I Need Blue
I turned around to see a masked man pointing a gun at me. It was just the beginning of a series of events, including robbery and abduction, which changed my life forever. I Need Blue, hosted by Jen Lee, is a podcast series featuring lived-experiences from survivors of life events. I NEED BLUE creates space for survivors of trauma to feel they BELONG, are LOVED, UNDERSTOOD and EMPOWERED! I called 9-1-1 and they provided me with life-saving directions to help my customer who was having a medical emergency. Law enforcement rescued us and caught the robber. Our first-responders face unique traumas every day. I NEED BLUE provides space for them too!
I Need Blue
Addressing Fetal & Infant Mortality with Compassion: Indian River County Healthy Start
Indian River County Healthy Start Coalition’s mission is to establish and support a local system of care that optimizes the health of moms, babies, and their families living in Indian River County.
In today's conversation with Megan McFall, CEO of Indian River County Healthy Start, we unpack the staggering statistics of infant mortality in our community and explore the Fetal and Infant Mortality Review process. By analyzing mortality cases, we uncover systemic issues, and our discussion reveals how identifying care gaps can lead to preventative measures that protect the most vulnerable.
Along the way, we confront the emotional challenges faced by healthcare professionals, especially regarding fetal demises.
We also discuss the need for preconception and interconception care, recognizing the health challenges many women face before pregnancy.
Megan shares Healthy Start's initiatives, such as trauma-informed care and implicit bias training, empowering caregivers with essential tools.
Contact: Indian River County Healthy Start Coalition
1555 Indian River Blvd, Suite B241 Vero Beach, FL 32960
(772) 563-9118
info@irchealthystart.org
https://www.irchealthystartcoalition.org/
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Everyone has a story. They just don't always have a place to share it. Welcome to I Need Blue, the podcast about to take you on an extraordinary journey where profound narratives come to life, one captivating episode at a time. I'm your host, jennifer Lee, and I founded this podcast because I know there is healing and sharing. Each story you will hear shared on this podcast is a testament to our collective strength, innate ability to transform in the incredible power of healing. Please remember you are never alone. Please visit and share my website with those seeking connection and inspiration wwwineedbluenet. Thank you, char Good, for composing and performing the introduction medley for I Need Blue. You can find information about Char on her website, wwwchargoodcom.
Speaker 1:Before starting today's episode, I must provide a trigger warning. I Need Blue features graphic themes, including, but not limited to, violence, abuse and murder, and may not be suitable for all listeners. Please take care of yourself and don't hesitate to ask for help if you need it. Now let's get started with today's story. If you'll remember, a week ago we heard the courageous story from Haley, a mother who lost her son at just eight days old. She experienced a pain I can't imagine, but she is not alone.
Speaker 1:There is a staggering statistic that in 2022, the infant mortality rate in the United States was 5.6 deaths per 1,000 live births. Infant mortality is defined as the death of an infant before their first birthday, and it's an essential indicator of a society's overall health. I invited my guest today to help us better understand this epidemic. I'm honored to introduce Megan McFall, ceo of Indian River County Healthy Start. Megan became CEO in June 2023 and is dedicated to improving maternal and child health in the community. She focuses on reducing maternal, fetal and infant mortality, while also working to enhance family engagement and promote healthy literacy in Indian River County.
Speaker 1:Megan began her career over 25 years ago. Driven by a deep desire to care for others, she moved to Vero Beach in 1985 and has made a difference in local family lives, with two decades of experience managing teams and fostering compassionate care. Before becoming CEO, megan spent 17 years at Cleveland Clinic Indian River Hospital, where she held leadership roles. One is director of women's health care, a position allowing her to impact mothers and children directly. Megan, thank you so much for being my guest today and welcome to the I Need Blue podcast.
Speaker 2:Thank you so much. I'm very honored to be here. You know this topic is near and dear to my heart, so anytime I have the opportunity to share information and to get more people knowledgeable about infant and fetal loss, I feel very blessed. So thank you.
