Reducing prematurity rates with equal access and care for all

November 10, 2020 Swedish Health Team

The numbers of babies born too soon have steadily risen over the past few years, particularly among women of color. 

  • What causes preterm birth?
  • How can access to care help prevent preterm birth?
  • Dr. Amber Wood shares her insight and experience on supporting women during pregnancy.

[3 MIN READ]

One in 10 babies are born prematurely, according to the 2019 March of Dimes report card. That’s 380,000 babies who are born before 37 weeks gestation every year. While many preterm babies grow up to be healthy, they can be at risk of developing serious health conditions, such as breathing problems, developmental delays and even cerebral palsy.

The numbers of babies born too soon have steadily risen over the past few years, particularly among women of color. In fact, the preterm birth rate among Black women is 49% higher than all other women. 

The numbers of babies born too soon have steadily risen over the past few years, particularly among women of color. 

One key approach to supporting all mothers-- particularly Black women and women of all backgrounds-- is to provide high-quality, comprehensive care before, during and after pregnancy.

“This is a topic that is near and dear to me,” explains Amber Wood, MD, maternal fetal medicine physician. “As a high-risk OB-GYN, I work closely with many women who may be at a higher risk of preterm labor, whether it’s because of a pre-existing health condition, a history of preterm labor or another risk factor. We do everything we can to listen closely to every woman we see and take their concerns and questions seriously.”

Dr. Wood shares her insight and experience on supporting women during pregnancy and what can be done to reduce rates of preterm delivery, and mortality and morbidity among pregnant women.

What is preterm birth?

Preterm birth refers to any labor and delivery before 37-39 weeks gestation. (39 weeks and beyond is considered full term.) Because different developmental milestones happen during pregnancy, medical professionals farther describe premature births as: 

  • Late preterm: Born between 34 and 36  weeks of pregnancy
  • Moderately preterm: Born between 32 and 34 weeks of pregnancy
  • Very preterm: Born at less than 32 weeks of pregnancy
  • Extremely preterm: Born at or before 25 weeks of pregnancy

What causes preterm birth?

There are many conditions that can cause preterm birth, but sometimes it remains unknown. When the reason is known, it likely falls into one of two general categories: 

Spontaneous preterm birth

This type of preterm labor happens, as the name suggests, spontaneously. A pregnant woman’s water may break, or she may naturally start the progression of labor with contractions, dilation or thinning of the cervix. Women may be at higher risk of spontaneous preterm labor if they have:

  • History of preterm birth
  • Multiple gestations (pregnant with twins, triplets)
  • History of large fibroids
  • Structural abnormalities of the uterus, cervix or reproductive organs
  • Infections like a urinary tract infection, bacterial vaginosis or Group B strep

Iatrogenic preterm birth

Sometimes, if a woman has a serious medical condition, such as high blood pressure, gestational diabetes or issues with the placenta, medical teams may recommend either inducing labor or performing a cesarean section even before 37 weeks. This is called iatrogenic preterm birth. Because of the serious complications of prematurity, doctors will only recommend an early delivery if mom or baby are at risk of other health issues. 

Maternal health, preterm labor and health inequity

Research and studies paint a startling and unsettling picture about the lack of fair and equitable healthcare for Black women and many women of color. A recent study from the Centers for Disease Control and Prevention (CDC) found that Black, American Indian and Alaska Native women are two to three times more likely to die from pregnancy-related causes than white women. Even more disturbing, most of these deaths were preventable.

Hospitals and healthcare providers across the country have been called to give this topic the attention, training and gravity it deserves. Swedish is dedicated to providing access to equal and quality care for all women. But, Dr. Wood notes, it goes beyond bias training, open communication and building trust between patients and providers, something Swedish is proud to do. It must also include providing the resources and community support for women of color. 

Until everyone has access to quality and affordable healthcare, at-risk women won’t always be able to afford the care they need," says Dr. Wood.

“We see women come into our high-risk clinic because their diabetes is poorly managed – not because they didn’t want to or know how to manage their condition-- but because they simply couldn’t afford the insulin they needed prior to pregnancy,” Dr. Wood shares. “We’re fortunate that high-risk OB services are covered by Medicaid and public insurance, but until everyone has access to quality and affordable healthcare, at-risk women won’t always be able to afford the care they need.”

When women are patients in the clinic, Dr. Wood and her team work diligently to get them as healthy as possible. That may include diabetic counseling, classes and programs, connecting them with resources in the community, or providing breastfeeding support

The high-risk clinic has a social worker who is available to help work through barriers women face outside of their pregnancy, including transportation to and from the clinic, food aid applications and much more.

“There’s no easy answer when it comes to supporting Black women and women of color,” Dr. Wood states. “We have to address it individually as providers, as healthcare organizations and as a society.”

Giving preterm babies a strong start

It can be overwhelming for families to have a baby born before 37 weeks. Many times, premature babies will wind up spending some time in a neonatal intensive care unit (NICU). These specialized units deliver the advanced care and support preterm babies need to grow healthy and strong. And, Swedish First Hill is one of only two facilities in Seattle to have a Level IV NICU, which means they have the proven experience and capabilities to provide the highest level of treatment for premature newborns.

If you have a question or concern about your pregnancy, or are worried about your risk of preterm labor, Dr. Wood encourages you to talk to your OB-GYN. 

“Your doctor can identify if you are at risk and make a plan to manage that risk,” she reassures. “And, if you need specialized care, you can take comfort in knowing you’ll be referred to a maternal-fetal provider who is experienced in caring for women just like yourself.”

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Find a doctor

Whether you require an in-person visit or want to consult with a doctor virtually, you have options. Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction and follow-up as needed. If you need to find a doctor that specializes in women’s care, you can use our provider directory.

Find out what we’re doing to keep you safe when you visit

Related Resources

Childbirth in a pandemic: How hospitals are keeping mothers and babies safe

Black breastfeeding week - and why it matters

2019 March of Dimes Report Card

COVID-19 Impact on pregnancy, delivery and new parenthood

Midwives fill a special role before, during and after pregnancy

Just had a baby and need support at home? Swedish doulas to the rescue.

This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.

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