NEW PORT RICHEY — Ericka Funtow hopped up onto the paper-covered table just before her appointment. At 31 weeks along, her knit shirt stretched over her round belly and her purple shorts nearly disappeared beneath it. She joked about diaper prices with her husband, Alex Funtow, and looked around the room while she waited.
Instead of typical doctor's office decorations — pastel flower paintings or anatomy charts — a graphic poster lettered "The Harmful Effects of Drugs and Alcohol on the Fetus" hung beside the table. Ericka's eyes paused on it for a moment and she tapped the poster.
The poster, at the Family Health Services clinic on Main Street that serves poor and at-risk mothers, represents one of three strategies the Healthy Start Coalition is using to keep Pasco's infant mortality rate on a decline. That rate has decreased by one-third since 2011 in Pasco, making it the lowest of the four Tampa-area counties.
The infant mortality rate is figured by the number of babies, per 1,000 live births, who die within their first year of life. Because the rate is in the context of birth numbers, it is not necessarily reflective of the number of infants who died in a county. For example, 20 infants died last year in Pasco County while nine died in Hernando. Because more babies were born last year in Pasco, the rate is lower (4.2 deaths per thousand births compared with Hernando's 6.5 per thousand).
In Pinellas, 4.9 babies per thousand died (41 total) and 7.6 per thousand (124 total) died in Hillsborough.
Mike Napier, head of the Florida Department of Health in Pasco County, said he's happy with the decline but isn't quick to take any credit.
"This number isn't just what the Health Department does," he said. "There are literally hundreds of factors that go into infant mortality."
The number factors in all infant deaths within the first year, regardless of the cause. Napier said even counties with historically low rates can spike in the rankings because of a car crash or fire that claims young lives. Still, he said, the number is generally regarded as a gauge of a county's overall health.
A lot of it has to do with education, teaching soon-to-be parents best health practices during pregnancy and in the first two years of the baby's life. In Pasco, the Healthy Start Coalition, which raises money for prenatal counseling in the Health Department, is trying to address three main health risks that executive director John Tschirhart says contribute to the mortality rate:
• Deaths due to sudden infant death syndrome and sleeping parents rolling over infants in the same bed.
• Babies born addicted to drugs because of parents who used them during pregnancy — the reason for the poster at the Family Health Services clinic.
• Low birth weights caused by pregnant women using tobacco.
Sometimes, intervening is easy: The coalition pays for cribs so parents don't have to sleep beside their babies. Or giving car seats to families who can't afford them or didn't know to use them. Counselors make recommendations to anti-smoking programs, too.
Other situations are more dire.
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Some women have to be weaned off drugs and onto opiate substitutes when they come into Dr. Faith Carlin's office at Family Health Services. Some smoke cigarettes. Others have smoked marijuana every day of their pregnancy, she said. When she pleads with them to stop or their babies will have low birth weight or will be born addicted to drugs, they don't listen.
Women who are in poverty or in high-risk domestic situations get referrals to come to her clinic for free or with reduced co-pays.
The majority of the pregnancies she works with are unplanned, Carlin said. Some women don't seek help until their second or third trimesters, because they either didn't know about the program or didn't think they could afford it. By that time, if women have pre-existing complications like diabetes, liver disease, sexually transmitted diseases or high blood pressure, she can't do as much for them. Many of them are on nutrient-poor diets.
"Pasco County has a long way to go in terms of maintaining good health habits," said Carlin, the only OB/GYN in the Health Department's Improved Pregnancy Outcome program, who sees about 200 patients a year. "If people would make better choices before they got pregnant then they would save themselves potential grief.
"What the mother does during pregnancy determines what the general health of the baby will be for the rest of its life. And most people don't know this."
About 37 percent of pregnancies in the United States are unplanned, according to the U.S. Centers for Disease Control and Prevention. Carlin said some of those mothers weren't raised to be parents. The small but important lessons of being a parent slip by. Things like putting baby down for a nap on its back, not its tummy because of increased risk for SIDS.
All of those factors match with what the CDC lists as the leading causes of infant deaths in the United States:
• malformations, deformations and chromosomal abnormalities
• disorders from a short time in the womb and low birth weight
Infant mortality rates have been on a steady decline across the country, the CDC states — down to 6.05 infant deaths per 1,000 live births in 2011 from 6.91 in 2000. As for the decline in Pasco County's rate, Carlin said she'd attribute it to better care for premature children because she's seen "no change in maternal behavior" in her clinic.
"In the old days people expected their babies to die. Now, nobody expects their babies to die," she said. "Babies are born really helpless, and it requires a really devoted parent … to take care of them … to get them out of childhood."
About half the time, though, she gets patients who aren't using drugs and who are without health risks. Patients like Ericka.
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The Funtows moved to New Port Richey two years ago from the Bronx. They have a healthy, 5-year-old daughter, Alexandra. They've been together seven years, married for four. Alex, 31, works maintenance at Caliente Resort in Land O'Lakes. Ericka, 29, is unemployed, which makes her eligible for Carlin's services, but she says she's going back to school.
When Carlin walked into the room last week at Ericka's early morning appointment, the talk was about exact weight gain and nutrition. Instead of the low-birth-weight warnings she issues to smoking pregnant mothers, Carlin chided Ericka about watching her calories.
Ericka said she had an English muffin, juice and water for breakfast. Carlin tested her. What was missing?
"Protein," Ericka said.
Right, Carlin told her. "Next time, put an egg on it."
She had Erick lay back and rubbed a clear jelly on her belly. She pressed a sonic heart-rate monitor to it and searched.
A distinct electric pulse filled the room and Carlin went quiet. The sound plugged along at a healthy 136 beats per minute. Ericka looked at Alex and smiled.
Contact Alex Orlando at firstname.lastname@example.org or (727) 869-6247.