Speaker 1:Of course you know I wanted to share a little background because I'm new to the area and so how I came across you all is you are offering a workshop on trauma-informed care and I was like, oh, I would really benefit from that. So I signed up and then the hurricane came through so it had to be rescheduled and I couldn't then make the dates. And then I saw that you had also a class on fentanyl. Oh my gosh, I was like I really need to meet them. So I visited and met with some of your coworkers. I know Jessica and I'm thinking that they want to talk about, you know, fentanyl or trauma. But when they said to me we really want to talk about pregnancy, fetal infant mortality, I was like, wow, as a mom, so many women, it really is and the statistics of the county where we live. You wouldn't think that it's almost like this hidden secret.
Speaker 2:Yeah, it's things that you don't talk about, right, because it's not glamorous, it's not sexy and it doesn't pertain to everybody. But it does and that's what people need to understand. It really does pertain to everybody. Like you stated in your beautiful opening, the health of women and children often really determines how healthy your community is.
Speaker 1:Absolutely, like you said, it affects the mom, it affects the dad, it affects the family, it trickles down, and so our conversation today is here to support everyone that has been affected by this epidemic. So, without further ado, as the expert, I'm going to let you take over and share some very valuable information with us. I really appreciate that.
Speaker 2:So I think it's important to first understand like how do we even get this information? In New River County Healthy Start Coalition, our job is to look at the gaps in care that are associated with infant mortality, fetal mortality, maternal morbidity and mortality and then provide programs that really address the gaps in care, that allow those to happen right, because one death is too many deaths, and so we do something here at Healthy Start called the Fetal and Infant Mortality Review, and what that is is we look at every single death that happens in our community. We get the birth certificates, the birth certificates, the death certificates, and then we ask for all the medical records for that particular case, from the moment that the mom got pregnant and hopefully had some type of preconception care up until the infant passed away. And then there's a nurse abstractor that sits down, compiles all that information and then puts a very detailed timeline together Again from the moment that the mom walked into her OB practice. From what type of education did she get? Was it the proper lab work? Does she have a history of depression and was that addressed? And was she hooked up with counseling immediately? Does she have substance use disorder, and did we get her into like a medication assisted treatment program, all of those things that could have contributed to the death. And then the case review team meets on a monthly basis. It's experts in the room that go over that case, it's OBGYN, social workers, the sheriff's department, medical examiners, and they say, if maybe we just would have had this in place, this death could have been prevented. And so we then take that information and give it to a community action group. And then the community action group says this is what I think Healthy Start needs to implement in order to address the gaps in care. So that's what we do here.
Speaker 2:I'm a registered nurse. I've been in the maternal child health space for 18 years, spent a lot of my time at the bedside, and you hit on this in the very beginning, and that is it's something that we don't really talk about. When I went to nursing school, I always knew I wanted to do maternal child health, and so I felt extremely blessed and so excited when I was able to get into that space. What they don't teach you in nursing school and what you don't come across in orientation hopefully, because it probably would make you run the other way are these fetal demises that come in right, these moms that will come into labor and delivery and say I haven't felt my baby move.
Speaker 2:I will never forget my first demise that I had, where a mom walked in and I was about three and a half years into my tenure at the hospital working as a labor and delivery nurse, and she said I haven't felt my baby move since last night. I've been so busy, you know, helping my mom prepare for my baby shower. And then it happened and I'm opening up all the gifts and as I'm going through I'm like gosh, I really haven't felt him move. And she's like so that's why I'm here. And so that wasn't abnormal to hear, right, moms coming in because they were concerned about fetal movement and so we would go ahead and put them on the monitor and nine times out of 10, it's fine, put the mom on the monitor. The mom takes a big sigh of relief and everything's good to go Well in this situation. Three and a half years in, it wasn't right. And so here I am faced with oh my gosh, how am I going to tell this mom that, like I can't find the heartbeat?
