Thurston County launches fetal and infant mortality review; Count the Kicks campaign to begin May 12

Thurston County Public Health on April 8 reported on a newly formed fetal and infant mortality review team that the presenters said is the first in Washington state to review fetal deaths as part of the county’s effort to reduce stillbirths and infant mortality.

Lisa Osler, who coordinates the county’s child fatality and fetal/infant mortality reviews, said the county began forming the team in January 2024, spent about six months on education and onboarding, and began case reviews in September. “We are the only county in this entire state of Washington that reviews fetal deaths,” Osler told the Board of Health.

Osler and medical presenters described early, qualitative patterns emerging in the small number of reviewed cases: decreased fetal movement not reported to providers, instances of gestational diabetes and high blood pressure or preeclampsia, and cases where patients were discharged and returned later with adverse outcomes. Osler said the team collects both records and family narratives and uses national fatality-review databases for coding and comparison.

The county will launch a local Count the Kicks campaign on May 12; Osler said national evidence shows the program can reduce stillbirth by giving expectant parents a simple daily monitoring routine and data to bring to providers. Dr. Joyce Gilbert said the clinical intervention for decreased fetal movement is prompt evaluation — typically a nonstress test — and hospitalization if the fetal monitoring indicates distress. “If you don't have the same number of kicks…something's impeding blood flow to that baby,” Dr. Gilbert said.

Presenters said data remain limited because of small case counts; Osler reported an increase in the county’s fetal-infant mortality rate from roughly 5.6 per 1,000 to about 7 per 1,000 but emphasized the sample is small and that qualitative findings are driving early recommendations. The team has started a monthly in-person bereavement support group and is working with epidemiology staff to develop ways to combine qualitative and quantitative evidence for prevention recommendations.

Board members asked about measurement and how family narratives will be translated into metrics for intervention and funding; presenters said they record themes from multiple case reviews and compare them with national examples before recommending changes to local clinical practice and provider education.