The Preterm Birth Rate in the United States is Too High. Here’s One Way to Save Lives.
Yvonne was filled with anxieties common to young expectant mothers. Asked if she was excited about her pregnancy, she replied with stark honesty: “Not yet.”
But then Yvonne joined Group Prenatal Care, a program designed to reduce the risk of preterm births. It brings together groups of eight to 12 women with similar due dates who meet monthly during their pregnancy and act as a support network for each other.
“All of us are going through the same thing,” Yvonne said. “Whatever we don’t know, somebody else will know and we learn off of each other. We create a bond, a friendship – something that you wouldn’t do if you just went to a regular doctor’s appointment and sat in a waiting room.”
Participants often talk candidly in a way they wouldn’t in the intimidating glare of a doctor’s office, or even with their own partners. A pregnancy counselor offers guidance along the way.
“It feels really good to take care of yourself the right way,” Yvonne said.
Later, looking back on the group’s experience, another mother in Yvonne’s group said, “We were so lucky – everybody had a relatively healthy baby, which is amazing when you think about a group of 10 or 11 of us.”
The Cost of Preterm Births
Indeed, Yvonne’s group beat the odds: Each year in the U.S., about one in 10 babies are born preterm, defined as 37 weeks or earlier. That’s almost 450,000 babies, and more than one out of three infant deaths are due to causes related to preterm birth.
In addition to the devastating human toll, premature births cost the U.S. $26 billion annually. The cost of preterm births to businesses is about 12 times as much as uncomplicated healthy births, driving up insurance costs for employers and employees.
“More than one out of three infant deaths are due to causes related to preterm-birth.”
But it doesn’t have to be that way. The March of Dimes and UnitedHealth Group are working together on programs that help cut preterm birth rates. Group Prenatal Care is one of them; it brings pregnant women together in a group setting for medical care, but importantly, also for moral support. This combination of social support and prenatal medical care can reduce the incidence of preterm births and low birth-weight babies by 33 percent, according to a study published in the Journal of Obstetrics and Gynecology. The evidence is so promising that the March of Dimes believes Group Prenatal Care can contribute significantly to its goal of reducing the U.S. preterm birth rate from 9.6 percent to 5.5 percent by 2030.
Public cost savings from the Group Prenatal Care model would be significant. States and the federal government bear a substantial share of the costs of preterm births through the Medicaid program, which covers roughly half of all preterm births. The potential net savings to the Medicaid program over a five-year period would equal roughly $12 billion if half the pregnant women enrolled in Medicaid were to receive care through a group model, according to research from the UnitedHealth Group Center for Health Reform & Modernization.
“We’re really trying to develop a model that is easier to implement,” said Paul E. Jarris, chief medical officer for March of Dimes. “And we want that program to spread so that more moms and babies can benefit from Group Prenatal Care.”
A Case Study at Jamaica Hospital
To get an up-close look at how Group Prenatal Care works, step inside Jamaica Hospital in Queens, New York, on a recent rainy afternoon, where five women leaned back comfortably in deep-seated chairs, chatting and smiling at each other’s stories. They are a small but diverse group. The Jamaica neighborhood is home to large African-American, West Indian, South Asian and Hispanic populations.
It was the women’s last prenatal visit as part of the Group Prenatal Care program, and midwife Ivonne Dabovich was quizzing them on the lessons of the last few months. How long can you keep breast milk in the refrigerator? What can you do to reduce your baby’s risk of SIDS? When should you childproof your home?
Twenty-eight-year-old Waldeline, a veteran mom, corrected first-timers who said they would wait until their babies were a few months old to lock the cabinets and block the electrical outlets. “Your baby’s going to need tummy time to learn to crawl, and what if they roll over and get into something?” Waldeline said, her 2-year-old daughter, Taylor, sitting quietly beside her.
Dabovich nodded approvingly. The conversation flowed from there, covering topics from nutrition to anxiety over bonding with newborns.
This is not how prenatal care is usually delivered. Most women visit their doctors alone once a month for 20 minutes. But in the group setting, women attend sessions together starting soon after they learn they are pregnant. In the first half-hour, each woman weighs herself and takes her own blood pressure. A doctor or midwife then listens to the fetal heartbeat and answers individual questions. The remaining 90 minutes are spent in structured conversations about topics that are relevant at that point in the women’s pregnancies.
“We believe very strongly that having another mother in the group say, ‘You really need to stop smoking,’ carries more weight than a doctor saying it,” said Jim Merwin, senior director, UnitedHealth Group Enterprise Research and Development. “If someone says, ‘I don’t have any transportation available, and the place where I get food only sells junk,’ other women might have ideas to help.”
Ventrice, 32, a mother of three as of February 2017, said the women in her group became fast friends as a result of their experiences. Three weeks after giving birth, they were still texting one another with questions and advice. This kind of friendship and support may well be an important component of the positive outcomes of group care.
“There are different hypotheses on what drives preterm births, and one is stress,” Merwin said. “While no one’s measured cortisol levels yet, we believe the group setting and the support women get reduces stress.”
Relating is Empowering
“Empowerment is the beauty of all this,” said Tracey Reed, vice president of maternal and child health at March of Dimes. “Providers are part of the circle, but they’re not giving all the answers. Women want to do what’s best for their babies; we’re just here to facilitate.”
That’s precisely what the mothers in Yvonne’s group liked about the program.
“At first I was scared to say some personal things because these are people you don’t even know,” one of the mothers said. “But when we met, it was like we had known each other for years.”
Yvonne added, “If I have another baby – baby number three – I would come back to group prenatal.”
Note: Names of expectant mothers have been changed to protect patient privacy.