Speaker 2:And then it rolled into my passion of I love labor and delivery and I love bringing life into the world, and there's nothing better than that, and this is the best job in the world. Until it's not, and you don't get the training, you don't have the knowledge. And it's why I came over to Healthy Start, because you really look at the cases that we look over and it is truly a knowledge gap that these families have in regards to proper prenatal care and how much smoking does contribute to infant and fetal loss. And so, you know, I started working with Healthy Start on their fetal and infant mortality review, became their nurse abstracter, and when you peel the onion layers back, you just sit there with your head in your hands and just shaking your head and thinking, gosh, if they just would have had the knowledge or if they just would have been involved in one of our programs, this outcome could have been completely different. And so that's the process that we do here.
Speaker 2:So we truly have a microscope on every single death that happens, and our rates are not what they should be in this community in regards to all of the additional support that we have in our community and with the philanthropic colors that we have. But we do. And so then, okay, well, how do we combat that? And the only way to do it is by doing that fetal and infant mortality review. And so, you know, I just sat down with my board of directors today in a retreat and going through data from 2022 to 2024. Now, please remember that the 23 and the 24 data, that's provisional, you know, it's not set in stone, but the death certificates that we have received from the beginning of 2022 to the end of 2024, we have had 22 infant deaths in Indian River County and again, that's from the time that a mom gives birth and the baby is born alive up until the first day before the baby's first birthday. So the child is 364 days old.
Speaker 2:There's different themes that you see, and the themes that I just really want to touch on today is the importance of preconception care and interconception care. So one of the things that we're seeing here in our community is that moms are walking into pregnancy extremely unhealthy. 89% of the cases that we reviewed had at least the mom had at least one comorbidity. So what does that mean? That means the mom walked into pregnancy maybe overweight or obese, and then with obesity comes diabetes and high blood pressure and all the other things. Maybe they have a history of substance use disorder and they've had a relapse.
Speaker 2:What happens is, at the age of 18, you know if your parents have done what they're supposed to do. From the time that you're born until the age 18, you go to your yearly well check visit and you see your pediatrician and you get some lab work done and you get some regular immunizations. And then, at the age of 18, your doctor, who has been your doctor for 18 years, is no longer your physician, right, because it doesn't allow them to go ahead and take care of you as an adult, and so you're often just faced with a lot of things. At the age of 18, right, it's considered adulthood. You're graduating from high school and trying to figure out what the next steps are. Are you going into the workforce, are you going to college, are you going into the military? And what you're not thinking about is oh, I'm 18 and I no longer have a doctor. And so these women are walking into pregnancy not having seen a doctor for however long it has been since they've seen their pediatrician.
Speaker 2:I just reviewed a case last night and it was of a mom who inadvertently found out that she was pregnant by going to the emergency department because she had had a motor vehicle accident found out, she needed some imaging done in the emergency department. Anytime you need a CAT scan or an x-ray. If you're of childbearing age, they make you do a pregnancy test and, lo and behold, she's five weeks pregnant. She didn't know. But the other thing that she didn't know is that she was diabetic. Her blood glucose was 296. So when she went to the obstetrician at eight weeks gestation she had her hemoglobin A1C drawn, which shows you what your blood sugar has been over a three month period, and it was 10.7. Now, that is well above what it should be and that means that her blood sugars have probably been running over 300 for months. And the OB provider in the notes had written well, when's the last time you saw a primary care provider? Oh, it's been quite some time. And so, unfortunately, that mom, from five weeks to 37 weeks, did her very best job to go ahead and carry that baby to term and two days after having her last appointment, hearing the positive fetal heart tones, two days later she walked into an ultrasound appointment that she had scheduled because she was diabetic and they did something called biophysical profiles every week and that baby didn't have a heartbeat.
Speaker 2:And when you sit back and you look at that case, you start questioning. Sit back and you look at that case. You start questioning did her uncontrolled diabetes contribute to the loss of this baby? And after looking through it, the answer is yes, and so would that mom have had a different outcome if she could have controlled her diabetes when she first knew that she had it right? So she's walking into pregnancy at the age of 30, not seeing a primary care doctor in 12 years. So who knows the last time she had her right? So she's walking into pregnancy at the age of 30, not seeing a primary care doctor in 12 years. So who knows the last time she had elapsed from? So that is a huge contributor.
