Reducing early deliveries key to solving infant mortality
In 2009, Rosalyn Colonel’s daughter became a statistic.
The South Carolina Department of Health and Human Services launched the South Carolina Birth Outcomes Initiative in 2011 to achieve a number of goals, including eliminating unnecessary early deliveries, increasing risk-factor screening for pregnant women and encouraging breast feeding.
The group comprises a number of policymakers and health care professionals, including several MUSC physicians and representatives from various groups such as March of Dimes and Blue Cross Blue Shield.
“Longer term goals are to decrease the C-section rate and to improve the mortality rates,” said Dr. Scott Sullivan, director of the Division of Maternal-Fetal Medicine at the Medical University of South Carolina and a member of the Birth Outcomes Initiative.
“It’s the first instance I know of that you have a public-private partnership where everyone meets together to try to tackle some of these issues,” Sullivan said.
“She was too early,” said Colonel, a Hanahan resident. “She couldn’t breathe on her own.”
She died shortly after birth.
Infant mortality, especially within the first 27 days after delivery, is a problem in South Carolina. An average 7.4 babies out of every 1,000 born in South Carolina died before their first birthday, according to 2011 data released last week by the South Carolina Department of Health and Environmental Control.
That’s high compared with the national infant mortality rate of 6.05. The rates for minority infants in South Carolina are worse. Black babies died 2.5 times more often than white babies in their first year.
But Colonel’s story has a happy ending. In 2012, when she became pregnant a second time, she knew there was an increased chance that her next baby would be born too early too.
That knowledge — and access to early prenatal care — helped Colonel carry her daughter, Ry’lee Gladden, a full 39 weeks and five days.
Pregnancy is a little bit like baking bread, said Charleston pediatrician Henry Lemon.
“If it comes out of the oven early, there are not a lot of things that you can do to make that loaf of bread, you know, done,” Lemon said. “So I would probably say the ideal would be to carry babies as long as possible in the womb and to deliver babies as close to on time as they should be delivered.”
Lemon, at the Medical University of South Carolina’s Northwoods Children’s Care clinic in North Charleston, said one reason South Carolina has one of the highest infant mortality rates in the country is because too many women are delivering babies that haven’t finished baking.
“We have a problem with pre-term delivery,” he said. “There are a lot of factors for that, and those are the ones that are closely associated with poverty — substance abuse, untreated infections, undiagnosed infections, inflammation conditions.”
It’s a complicated problem to tackle and there is not one Band-Aid to fix it, but that’s why state leaders and health-care experts have organized the South Carolina Birth Outcomes Initiative to brainstorm a variety of projects aimed at reducing the infant mortality rate.
“We’re clearly below average in how well our health system is helping women get access to prenatal care,” said S.C. Medicaid Director Tony Keck.
But expanding free health insurance to include more women won’t help reduce infant mortalities, he said.
“Just because you have access to health insurance, doesn’t mean you get access to health services or the right number of health services,” he said. “Even women who have Medicaid are not getting the level of prenatal care they should get.“
In South Carolina, pregnant women who earn up to 185 percent of the federal poverty level — $1,723 or less per month for a single woman with no other children — qualify for Medicaid benefits, but eligibility requirements keep many of the same women from qualifying before or after their pregnancy.
Doctors across the state agree that treating women as early as possible during a pregnancy — even offering crucial medical advice before conception — is a key part in ensuring healthy pregnancies and healthy babies.
“It’s as simple as starting a prenatal vitamin very early,” Lemon said. “Folate supplementation in the last trimester isn’t nearly as effective and probably has very little impact than if you started on folate in your first trimester or before you were pregnant.”
Dr. Amy Picklesimer, medical director of the obstetric center at the Greenville Hospital System and a member of the Birth Outcomes Initiative, said women should ideally seek medical care before conception. But expanding Medicaid eligibility to include previously uninsured women is a political hotbed, she acknowledged.
The Birth Outcomes Initiative is trying to find ways to get women the health care they need as quickly as possible during and between pregnancies, including streamlining Medicaid enrollment.
“When people get pregnant, a lot of women get (Medicaid) coverage for the first time. There’s always a gap between eligibility and coverage in Medicaid,” Picklesimer said. “Is it something we can streamline online? We’re trying to take down barriers to help women get care more quickly.”
A relatively new drug, 17 alpha hydroxyprogesterone caproate, is also showing promise, Picklesimer said. The shot, administered weekly to pregnant women with a previous history of delivering premature babies, can reduce the risk of early delivery by 30 percent. The state is making the drug’s availability a priority, especially for African American women who have a demonstrated higher risk for premature delivery, she said.
Kim Cox, spokeswoman for the South Carolina Department of Health and Human Services, said another major coup for the Birth Outcomes Initiative was an agreement signed last year by all hospitals in the state to stop elective pre-term deliveries.
“Everyone just seems to think that once you get to 30-something weeks, you’ll be fine,” Cox said. “Forty weeks is ideal, although 39 weeks is where the medical community feels comfortable that the baby has had time to develop.”
On the local level, there are techniques working at the Northwoods clinic, a practice that predominantly serves minority patients, that are helping too, including enrolling women and children in a Medicaid plan on site at the doctor’s office. The fact that the office is located outside the peninsula is a big draw for Colonel, who took her daughter Ry’lee in for a newborn check-up at the clinic on Thursday.
Proximity to public transportation, offering extended hours and same-day office visits are other ways the medical community can bend to meet the needs of its patients, Lemon said.
“We can do a better job at being more culturally competent,” Lemon said. “For our Latina population, that means having people here who speak their primary language. For the African American community, it may mean having a workforce that reflects better that demographic, having a diverse workforce that people can identify with.”
The bottom line is that the infant mortality rate related to premature birth should improve if more women seek medical attention early and often during a pregnancy, Lemon said.
“We have people who work very, very hard at MUSC, specialists who work to keep very small babies alive and they make progress. They can apply the greatest technology to that. But even then — and we’ve made tremendous impacts on baby outcomes — there are still things that we cannot do well,” he said.
“I’m not sure that a simplistic answer — that it’s black vs. white, a racist thing — is productive because we need to have people plan and take care of pregnancy as if it’s a very important thing, a treasured thing, understanding and accepting that routine, periodic health visits during the pregnancy is vital.”
Reach Lauren Sausser at 937-5598.