Like a cranky old teacher, the March of Dimes sets high standards when it evaluates the efforts states make to reduce the number of babies born prematurely. Grades are given out, but because the prematurity rate in the U.S. has crept up (until recently), no state has ever earned an "A." Until now.
For the first time ever, the March of Dimes awarded Vermont an "A" this year, the only state in the nation to earn one. (See your state's grade here.) Vermont's preterm delivery rate was 9.3 percent in 2009.
I know how hard it is to reduce the prematurity rate -- I deliver my share of premature babies for very good medical reasons, and I've worked with the Massachusetts Chapter of the March of Dimes (a dedicated crew if ever there was one) on this problem for years.
To find out what they did, I called the state director, Roger Clapp, to find out. A self-effacing New Englander, Clapp pointed out that a lot of it has to do with luck:
- Vermont has great health insurance coverage, so essentially all pregnant women have health insurance to cover their prenatal visits.
- Second, bending to the reality of American obstetrics (and reflected in goals downward in Healthy People 2020), the March of Dimes raised their target for the prematurity rate to 9.6 percent.
But other factors had to do with the team-oriented public health leaders in Vermont (and in neighboring New Hampshire). I'm going to sound like a broken record here, but the interventions that worked take a systems-based approach to the problem:
- The March of Dimes supported a collaborative meeting and data-sharing program that got the obstetric and pediatric care providers at the state's 11 birthing hospitals together to talk about problems, data and solutions with public health leaders. (The collaboration included New Hampshire's Dartmouth Hitchcock Medical Center, which provides a lot of tertiary care for middle of neighboring Vermont.)
- This collaborative encouraged cooperation and communication between pediatricians and obstetricians, which helped because the pediatricians (who get stuck taking care of babies with the problems of late-term prematurity) got to drive the point home to the obstetricians (who deliver the babies and often don't learn about the problems that develop later).
Recognition should also go to public health leaders and obstetric care providers everywhere, because the United States has seen a slight decline in the prematurity rate nationwide over the past three years (from 12.6 percent in 2006 to 12.2 percent in 2009).
It's not often that we get to cheer a public health success. Great job, March of Dimes Vermont.
Follow Adam Wolfberg, M.D. on Twitter: www.twitter.com/AdamWolfberg