Southeastern states got poor grades last year in a report card on their rates of premature births, with Mississippi, Alabama and Louisiana earning F’s.... Premature birth: State, hospitals aim to reduce rates
A baby carried to full term -- 39 weeks -- is more likely to be born healthy.  Photo courtesy of Northside Hospital

A baby carried to full term — 39 weeks — is more likely to be born healthy. Photo courtesy of Northside Hospital

Southeastern states got poor grades last year in a report card on their rates of premature births, with Mississippi, Alabama and Louisiana earning F’s.

Georgia scored a D, coming in 45th among states in the “preterm” birth report card, based on 2009 data presented by the March of Dimes.

According to the most recent data, though, the state’s percentage of babies born too soon has been reduced from close to 14 percent to 12 percent.

Recently public health officials in Georgia and 47 other states have agreed to accept a national challenge to reduce their preterm rates by 8 percent.

“If each state meets the 8 percent challenge, it would give 40,000 more babies a healthy start in life,” said Dr. Jennifer Howse, national president of the March of Dimes Foundation. “Meeting this goal would lower the nation’s preterm birth to about 11 percent, and save about $2 billion in health care and socioeconomic costs.”

The challenge – issued by the Association of State and Territorial Health Officials’ president, David Lakey, and backed by the March of Dimes, a leading nonprofit organization for pregnancy and baby health – would lower Georgia’s preterm birth rate to 11.2 percent.

Premature births are a major health problem, and a costly one. These births are the leading cause of newborn death. Babies who survive an early birth often face the risk of lifetime health challenges, such as breathing problems, cerebral palsy and mental retardation.

“They may be at higher risk for chronic medical conditions and delays in academic achievement,’’ said Dr. Seema Csukas,  director of the Maternal and Child Health Section of the Georgia Department of Public Health. “Preventing an early birth gives that child the best opportunity for a healthy and happy life.’’

A 2005 Institute of Medicine report found that preterm births and associated complications had cost the United States at least $26.2 billion that year.

The causes of preterm births are not fully understood. But the risk factors include a lack of prenatal care, as well as alcohol consumption, drug use and smoking by pregnant women.

Another factor is the high number of early Caesarean-section births that are not medically necessary.

Many women schedule C-sections before their pregnancies are at full term (the 39-week mark) and as a result, many have preterm births (those before 37 weeks of gestation), says the March of Dimes.

 

Some hospitals draw the line

 

The March of Dimes is working with hospitals to reduce the incidence of early elective deliveries (EEDs), which are medically unnecessary inductions and C-sections scheduled before 39 weeks of pregnancy.

The Georgia Hospital Association (GHA) and its member hospitals, as well as the Georgia Department of Public Health, are also partnering in this effort.

Overall, Georgia hospitals reduced the occurrence of EEDs from 8.83 percent in March 2012 to 3.58 percent in August 2012, representing a 57 percent decrease, GHA said. Thirty-two percent of the hospitals that submitted data achieved a complete elimination of EEDs. This reduction represents a cost savings of $2 million, assuming that at least a quarter of those babies would have gone to the neonatal intensive care unit after delivery.

Northside Hospital in Atlanta, which for years has had the most births in the state, implemented a “hard stop” on C-sections without medical indication in early 2011 and a “hard stop” on inductions without medical indication in early 2012. In other words, the hospital won’t do these procedures unless there’s a valid medical reason.

The average rate of elective delivery prior to 39 weeks reported by the Joint Commission is 15 percent, according to Northside. The Atlanta hospital’s most recent rate of early elective delivery without a medical indication was 7.3 percent, said Russ Davis, a Northside spokesman.

The hospital has joined in the GHA initiative to reduce early elective deliveries in Georgia. Northside Atlanta reports that its preterm birth rate declined from 12.8 percent  in 2010 to 11.2 percent through June 2012. This compares to a national average of 11.99 percent, Northside said.

“We don’t know everything about premature birth, but we know there are steps that can make a difference, such as improving access to health care, helping women quit smoking and ending early elective deliveries,’’  said Sheila Ryan, Georgia state director for the March of Dimes.

State health officials are conducting an educational campaign with the March of Dimes to let pregnant women and their medical providers know that “Healthy Babies Are Worth the Wait.”  Women will be advised that if their pregnancy is healthy, it’s best to wait for labor to begin on its own rather than scheduling an induction or C-section.

In addition, the Georgia Department of Public Health and the March of Dimes have targeted high-risk areas across the state – Atlanta, Columbus and Savannah – and have scheduled stakeholder meetings with health officials in those communities.  The goal is to identify specific populations with the highest incidence of preterm birth and infant mortality and determine how these problems can be addressed.

Dr. Paul Browne, head of maternal-fetal medicine at Georgia Health Sciences University, said the South’s higher rate of preterm births comes from the region’s higher percentages of poor people, minority patients, and mothers with hypertension problems.

Browne noted that the state’s preterm rate has been declining, a sign of progress. He said cutting funding for Public Health, part of the 3 percent statewide budget reductions ordered by Gov. Nathan Deal,  is not what is needed now.

“We’re at the point where if we reduce more, we’ll increase bad outcomes,’’ Browne said.


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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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