Delaware’s preemie birth rate better; disparities remain

All Larissa Cobbs wanted was a baby.

Looking at her nearly 6-month-old daughter, O’Naja, at Nemours/A.I. duPont Hospital for Children hooked up to tubes filtering breast milk directly to her small intestine and oxygen to her lungs, Cobbs is reminded of how difficult the road to motherhood has been.

O’Naja was born May 30 at 23 weeks and 6 days old, which is 17 weeks premature. She struggles with bronchopulmonary dysplasia, which causes her lungs to be underdeveloped, pulmonary hypertension and cardiac issues. She has spent most of her life in the hospital’s Neonatal Intensive Care Unit, but doctors hope that she can finally go home in about a month.

“She’s beaten all the odds,” said Cobbs, 38, of New Castle. The mother spends her weekdays and nights by O’Naja’s side.

“I want her to know her mommy’s here,” she said. “I waited so long for her.”

O’Naja is not an anomaly. In 2014, one out of every 10 infants in the United States were born preterm, before the typical 37-week gestation. Preterm birth is the leading cause of infant death as well as long-term neurological disabilities.

Though Delaware’s prematurity rate has significantly decreased to about 11 percent from peaking in 2007 at 14.3 percent, experts say a recent premature birth report card from March of Dimes shows there is more to be done to address race and prematurity rates.

The report card analyzed births from 2013 and found that 12 percent of all African-American babies were born premature. In comparison, 8.6 percent of Caucasian babies, 8 percent of Hispanic babies and 7.7. percent of Asian babies were preterm.

The primary driver of the disparity is not lack of access to care, said Dr. David Paul, chairman of the Delaware Healthy Mother and Infant Consortium. It is poor health, he said.

Moms-to-be who are in poor health have a higher risk of delivering a baby too early. Chronic health issues such as diabetes, hypertension, smorking tobacco and obesity are among the issues that can contribute.

In the most recent Pregnancy Risk Assessment Monitoring System survey for Delaware, 8.6 percent of of African-American moms surveyed had high blood pressure three months before they got pregnant compared with 3.8 percent of Caucasian moms and 6.1 percent of Hispanic moms.

In that same pre-pregnancy time frame, 28.2 percent of African-American moms had anemia or low iron compared with only 7.6 percent of Caucasion moms and 14.2 percent of Hispanic mothers.

Even so, some premature births have no known cause and are influenced by multiple risk factors.

“Moms, for the most part, have access to care. There’s great neonatology care in the state,” said Paul, also the chair of pediatrics for Christiana Care Health System. “If moms are unhealthy at the beginning of their pregnancy there’s only so much that [you] can do to change that course.”

Mother’s health reflects population’s health

A mother’s health reflects the health of the population, Paul added. Addressing their health sometimes goes beyond making sure they make their prenatal check-ups.

“You really have to think about the social determinants of health that are present throughout their life,” he said.

Social determinants describe a person’s past and daily life: how he or she grew up, as well as how he or she lives and works. A woman’s risk of giving birth to a premature baby can be impacted by poverty, racism and access to transportation, Paul said.

Dr. Garrett Colmorgen, a fetal medicine specialist at Bayhealth Medical Center and medical director for the Delaware Perninatal Cooperative, agreed that medical care is available, but said, “Getting people to feel comfortable to access that care may be part of the problem.”

The day Cobbs was in labor with O’Naja she was hesitant to call her doctor. She couldn’t shake her previous trauma: The year before O’Naja was born she lost a son after he spent 21 days in the NICU. He also was born just over 23 weeks premature.

“I was terrified,” she said.

Cobbs has been pregnant eight times. She’s miscarried five times and delivered three babies.

Her eldest son, 5-year-old Ollie, also born preterm, was diagnosed with autism. He struggled with walking growing up, Cobbs said, and he still does not speak.

Doctors said Cobbs’ difficulties are related to a cervix that doesn’t work properly. The cervix is the lower part of the uterus that connects to the vagina. Typically it is closed, but as a woman prepares for birth, the cervical tissue softens and opens. In a case such as Cobbs’s, the cervix opens too early, causing the birth to happen too soon.

Programs like the Delaware Healthy Women, Healthy Babies initiative help to connect at-risk women to a range of free services from weight and stress management to genetic testing. Women also can create a life plan to help them reach their health goals.

Currently 3,510 women are enrolled in the program through Westside Family Healthcare, said Dr. Tom Stephens Westside’s chief medical officer.

“We’ve certainly seen a big improvement,” Stephens said. “There’s still a long way to go.”

Improving care for moms is a component of Delaware’s health care innovation plan. The plan, bolstered by a $35 million federal grant, aims to lower health care costs and develop 10 healthy neighborhoods in the state.

The creation of a healthy neighborhood can go a long way, Stevens said, by helping communities improve the number of grocery stores and increase places where families can play and exercise safely.

“Essentially every community is different, so the solution has to be different. And the solution to some degree has to be homegrown,” he said. “It’s just such a challenge. There’s not just one single switch to flick and make things better.”

Overall, Delaware was among 17 other states given a “C” grade for premature births by the March of Dimes, which is better than previous rankings, Colmorgen said.

But he cautioned that the data only captures births during one year and “being in the mid-pack should not be comfortable for us.”

Early intervention

Early maternal and fetal education can help.

For example, the American Academy of Pediatrics recommends babies should be “exclusively” breast-fed during the first 6 months of life – up to a year is more beneficial. However, only 34.4 percent of Delaware mothers surveyed in the the Centers for Disease Control and Prevention’s 2014 Breastfeeding Report Card reported breastfeeding their babies at 6 months.

Cobbs said she did not know the benefits of breastfeeding. Growing up in New York, she said that she never got the time from doctors to explain it.

“I didn’t want to breastfeed,” she said. “I wanted to do what my mom did.”

But with O’Naja, she learned that the hormones, cells and antibodies in breast milk protect against ear infections, obesity, asthma and diarrhea. On top of that, it can help a woman lose weight, Cobbs joked.

It’s a lot of work; Cobbs had to pump her breast milk up to 10 times a day because O’Naja couldn’t suckle and she needed a continuous stream of food.

“I haven’t stopped,” she said.

For moms who have had a traumatic birth, it is difficult to breastfeed, said Marguerite Fritsch, nurse manager of Nemours’ NICU.

At any one time Nemours treats about 18 or more premature babies. They promote breastfeeding to moms and even offer meal vouchers to eat in their cafeteria if they breastfeed.

“We have to make it easy for the moms,” Fritsch said.

Cobbs considers herself lucky to be in Delaware. She’s eager to set up O’Naja and Ollie for the best life and credits the medical care she’s received with helping to set the foundation.

She hopes other moms will not be afraid to ask questions and will embrace learning things such as breastfeeding for their children.

“Make sure you go to every appointment,” she said. “Do not hesitate...you never know what’s going to happen.”

Jen Rini can be reached at (302) 324-2386 or jrini@delawareonline.com. Follow @JenRini on Twitter.