Maternal, Fetal and Infant Mortality Review Panel Member Application

The Maternal, Fetal, and Infant Mortality Review (MFIMR) Panel honors the lives of mothers, pregnant people, and babies who passed away during pregnancy or within one year of birth, by understanding what may have led to their death, and making actionable recommendations to prevent future deaths.

Thanks for your interest in improving the health of birthing people, children and families here in Maine! Your application helps us build well-balanced panel for review of cases of maternal and infant deaths and stillbirths in our state. The information you provide will be kept confidential and only reviewed by a small team for the purpose of this application.

The MFIMR Panel requires a commitment of the following:

Attending a virtual orientation training (1 hour)
Attending MFIMR Panel meetings (4 hours every 2-3 months)
Reviewing meeting materials before each meeting (Approx 1-2 hours)
Attending an in-person day-long annual retreat in the fall
a 3-year term
respond to coordination emails periodically

We are currently recruiting for the following roles:

Clergy
Emergency Department staff
Federally Qualified Health Center staff - ideally with embedded mental health counseling
Individuals from Disproportionately Impacted Communities
Individuals with Perinatal Loss Lived Experience
Individual in Recovery or Peer Support Work in the field of Substance Use
Law Enforcement Officer
Nurse Midwife - actively practicing
Perinatal or Infant Grief Professional
Private Insurer
Social Worker (Social Work/Care Coordination)
Tribal Organization Representative

Question Title

* 1. Where did you hear about this?

An Email (From)

Recent Meeting (Which)

MFIMR Website

Other

Question Title

* 2. Contact Information

Name

Address

Address 2

City/Town

County

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 3. Name/Pronouns

Name you prefer, if different:

Pronouns:

Question Title

* 4. We are currently recruiting for the following roles, please check which one(s) describe you.

Clergy

Emergency Department staff

Federally Qualified Health Center staff

Individual from Disproportionately Impacted Communities

Individual with Perinatal Loss Lived Experience

Individual in Recovery or doing Peer Support work in the field of Substance Use

Law Enforcement Officer

Nurse Midwife

Perinatal or Infant Grief Professional

Private Insurer

Social Worker (Social Work/Care Coordination)

Tribal Organization Representative

Other (please specify)

Question Title

* 5. Do you currently sit on or have you ever sat on a review panel like this?

Yes

Maternal, Fetal and Infant Mortality Review Panel Member Application

Question Title

* 1. Where did you hear about this?

Question Title

* 2. Contact Information

Question Title

* 3. Name/Pronouns

Question Title

* 4. We are currently recruiting for the following roles, please check which one(s) describe you.

Question Title

* 5. Do you currently sit on or have you ever sat on a review panel like this?

Question Title

* 6. If yes, what panel and when?