FIMR is a community-oriented process that reviews the circumstances surrounding a fetal or infant death to improve the health and safety of the community. This page contains key materials for understanding FIMR principles, models, confidentiality, roles of team members and provides guidance on conducting effective review meetings.

The Operating Principles of Fetal Infant Mortality Review

Ensuring that all babies survive and thrive should be the concern of the whole community; it is an issue too multidimensional for responsibility to rest in any one place.  Fetal and infant deaths are sentinel events that illustrate system and resource issues. Fetal and Infant Mortality Review (FIMR) teams are diverse, multidisciplinary groups of professionals who come together to examine de-identified individual cases of fetal and infant deaths to understand the “how” and “why” surrounding the death to prevent future deaths. The parent/family interview includes the voices of those who have lost an infant and offers information not available through routine quantitative methods, equipping teams to make more effective community recommendations. Reviews lead to identification of local factors contributing to fetal and infant mortality.

The purpose of the FIMR process is to identify and take action to prevent a wide range of local social, economic, public health, education, environmental, and safety factors that contribute to the tragedy of fetal and infant loss. Systematic review of individual cases leads teams to make recommendations and to develop and implement innovative local actions that improve systems of care, services, and resources for women, infants, and families. Learn more about FIMR’s seven primary objectives

FIMR Models

There are different approaches used by teams around the country to conduct fetal and infant death reviews. Most reviews are conducted at the local level.  There are certain basic steps that, if followed, will help lead to complete and thorough reviews that address the systems and services issues involved in fetal and infant deaths.

From the very beginning, the FIMR model strongly emphasized the importance of a community-based, two-tiered process that promoted the use of separate groups to carry out an analytic function and a subsequent action function.  The Case Review Team (CRT) acts as the “information processors.”  Members review the story: What happened to this baby and family from the time leading up to conception until the time of death?  The CRT takes their findings and drafts preliminary recommendations, then passes those recommendations to the Community Action Team (CAT).  The CAT, then, refines and implements action strategies, such as improving policies and programs, to address the identified systems and resources issues, and to disseminate findings to community.

For each fetal and infant death case reviewed by teams, every attempt is made to contact the family and request a confidential parental interview.  Interviews provide a narrative and key details that are unavailable elsewhere, including the context of the pregnancy and the baby’s life.  The FIMR Interview provides insight into the social determinants of health that may have impacted the parent’s and/or infant’s health.  Differences in health are striking in communities with unstable housing, poverty, unsafe neighborhoods, or substandard education.  Parents’ stories can also shed light on experiences of racial or other types of discrimination in accessing and receiving quality medical care.  Many FIMR programs describe interviews as a key strategy to understand how women of color’s lived experience can influence maternal and child health outcomes.

All information that identifies an individual, a family, health care providers, agencies, or institutions is removed before the case is reviewed by the FIMR Case Review Team.  Personnel abstracting medical records and preparing case summaries take strict measures to keep all materials secure, and any documents with identifiers are destroyed after the review meeting is concluded.  Review staff and review team members take a pledge of confidentiality that assures they will not discuss or share information about individual cases and the proceedings of the CRT meeting outside of the review meeting.  Team members are asked to refrain from naming individuals associated with the case (including family members, providers, or institutions) or sharing anecdotal information about them during the CRT meeting.

  • Case Review Team (CRT) The CRT reviews and analyzes de-identified cases of infant deaths in the community. Data is obtained through an interview with the parent/family, medical records, WIC, social service agencies, and birth and death certificates.  Membership on the CRT is a critical part of the team’s success, getting the right people to the table.   Successful FIMR teams have 10 – 20 members from diverse professional and consumer backgrounds.  The broader the representation on the FIMR team, the more relevant the proposed interventions will be to the community.  Professionals and agencies on the review team should characterize the ethnic and racial make-up of the community and represent agencies that provide services and resources to parents, infants, and families.   Minimally, the team should include the local health department, primary and tertiary care institutions, obstetric and pediatric providers, hospital administrators, Medicaid supervisors, WIC program nutritionists, family planning providers, heath educators, community health workers, and representatives of drug treatment centers. Other representatives might include minority rights advocates, faith-based community members, Chamber of Commerce health committee members, and local SUID coalitions.  Responsibilities of the CRT member include:
  • Community Action Teams (CAT) The CAT is composed of two types of members: those who have the political will and fiscal resources to create large-scale systems change, and those who can define a community perspective on how best to create the desired change in the community.  The goals of the community action team (CAT) are to:
    • Receive the findings and the recommendations from the CRT
    • Develop an action plan based on those recommendations and implement the actions.

    The overall goal of the action plan should be to enhance the health and well-being of women, infants and families in your community by improving the resources and services systems available to them.

Role of team members (PDF)

Role of the Community Action Team (PDF)

There are different approaches used by teams around the country to conduct FIMR  reviews. But there are certain basic steps that if followed, will help lead to complete and thorough reviews that address the maximum number of issues involved in fetal and infant  deaths while focusing the team on improving pregnancy outcome and prevention.

At the case review:

  • De-identified case summaries are reviewed, including information from the medical records, social service records, and the parent/family interview
  • Teams identify sentinel events, trends over time, and incidental findings
  • Teams discuss factors that were present and could have contributed to the death
  • Team members discuss service delivery and any barriers or gaps in care
  • Based on the review findings, the CRT makes recommendations for systems improvements and improved resources
  • The team conveys recommendations to the Community Action Team (CAT)

Effective Reviews (PDF)
FIMR Program Manual (PDF)

The Operating Principles of Fetal Infant Mortality Review

Ensuring that all babies survive and thrive should be the concern of the whole community; it is an issue too multidimensional for responsibility to rest in any one place.  Fetal and infant deaths are sentinel events that illustrate system and resource issues. Fetal and Infant Mortality Review (FIMR) teams are diverse, multidisciplinary groups of professionals who come together to examine de-identified individual cases of fetal and infant deaths to understand the “how” and “why” surrounding the death to prevent future deaths. The parent/family interview includes the voices of those who have lost an infant and offers information not available through routine quantitative methods, equipping teams to make more effective community recommendations. Reviews lead to identification of local factors contributing to fetal and infant mortality.

The purpose of the FIMR process is to identify and take action to prevent a wide range of local social, economic, public health, education, environmental, and safety factors that contribute to the tragedy of fetal and infant loss. Systematic review of individual cases leads teams to make recommendations and to develop and implement innovative local actions that improve systems of care, services, and resources for women, infants, and families. Learn more about FIMR’s seven primary objectives