USF joins initiative to decrease early deliveries

A new statewide program is hoping to decrease the number of pre-term childbirths that are not health related in Florida hospitals.

When the state of Florida received its third consecutive “F” report card grade in 2010 from the Infant Health Foundation, the March of Dimes, the organization introduced a program into state hospitals that would reduce the number of preterm births to Caesarean sections – a health risk for both mothers and their children.

The Lawton and Rhea Chiles Center at USF received a grant of approximately $100,000 from the March of Dimes foundation to establish the Florida Perinatal Quality Collaborative. The collaborative was established on Jan. 3 to equip hospitals with checklists that ensure that infants receive the necessary gestation period in the womb and early deliveries are not scheduled without medical justification. The collaborative will end in Dec. 2011, when data will be analyzed.

Six local hospitals, including the St. Joseph’s Women’s Hospital on Martin Luther King Blvd, were competitively selected to participate in a collaborative program that changes their policies to no longer permit preterm deliveries without medical validation.

In Florida, preterm deliveries have been higher than the national average of 7.6 percent since 1997, currently sitting at 13.8 percent, according to the March of Dimes website. Florida is one of five states in the nation targeted by the March of Dimes to improve full term delivery. These five states – Florida, California, New York, Illinois and Texas – make up 40 percent of all babies delivered within the United States.

But Lori Reeves, State Program Director for the Florida division of March of Dimes, said the Florida Perinatal Quality Collaborative was established to combat the issue, not only in Florida, but also throughout the country.

“We had some questions we were talking about relating to prematurity in the state of Florida,” Reeves said. “We thought if we could come up with significant programs to implement that made a difference in outcomes for babies, that we could begin right away to reach a large proportion of the babies in the United States.”

While the average gestation period is 40 weeks, a study conducted by the March of Dimes in 2006 saw a large trend of a 39-week gestation period. John Curran, the associate dean of the USF College of Medicine and a leading figure of the collaborative, said this could be attributed to many societal factors.

“Mothers may be tired of carrying for so long. Maybe a grandmother can’t come to watch the kids. Maybe a husband is being deployed to Afghanistan,” he said. “By and large (women) say, ‘What’s wrong with having my baby after 36 weeks?’ Everyone knows that nine months is a pregnancy, and there are four weeks in a month. Therefore nine times four (weeks) is 36 weeks, then (it) must be time to have a baby. They forget the calculation actually obscures it; 40 weeks is a full term.”

Though the shift may also be due in part to the increase in multiple births as a result of fertility treatments, the majority of early deliveries are still due to scheduling convenience, he said – something that may put infants at risk.

“The problem is not the NICU (Neonatal Intensive Care Unit), because (premature) babies are surviving,” Curran said. “Preterm deliveries put the babies at greater risk later. Most of the brain development that should take place within the mother is taking place outside.”

Studies have correlated preterm pregnancies with slower brain development and growth until the age of two, even amongst those who seem healthy and survive past critical stages. The risk of mental retardation, learning and emotional disabilities, and autism are greatly peaked for babies born prior to 37 weeks, according to the March of Dimes website.

“The purpose of the pilot project is to test it,” Reeves said. “We’re not testing whether the idea is a good one, we know for a fact that babies should be delivered at earliest 39 weeks if possible; but what we want to find out for sure is whether this specific tool kit is helpful to hospitals implementing this policy.”

Curran said he believes that education must not only take place at the hospital level but also in the form of public education programs for mothers – the next step in the project.

“The importance here at USF is we’re trying to tie together a collaborative (effort) to make life better for mother and baby, and that’s part of the mission for what the Lawton and Rhea Chiles Center is, and that’s what public health does best,” he said.