Speaker 2:In Indian River County, let's see the stat. Is that? Wow, 90% of the cases that we reviewed in Indian River County, 90% of the moms from 2022 to 2024 had not seen a primary care provider. I mean, that's alarming, right? And so I think most people, once they get into young adulthood, they start imagining what does my future look like? Right, and for the majority of people, I think that they see a family in their future, and so, with that needs to be the conversation of okay, but in order to get there, you need to have a primary care provider. And let me tell you what the statistics could be if you don't do the work ahead of time. Right, it's like saying, go to college without doing the prep work. Nobody would do that right? Like you have to graduate high school or get your GED and show an equivalence that you are ready to be able to walk into college. It's the same thing with pregnancy you have to make sure that your body is fueled enough and healthy enough to be able to carry a baby to term. And then, once the baby is carried to term, what do we have to do and what kind of education do we need in order to make sure that that baby doesn't die before its first year of life?
Speaker 2:In River County, we had four deaths related to sleep. It was either bed sharing with a family member and unfortunately there was some type of suffocation that happened, or leaving that child in their own sleep environment, but maybe with a pillow and a blanket, or someone sleeping in their car seat for an extended period of time. Blanket, or someone sleeping in their car seat for an extended period of time, and all that is is just education, right? So I like to tell the story of I have two girls and when my first daughter was born, it was you put your baby on their belly to sleep. Right, that's what I knew, that's what my parents had told me, that's what my aunts had told me. You know, baby sleep on their belly. And so I did that.
Speaker 2:And then, four and a half years later, when I have my second daughter, there was science and education that came out that sleeping on your belly contributed to increased risks of sudden infant death syndrome, which you know would fall into an infant death. And I was like Whoa, whoa, whoa, whoa, whoa. Like what are we talking about? My daughter was fine and like she's now four and a half, and but you have to pay attention to the science, right, and you have to pay attention to the research. So research tells you, in order to have your best outcome possible and not have a sleep related death, you need to make sure that your baby is alone on their back, without any type of blankets or stuffed animals, and they're not overheated, and breastfeeding helps contribute to that. So it is us getting in front of the families and just giving them that education in order to not have an adverse outcome.
Speaker 1:Right In regards to women having a physician. How much does not having health insurance play into that?
Speaker 2:It's a really great question. So in Indian River County we are extremely fortunate and this isn't in every county, but what I can do is I can speak to Indian River County. So let's just start. If you're pregnant in the state of Florida, if you do not have insurance, there is something called a PEPW process. That's presumptive eligibility for pregnant women and that is emergency Medicaid that you can get for the first 45 days and then for 45 days you have the opportunity to go ahead and bring in all the supporting documentation and for the most part of people in childbearing age, the cost of care exceeds what you're bringing home from a paycheck perspective. 50% of the deliveries that happen in the state of Florida are covered by Medicaid. I tell everyone just try. You have no idea if you'll be approved or not.
Speaker 2:In our community we have something called Indian River County Hospital District and the hospital district gets a certain millage from taxpayers' dollars to look at the health care in the community and provide support, monetary support, to programs that help benefit the outcomes in our community. In the early 90s the hospital district was looking at infant mortality and maternal morbidity in our community and saying we've got to do something, because it was well above where we're at right now. And so they put a request for a proposal out and said we want to go ahead and start an OB practice that provides care to women regardless of their ability to pay, and we will supplement the cost of that care to the tune of whatever you're showing is the need. And so, at that time, what was Indian River Medical Center said, well, we want to do that. And so the first hospital owned practice was started in our community. And so, in Indian River County, it doesn't matter what type of coverage you have, you have the ability to have phenomenal, phenomenal OB care.
