Fetal and Infant Mortality Review


Fetal and Infant Mortality Review (FIMR) is an action-oriented, community-based process that examines the factors and issues that influence fetal and infant mortality in a community. It is an essential element to OCCHD’s Maternal and Child Health Outreaach program. The mission of FIMR is to identify and create systemic change that results in the reduction of the fetal and infant mortality rate. Ultimately, FIMR aims to inspire community changes that result in more women being healthy when they become pregnant, therefore increasing their chance of having a positive pregnancy outcome.

OCCHD’s Maternal and Child Outreach program offers support to families through referrals and resources. We serve families who are pregnant, are parenting a child under the age of one, or have experienced a pregnancy or infant loss. Resources we provide include: a) Basic needs for families, b) SoonerCare assistance, c) Grief and bereavement, d) Domestic violence prevention, e) Depression and anxiety, f) Substance abuse, g) Referrals for legal services, h) Other community resources.


The objectives of FIMR are:

  • To examine the significant social, economic, cultural, safety and health system factors that are associated with fetal and infant mortality through review of individual cases;
  • To plan a series of interventions and policies that address improvement to service systems and community resources;
  • To participate in the implementation of community-based interventions and policies; and
  • To assess the progress of the interventions.


Infant mortality rate (IMR) is defined as the number of infant deaths per 1,000 live births. IMR is a key indicator often used to measure the health and well being of a population. Factors such as problems in pregnancy, poverty, an unhealthy physical environment, and barriers to health care and services have a bigger impact on infants than on any other population. The first year of a child’s life is the most vulnerable.

Review of fetal and infant deaths allows the community to respond to the needs identified by the cases reviewed. Reviews provide a voice for local families who have lost their babies. FIMR is a tool that helps the community implement changes designed to address the needs of the society’s youngest population.


The four fundamental steps in the FIMR process include data collection, home interview, case review, and community action.

The FIMR process brings together key members of the community in order to:

  • Identify the factors associated with those deaths.
  • Determine if they represent system problems that require change (such as barriers to care or gaps in service delivery).
  • Develop recommendations for changes and assist in the implementation of change.

Each year approximately 3500 infants in the US die of sleep-related infant deaths, including sudden infant death syndrome (SIDS) ill-defined deaths, and accidental suffocation and strangulation in bed.*

The American Academy of Pediatrics Guidelines for Safe Sleep

    • Back to sleep for every sleep. 
    • Use a firm, flat, non-inclined sleep surface to reduce the risk of suffocation or wedging/entrapment
    • Feeding of human milk is recommended because it is associated with a reduced risk of SIDS. 
    • It is recommended that infants sleep in the parents’ room, close to the parents’ bed, but on a separate surface designed for infants, ideally for at least the first 6 mo. 
    • Keep soft objects such as pillows, quilts, comforters, mattress toppers, fur-like materials, and loose bedding away from the infant sleep area to reduce the risk of SIDS, suffocation, entrapment, wedging, and strangulation.
    • Offering a pacifier at naptime and bedtime is recommended to reduce the risk of SIDS.
    • Avoid smoke and nicotine exposure during pregnancy and after birth. 
    • Avoid overheating and head covering in infants. 
    • It is recommended that pregnant people obtain regular prenatal care. 
    • It is recommended that infants be immunized in accordance with guidelines from the AAP and CDC. 
    • Do not use home monitors as a strategy to reduce the risk of SIDS.
    • Supervised, awake tummy time is recommended to facilitate development and to minimize the risk of positional plagiocephaly (flat spots).

OCCHD’s Maternal & Child Health Program provides free, comprehensive training on the American Academy of Pediatrics recommendations for infant safe sleep.

Quarterly three-hour safe sleep training courses are available for professionals who work with families.   This course satisfies the Oklahoma Human Services childcare licensing requirement for safe sleep training, and clock hours are awarded.

For more information on safe sleep training, please contact us at [email protected].


Whether your loss has occurred during pregnancy or after birth, you may go through a variety of experiences including physically, emotionally, and spiritiually. Your emotions may be unpredictable and unstable. You may dwell on questions such as “What if…” and “If only…”

You may also feel:
Self-Criticism and guilt
Difficulty concentrating
Physical sensations – tightness in the throat or chest, shortness of breath, a lack of energy, body aches or heart palpatations.

Take care of yourself
This experience may be overwhelming for the whole family and at times you may feel alone. Here are some suggestions.

Sleep – give yourself plenty of time to rest. Grief is emotionally and physically draining.
Exercise: Take walks or exercise frequently. Physical activity can reduce stress and may give you time to gather your thoughts. Make sure and check with your physician before starting any new exercise routine.
Talk with others: Consider seeking out others, through support groups, church groups, family and friends.
Cry, cry, and cry: Tears are very healing. You don’t have to cry in front of others. However, sometimes in the deepest of grief it helps to cry with another person.
Honor your feelings: Embrace your emotions. They may range from anger to sorrow to hope; everyone reacts differently.
Don’t expect to “get over it”: You will begin to experience happy times again in your life. Acceptance happens gradually and gently over time. 

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