Center for Health Journalism | By Giles Bruce | January 14, 2019
The U.S. has some of the best perinatal care on earth, but kids die before the age of 1 here at a higher rate than the most of the developed world.
A big part of the problem is that high-risk pregnant women and newborns aren't getting the right care during their time of need.
That's a problem lawmakers across the country are increasingly trying to address. Indiana, for instance, recently passed a law establishing a system that rates hospitals on the complexity of neonatal and maternal care each can provide. At least 22 states have rating systems for neonatal care, while 17 have them for maternal care, according to the March of Dimes.
State health officials say these measures help ensure expectant mothers and infants are cared for in the appropriate facilities.
"The purpose of it really is to make sure that, if at all possible, we identify any risk factors a pregnant women has or a baby has ... and we make sure that the woman or child not only has the level of personnel but also the level of technology and the level of equipment that's required to address whatever those risk factors are,” said Indiana State Health Commissioner Dr. Kristina Box.
Those risk factors might include a baby with congenital birth defects or a mom with a previous preterm birth, heart condition or bout of preeclampsia, Box said.
Will these laws save the lives of infants? The data suggests that making sure babies are delivered at the right kind of hospital can be a matter of life and death.
In 2010, researchers from the Centers for Disease Control and Prevention reviewed more than 30 years of mortality data on both babies with very low birth weights (less than 3.3 pounds) and who were also born very premature (less than 32 weeks). The scientists found that those infants were more likely to die if they weren't born at highly specialized (or “Level III”) hospitals.
One of the earliest systems of this kind started in Arizona in 1975, with a grant from the Robert Wood Johnson Foundation. The state also funds medical transport for high-risk pregnant women and newborns to ensure they’re taken to a facility equipped to care for them.
But has this reduced infant mortality in the state?
"We know it has," said Deb Christian, executive director of the Arizona Perinatal Trust. "We transport approximately 700-plus mothers and 700-plus babies a year. Previously a significant number of patients would have been delivered or taken care of at the wrong levels of care."
Arizona’s infant mortality rate fall from 14.8 deaths per 1,000 live births in 1975 to 5.4 today, though that decline roughly mirrors that of the country overall.
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