Speaker 1:That's amazing and I think we definitely need to get the word out as well. And maybe there are other counties and other states and maybe they already do not sure that offer that same model. Yes, absolutely.
Speaker 2:Yeah, I would be extremely scared to see what our rates would be if we didn't have that type of comprehensive care.
Speaker 1:Yeah, now the data prior to 2022, do you have that?
Speaker 2:to compare. There was a spike, and we saw that around the entire country. I hate to blame everything on the pandemic and COVID, but that definitely had things to do with the outcomes that we had in our community. The other thing is and I don't want to go too far deep into this because then you're opening up a little bit of Pandora's box but there was some statute language that was changed in regards to what gestational age to count a fetal death. What weight cutoff do you have? There used to be that within the statues and there isn't that any longer, and so sometimes we'll be reviewing a 18 week infant death that happened. That was born. The baby weighed 310 grams but showed signs of life. So then that baby gets a birth certificate because it did show signs of life, but there's no way that that baby would have survived outside the room. That's a very, you know, pre viable age, and so that contributed to some of our numbers being skewed a little bit. But even with that being said, we know that there was a true increase in those numbers and definitely related to COVID from a physiological standpoint and what COVID was doing to the placentas, to just the regular things that happened with being in the home and cooped up and not being able to work, and the stressor levels.
Speaker 2:Let me just find this data real quick. The beauty about having a fetal and infant mortality review at your fingertips and having all of the medical records is you have the ability to really, like I said, do that deep dive. And what I love to look at is those social aspects that contribute to the deaths. Right, because we want to often point our fingers to the medical side of things. Right, the medical community. And was there a lack and was there a knowledge deficit on their end? A lot of the times, the answer to that is no. Okay. So 62% of moms who suffered an infant loss had some type of history with mental health disorders. So they had some type of anxiety, some type of depression, maybe ADHD, whatever the case might be 62% of those moms. So if you already had a mental health, if you didn't have a mental health disorder but anxiety before COVID, I can guarantee you that number spiked afterwards and I know that that definitely contributed to the outcomes that we have Absolutely.
Speaker 1:You know, I have two things. I wanted to ask Something else I had not thought of. Is you as a nurse, as a midwife, as doctors, anybody in that? I still consider y'all first responders. Well, thank you Absolutely. I never considered what it was like for you to not find a heartbeat. What does that conversation sound like?
Speaker 2:You know, that's the other reason I love where I work now, because, again, we don't get that training right. First of all, what is this like? It's devastating. It changes you right. There's a level of PTSD that I have related to the work that I have been in, because, again, it is being in the labor arena is the absolute most rewarding job in the world and it's the best until it is not, and so it's devastating and you never get used to it. Every single patient just really puts an imprint in your heart.
Speaker 2:The important thing is for the outside organizations, like Healthy Start, is to recognize that and to be able to give us the tools that we need in our toolbox in order to be able to keep going Right. Keep going right, because I've seen many people walk away from the bedside because they just can't handle telling another mom or another family that what they thought their life was going to look like doesn't look like that anymore, and so we have to be able to figure out how to unpack that, how to wrap that up in a box and, you know, go ahead and put it away on the shelf. And you spoke about how you first got introduced to Healthy Start, so one of the things that came out of our femur is that we recognized the people in the space that were doing the work with the families didn't have all the tools and the resources that they need. So we built this program called Healthy Communities in order to be able to outfit the individuals who are caring for the moms and the dads and the siblings in the household that were having losses. The training.
Speaker 2:So we talk about trauma-informed care, implicit bias training, motivational interviewing, healthy helping relationships. All of these programs really give you tools in your toolbox to be able to better care for the patients and to care for yourself. Healthy Helping Relationships talks to you about boundaries. We as caregivers most of us are really bad at that. I mean, I can only speak for myself. I'm horrible at boundaries, but when you take that course, you're like, oh yeah, I might have gone a little bit too far on that, and so it is knowing the resources in your community and being able to educate yourself and making sure that you take those classes.
