MONTGOMERY – The first sign of trouble came when 45 more babies died in Alabama in 2005 than in 2004, marking the first increase in infant mortality in eight years. Hope for a turnaround after a slight dip in 2006 was dashed by data showing the infant mortality rate in 2007 was its highest in nearly a decade.

State Health Officer Don Williamson has been calling for the formation of a Fetal Infant Mortality Review Board to pinpoint the reason for the increase and to develop a plan to reverse it.

But legislators have not approved the $500,000 he requested for the task force, so he’s taking matters into his own hands.

Five nurses in the state health department have been reassigned to focus on infant deaths instead of their previous duties with other pregnancy issues. Officials are currently gathering public comments on the proposal and hope to have the review board running by January.

“We’re losing our future and we couldn’t sit by and say ‘Well, when we’re able to get the money we’ll do something,’” Williamson said during an interview at his office this week.

“We needed to figure out a way to do it. Maybe we’ll be able to identify some interventions that we can then go to the Legislature and say, ‘Here’s the problem,’ whether it’s drug use or whatever it is,” he said.

The nurses will spend their time studying every aspect of baby deaths in 2009 — including in-depth interviews with the baby’s parents and doctors. They will also review miscarriages, which are classified as fetal deaths.

About $450,000 will be redirected to conduct the reviews, which Williamson said will be done on about half of the baby deaths in 2009, with hopes to do all deaths eventually.

“If you don’t really know why babies are dying, you can’t plan an education program or appropriate medical interventions,” Alabama March of Dimes director Robin Collins said. “Usually we just have the death certificate but it doesn’t have the mitigating factors that surround the death.”

Last year there were 10 deaths out of every 1,000 live births through the first year of life, up from nine in 2006. The number of babies born in the state has steadily increased, with 64,180 born in 2007. There were 641 infant deaths that year, up from 569 in 2006.

The rate of death for black and Hispanic babies remained nearly unchanged, going from 14.3 to 14.6 for black mothers and from 7.2 to 7.3 for Hispanic mothers. White mothers saw a significant increase, from 6.7 deaths per 1,000 live births in 2006 to 8.0 in 2007.

Also, while the state’s mortality rates for black babies has remained fairly close to the group’s national average of 13.7, the white rate has climbed well above the national 5.7 average.

Maternal smoking is a persistent problem. Smoking was more prevalent among white mothers than black women during pregnancy, with black teens smoking the least.

Health officials are trying to stamp out the practice with stepped-up campaigns and more resources like a toll-free Quitline, billboards and more doctor-patient counseling on the dangers of smoking both during and after pregnancy.

Youth Tobacco Cessation Coordinator Laarni Cox said her office has seen a slight increase in the number of teens calling the Quitline since this spring. Teen mothers are among the most difficult demographics to work with, she said.

“Some research has shown that pregnant women may continue to smoke as a way to keep their weight down or have smaller babies because they think their labor will be easier,” she said. “And cigarettes might be a comfort to a pregnant, stressed-out teenager who’s relying on nicotine. It’s really a complicated, complex web and tobacco use is just a part of it.”

Low-birth weight is a huge contributor to infant mortality and factored in 63.5 of infant deaths.

Also in 2007, the number of the tiniest of babies — those under slightly more than a pound — was 171, which is the most in state history.

Deaths for twins and other multiple births was up, along with the number of women without adequate prenatal care and private or Medicaid health insurance, and maternal smoking among adults.

Williamson called the current infant mortality picture “one of the most troubling things I’ve dealt with in 16 years here.”

“It’s not that people aren’t doing the right thing. The care system works,” he said. “It’s because not enough people are availing themselves of it and some of the interventions are now going to have to be outside of the box.”

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On the Net:

State Health Department: www.adph.org