Report Highlights Local Inadequacies, Racial Disparities in Prenatal Health

After undergoing an emergency cesarean section at 34 weeks, it was immediately clear to Danielle Rivera that her newborn son, Dylan, was experiencing dangerous repercussions from his preterm birth. 

“Dylan came out and his arms were all tucked in. They got him on the incubator breathing but they seemed to think that there was some kind of brain damage,” she tells Queen City Nerve.

Dylan went into cardiac arrest twice and was transferred to another hospital before doctors were able to stabilize him. He remained relatively stable for the next five months before his condition “began deteriorating,” as Danielle puts it, leading to his death a month later on March 9th, 2009.

When I ask if she’d like to stop the interview after reliving such a heartbreaking experience, Danielle confidently responds, “It’s okay. It’s part of our lives. We’ve just kind of learned to move forward with that experience.”

In the 10 years since her son’s death, which happened in Westchester County, New York, Danielle has moved to Charlotte and become an advocate for parents and newborns across the country, hoping to save them from the same experience she lived through.

As a part of her grieving process, Danielle began looking for ways to channel her grief into something positive. She found that opportunity through March of Dimes, a nonprofit devoted to improving the odds for mothers like Danielle and babies like Dylan.

According to a recent March of Dimes report, however, they’re losing ground in that battle. The organization releases an annual report card that focuses on preterm birth rates, a key indicator of maternal and infant health, and this year’s report, based on 2018 statistics, shows a rising preterm birth rate nationwide and gives North Carolina a D+ grade in that category.

“Every American should be alarmed about the state of maternal and infant health in this country, because it is an issue that touches each one of us. This is one crisis, not two. The health of moms and babies is powerfully linked, and we need to start treating it as such,” March of Dimes President and CEO Stacey D. Stewart said in a release. “This crisis is about the moms and babies we have lost, and those who face serious health challenges. It’s not fine.”

According to the report, released Monday, while preterm birth rate dropped statewide from 10.5% to 10.4%, that still puts North Carolina at 36th among the 50 states. In Mecklenburg County, preterm birth rates have remained at 10.3%, though the total numbers have risen slightly since 2017. In Charlotte, preterm birth rates have risen to 10.5%.

More detailed stats show that African-American and Native American women are at highest risk for giving birth prematurely. According to the report, Native American mothers experience preterm births 11.9% of the time, while that number rises to 13.8% for African-American mothers. No other racial group exceeded 9.3%. The report states that, in North Carolina, the preterm birth rate among black women is 48% higher than the rate among all other women.

Of the seven counties outlined in the report, all saw increasing preterm birth rates compared to last year except Cumberland, which improved to a D-; and Wake, which stayed the same at a B. Wake County has the highest score of any North Carolina county included in the March of Dimes report and the lowest percentage (21%) of African-American residents according to United States Census Bureau.

The remaining counties included in the report — Mecklenburg, Forsyth, Guilford and Durham — all have populations between 27.5% and 37.3% African-American, compared to the national demographic of 13.4% African-American.
The report laid out recommendations that leaders in North Carolina can take to push back on the rising preterm birth rates, including closing the healthcare coverage gap by expanding Medicaid, enhancing insurance reimbursement for group prenatal care, and mandating paid parental leave and workplace accommodations for pregnant and nursing women.

“The health of moms and babies in North Carolina must be a priority issue for all of us. By working together, as individuals and across the public and private sectors, we can make significant changes that can give every mom the care she deserves and every baby the best possible start,” added Stephen DeMeo, doctor with the Division of Neonatology at WakeMed Health & Hospitals and March of Dimes Maternal Child Health Committee member.

Given that ethnic groups experiencing the highest preterm birth rates also tend to be the most economically disadvantaged, they are more likely to be deeply burdened by the average $64,000 cost of a preterm birth, as cited by March of Dimes. This amount includes expenses for short-term services such as early intervention medical care and long-term expenses like special education services that could be required for the premature child.

In Danielle’s case, these post-delivery services included weekly visits with a nurse who would make house calls along with a massage therapist who would arrive to “massage his little body,” as she describes. Her family also visited a specialist to determine what Dylan’s future might look like and remained in constant contact with the hospital where he had been delivered.

Financial struggles can be a major burden for the uninsured when they seek medical assistance, often leading to inadequate care and resulting in complications and potentially a premature birth. The report shows that 14.9% of North Carolina women between the ages of 15 and 44 are uninsured and 18.7% of women in the same age group live below the poverty line.

Along with the report, the March of Dimes offers a “Spotlight on State Progress” platform, in which state health departments unaffiliated with the organization can report what they are doing to improve preterm birth rates. North Carolina is not one of the 17 states currently taking part.

For Danielle, reports like the one released this week only justify the work she’s dedicated so much of her time to since the loss of her son.

“Let’s see if we can change the lives of other parents,” she says. “It would be a great feeling for me. It would be great for my other children so they can see that we’re trying to help other babies. We don’t want them to experience what we did.”