Speaker 1:Yeah, you just said something that's going to segue me into where I wanted to go next. Y'all not only provide research, but you are a resource, and when I visited the diapers resource and when I visited the diapers, the formula, the room set up for fathers to come in and speak with each other about their grief Amazing. So can you share with us, as a resource in River County, what else you offer?
Speaker 2:Sure. So we have nine different patient-facing programs underneath the Healthy Start umbrella, and so I like to say that there's truly something for everyone. All of our programs are free of charge, and it is not just for the underserved, because, unfortunately, if you have a loss, it's oftentimes doesn't care what's in your bank account or what color of skin you have, right it just it runs across the gamut. And so we have something for everyone. We recognize that in our community, a mom had a loss. We didn't have a place to be able to say you need to go here. All of our programs have a bit of bereavement in there, and all of our individuals are trained, but they don't necessarily have shared life experiences and so one of the things that we're starting that I'm so excited about I'm sad to say that I'm excited about it because you shouldn't be excited about starting a bereavement support group. However, you know being in that line of work for so many years and not being able to say hey, listen, you need to call healthy start. Here's the number they have you know, a space for moms, dads and siblings every other Tuesday at this location. We didn't have anywhere here. I've been here for a year and a half.
Speaker 2:And that mom that I spoke about, who had her loss in her third trimester, is a mom that's actually now going to be running our bereavement programs, because it's been quite some time. She's been able to work through a lot. She has gone through a lot of our training. She's actually one of our doulas, which is a non-medical trained individual to help you through the prenatal, birth and postpartum process, and she just said, you know, I want to be able to provide that support to the moms and allow them to know that everything that they're feeling and not feeling is normal, and so that starts in January and we're really excited to see how we can better support, you know, our moms and our dads in this community.
Speaker 2:We have a fatherhood program too. It's phenomenal. You know we used to focus on just moms and babies, moms and babies, and forgetting about such a vital part of the family dynamic, and what I love is it meets the families where they're at right. So we talk about struggles with co-parenting. You don't necessarily need to be with the mom to go ahead and come to this class, you just need to be a dad. It talks about bereavement, and so we have a little bit of something for everyone.
Speaker 1:I love that, and so many times men deal with grief very differently than the mom does. Yeah, absolutely. Is there anything else you would like our listeners to take away from our conversation today? I'm sure?
Speaker 2:you have a variety of listeners, right, and so this is what I love to tell everyone If anybody is thinking of becoming pregnant, is pregnant or, you know, has a child under the age of five, I implore you to really just really dig into your community and see what resources are out there. I mean this is such a cliche saying, right, but there's so much truth behind it, and that it takes a village to raise a child period. End of discussion. I have two phenomenal human beings that are my daughters, right, but my husband and I surely did not do that on our own. We had a phenomenal village that really helped us, and I wish I would have known of all of the resources that we had in our community you know 25 and 20 years ago, because I would have known of all of the resources that we had in our community you know 25 and 20 years ago, because it would have made things maybe even easier, and so I would recommend everyone just finding out what resources you have in your community.
Speaker 2:If you live in the state of Florida, you have access to a Healthy Start Coalition. Every single county either has a Healthy Start Coalition or has access to one, so the smaller counties may not have their own coalition, but they have access and every coalition, again, is bound to look at the outcomes in the community in regards to maternal, child health and building programs. So, if you live in the state of Florida, look at your local Healthy Start Coalition. Call them up and say what do you have for me?
Speaker 1:Love it and my final message is don't be afraid to ask for help. You are not alone. Yes, yes, absolutely. Megan. Thank you for being my guest today on the I Need Blue podcast.
Speaker 2:Thank you for having me. I really appreciate it. I'm so glad we got connected. I'll be excited to see you come to our trainings. You know, knowledge is power right?
Speaker 1:Oh, absolutely, and thank you for listening. This is Jen Lee with the I Need Blue podcast. If you want to learn anything and everything about I Need Blue, visit my website, wwwineedbluenet. And remember you are stronger than you think. Until next time.
