Erin Boland’s pregnancy took a turn for the worse in a matter of hours.
The South Portland woman developed HELLP syndrome, a condition involving the destruction of red blood cells, elevated liver enzymes, and a low platelet count that can rapidly worsen and threaten the lives of both mother and baby.
Doctors advised Boland to go into labor 12 weeks early. On May 3, 2011, she gave birth to her son, Gevin, at Maine Medical Center in Portland. He weighed just 2 pounds, 11 ounces.
“He was a peanut,” Boland said.
After a short time on a breathing tube and later a breathing machine, Gevin could inhale and exhale on his own, Boland said. He spent 53 days in the neonatal intensive care unit.
“We were more fortunate than some families whose babies have a harder time,” she said.
For years, health care providers and public health groups in Maine have worked to lower the number of babies born prematurely. On Wednesday evening, the March of Dimes honored the state with its Franklin Delano Roosevelt Award, which recognizes statewide efforts to reduce preterm births, or births prior to 37 weeks.
Maine’s preterm birth rate dropped to 9.2 percent of all births in 2012, besting the national average of 11.5 percent and tying Maine with Alaska for third in the nation. Maine’s performance made it one of six states to earn an “A” grade on the March of Dimes’ most recent report card on premature births.
While the national average of 11.5 percent marks a 15-year low, the country earned a “C” on the report card. The March of Dimes says the rate could drop to 9.6 percent if prevention efforts were more fully adopted.
At the award ceremony on Wednesday night, the March of Dimes also presented Maine Medical Center with a “Wall of Hope,” featuring photos and stories of seven premature babies, including Gevin Boland, for display in the hospital’s neonatal intensive care unit.
Today, Gevin’s a “rambunctious two-and-a-half year old,” said his mother, who serves on a family council at the March of Dimes. Aside from some minor speech delays, he’s fully recovered, she said.
Other premature babies aren’t so lucky.
“Some of these infants have great outcomes and they have no health problems ongoing. It’s amazing,” said Erin O’Connor Jones, director for the March of Dimes’ Maine chapter. “Some of the infants who are born preterm have some cognitive delays and some cognitive disabilities or they have some physical disabilities.”
Preterm births also carry financial costs, to the tune of an estimated $26 billion a year nationally, Jones said.
“Babies born too early and too soon, they have admissions to neonatal intensive care units, of course, which is very expensive,” she said.
That tally doesn’t include the costs of treating long-term health problems, parents’ lost productivity in the workplace, necessary therapies or special education, Jones said.
“The goal is to ensure that every baby gets a healthy start,” she said. “Babies do best when they get their full 40 weeks — their brains are fully developed, their respiratory systems are fully developed, their immune systems are fully ready.”
While women sometimes enter preterm labor for unknown reasons, access to health insurance, good prenatal care and quitting smoking reduce the risk, Jones said.
Factors recently getting more attention are early elective C-sections and inductions, in which women opt for surgery or an induced labor when it’s not medically necessary. The reasons can range from convenience, for the mother or the doctor, to asserting control over the birth experience, to avoiding some of the physical damage that can result with a vaginal delivery, though surgery also carries risk.
The American Congress of Obstetricians and Gynecologists recommends that without a clear medical reason for surgery, mothers choose a vaginal delivery rather than opt for a cesarean before 39 weeks of pregnancy. Elective inductions before 39 weeks also aren’t recommended.
“Benefits of vaginal births for women include shorter hospital stays, lower infection rates, and quicker recovery,” the organization said in March. “Babies born vaginally have a lower risk of respiratory problems.”
Babies born early have higher rates of respiratory problems, pneumonia, and admission to neonatal intensive care units, according to ACOG.
The March of Dimes has called on hospitals and health professionals to eliminate elective deliveries before 39 weeks that aren’t medically necessary. Maine’s rate has decreased over the last two years, Jones said.
The March of Dimes credited Maine for that in its report card, as well as the state’s successes in preventing pregnant women from smoking or helping them quit. But the organization urged lawmakers to expand insurance coverage for women of childbearing age, including Medicaid, and encouraged employers to create workplaces that support the health of mothers and babies.
The Maine Center for Disease Control and Prevention has urged mothers to avoid early elective births, according Director Dr. Sheila Pinette. Many Maine hospitals also follow that guideline, unless there’s a risk to the mother or fetus, she said.
When Pinette and her husband, Dr. Michael Pinette, director of maternal-fetal medicine at MMC, were recruited to Maine in 1988, the rate of preterm labor was high, she said. Since then, partners throughout the state have worked to boost outreach to pregnant mothers and stress the importance of prenatal care, and improve the availability of specialized physician consultations, Pinette said. More recently, the state’s Snuggle ME program has focused on improving the health of pregnant women facing drug addiction and their babies, she said.
Today, 13,000 babies are delivered in Maine each year, Pinette said. Far fewer than before are born early. Maine’s preterm birth rate has dropped in each of the last several years, from 11.1 percent in 2006.
“This is a long time coming and this did not happen overnight and we certainly did not do this alone,” Pinette said.