Antoine Dow was working at his barbershop in Druid Heights two years ago when a woman came in and asked if he knew how to correctly put his baby down to sleep.
Turns out he didn't. He had laid his first son on his stomach, and planned to do the same with his second son, who had recently been born prematurely and would arrive home from the hospital any day.
"No! That is not correct!" he remembers the woman saying emphatically before pulling out a video showing the proper technique: baby alone, on its back, in a crib.
Grass-roots efforts like this are what have helped drive down the state's infant mortality rate to a record low for the third year in a row, state officials said Wednesday.
Maryland's infant mortality rate last year was 6.3 per 1,000 live births, down 6 percent from 2011. The rate dropped 21 percent between 2008 and 2012, reflecting 368 fewer babies losing their lives prematurely during those four years.
The state's national rankings have also improved. Maryland ranked 41st in 2009 and 29th in 2010, the latest national numbers available.
"We have moved down the dubious rankings of infant mortality," said Gov. Martin O'Malley as he joined Health Secretary Dr. Joshua M. Sharfstein at Baltimore Medical System's Highlandtown Healthy Living Center to announce the improvements.
When O'Malley first came into office, his administration set a goal of reducing Maryland's infant mortality rate 10 percent by 2012. That goal was quickly reached, so a new one was set to reduce the rate by an additional 10 percent by 2017.
Programs to teach safe sleeping practices for babies, educate fathers and get mothers both prenatal and general health care all have contributed to the decline, O'Malley said. Health officials said they also organized parenting classes and initiatives to reduce smoking and maintain proper weight during pregnancy.
Some of the most successful efforts have been at the neighborhood level. Using mapping techniques, advocates such as those at Baltimore Medical System targeted areas where pregnant women may not be receiving adequate health care. Outreach workers then canvass those neighborhoods, looking for pregnant women or asking neighbors if they know of pregnant women who may need health care.
Stacey Stephens, director of B'More for Healthy Babies' Upton and Druid Heights program, was the outreach worker who showed up at Dow's barbershop that day. She said both moms and dads often are surprised to find they are doing things that put their babies in danger.
"A lot of unsafe sleep happens when dads have the baby," she said.
B'More for Healthy Babies now has a program designed to reach dads through barbershops. Dow regularly shows the video that educated him about how a baby should sleep at his shop, and he stars in the most recent video. He said he is grateful for Stephens' intervention.
"He was a preemie, and I was laying him down wrong and just risking his life," Dow said about his son. " I really consider myself lucky, and I'm glad she came to my shop."
Much of the 2012 improvement is attributable to a decline in the mortality rate among African-American babies, which dropped by 14 percent, to 10.3 per 1,000 live births statewide.
The infant mortality rate in Baltimore in 2012 was 9.7, down from 10.5 the year before. The city's African-American infant mortality rate fell to 12.6 in 2012 from 14.5 in 2011.
Infant mortality rates can fluctuate from year to year, but state officials said it is encouraging that the declines have remained steady over an extended period in Maryland.
"If you look at what has gone on in the last several years — a sustained decline — it is really good news to see," Sharfstein said.
Health reform should help to further reduce baby deaths, O'Malley and Sharfstein said. The hope is that as more people get insurance the population will become healthier. Women with diabetes, high blood pressure and other preventable diseases face higher risk pregnancies.
State officials said work remains to be done. The Eastern Shore, for instance, is dealing with a disproportionately high rate of infant mortality.
O'Malley pointed to several statistics, including having the highest number of Ph.D.s and being ranked as a top state for innovation and entrepreneurship, that give Maryland bragging rights.
"Despite these accomplishments, every year we still lose far too many babies to infant death," he said.
Maryland: 493 in 2011, 458 in 2012
Baltimore metro area: 220 in 2011, 220 in 2012
Source: Vital Statistics Administration