access to health care.
In the article, Improving Maternal and infant child health outcomes with community-
based support groups: Outcomes from Moms2B Ohio, a study being conducted examining the
program, Moms2B. It started in 2011 and went to 2014. The results are based on 195 pregnant
women in attendance for one or more sessions. Out of the 195 women, 75% are African
American with incomes less than $800 per month and limited medical resources. Moms who
participated in the Moms2B programs saw a reduction in the rate of infant death within the first 4
years of the program. This shows that by attending and participating in the program it allowed
these misfortunate and impoverished mothers to learn the necessities to better care for their
Education on the Prevention of Infant Mortality 20
From 2007 to 2010, there were 442 births and 6 infant deaths within the program of
study. From 2011 through 2014, there were 339 births with only 1 infant death (Gabe et al.,
2017). A strength of this article was that it was easily measurable in that the outcomes of the
study allowed the researchers to conclude that improvements were reached in infant health and
maternal outcomes.. Before doing this study, infant mortality rates among African Americans in
Ohio were ranked 50th in the nation in 2011 (Ohio Department of Health. 2015). Infant mortality
The Moms2B program was initiated to reduce disparities in infant mortality by focusing
on low income, predominantly African American pregnant women to improve their nutrition,
social and medical support while pregnant and continue through their child’s first year of life.
This study was conducted from 2011 to 2014 in Weinland Park, focusing on 24 pregnant African
American women living in the area. The mothers were recruited by sending out flyers to endorse
their participation. Participants were offered sessions every week that provided them with WIC
involvement, breastfeeding information and how to properly nurture and care for their infants.
The researchers used questionnaires to assess the mothers each week based on their needs.
Throughout the duration of the study, 194 Moms2B sessions were held and 206 pregnant women
were visited, with 61.7% of participants attending more than 3 sessions. This was the baseline
that the researchers felt they could get a positive impact from the sessions.
This study focused on women predominantly in poverty, enrolled in WIC and had some
stressors in their life. A weakness of this study is that it overrepresented African American
women. Infant mortality rates went from 14.2 to 2.9 per 1000 births. Most women in the study
agree that the Moms2B sessions truly helped them in their pregnancy. Breastfeeding also
Education on the Prevention of Infant Mortality 21
increased from 37.9 to 71.4%. It is believed that by providing these mothers with emotional and
physical health guidance they have better outcomes with their births. Finally, a major limitation
to this study is that it is confined to a small urban community in Ohio. It may have been different
had the population of the study been larger. Overall, this study proved that Moms2B is a
successful intervention in limiting infant mortality and providing mothers with the proper tools
Limitations
The literature presented in this review has limitations on the individual level that control
the results of the studies involved. Overall, many limitations have similar themes pertaining to
the race, age, socioeconomic status, and location of the sample. This includes, as mentioned in
each individual review, use of only certain ethnicities; small population and sample sizes; the
focus on only urban neighborhoods and impoverished mothers; the age and education level of the
mother; the lack of local, state, and national databases; estimates based on older and modeled
data lacking accuracy; limited reporting on infant deaths and causes; missing and misclassified
information; lack of resources; slow return times on published statistics; and variances in data
A major limitation in one of the studies was that deaths of newborns with visible
congenital malformations were the only deaths attributed to congenital causes. One study was
also specifically limited by the data and how it was collected regarding infant sleeping position.
Data collection through another research study was also limited by the difficulty to distinguish
between SIDS and death from suffocation and strangulation when discriminate investigation was
not done.
Education on the Prevention of Infant Mortality 22
While there are various causes occurring at different stages of pregnancy and birth, the
combined literature presented in this review seems to agree that infant mortality can be
significantly reduced and prevented by providing proper education to families. Guided by Sister
Callista Roy’s theory of adaptation to change, this research proves that by making important
lifestyle changes in how a mother cares for herself and her infant prepartum, during delivery, and
healthy living for infants. Expecting mothers as well as women who intend to become pregnant
need to increase their intake of folic acid in order to avoid preventable birth defects that can lead
to mortality. In addition to this increase, expecting mothers also need to take special care of their
child during pregnancy by first taking care of themselves by attending doctor’s appointment,
eating properly, and avoiding things that can cause potential birth defects.
Based on the literature, there is a need for a local, state, and national database on infant
mortality to understand infant mortality. Highly focused education for the staff as well as the
infant caregivers is needed from the moment of admission until discharge. Modeling of safe
sleep practices by hospital staff and caregivers during the hospital stay greatly increased
adherence to this practice once discharged to home. Focused and tailored education is needed for
mothers and infants who possess greater risk factors for sudden unexplained infant death.
Implementation of SSP can easily be integrated in to the care of infants in NICU’s as well as
In postpartum care, the studies concluded that mothers need education from nurses on
Education on the Prevention of Infant Mortality 23
how to provide the proper care for their infants. It is also suggested that through programs such
as Moms2B and informational support groups, new mothers can gather the knowledge they need
in order to prevent infant mortality. Another source for support are programs like WIC and
The implications for nursing to reduce and prevent infant mortality in postpartum care are
clear to understand. It is important for nurses to encourage participation in support groups, such
as the Moms2B program. Attending and actively participating in 3 or more sessions is proven to
have a positive impact on mothers. Mothers who received nutritional support and educational
information by nurses while in the support programs were able to properly care for their infants,
which lead to a reduction in infant mortality. Home health visits by nurses ensures safe care of
infants within the home once being discharged from the hospital. It is proven that these visits
reduce future medical costs, as well, therefore reducing further medical problems that could lead
to infant mortality.
Education on the Prevention of Infant Mortality 24
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