New Report Details Poor Infant And Maternal Health In W.Va.

A new report from the March of Dimes shows West Virginia’s already high preterm birth rate is rising.

West Virginia earned an “F” on its March of Dimes report card for infant and maternal health. 

The national percentage of preterm births (PTB) is 10.4 percent, while West Virginia’s rate is 13 percent.

The World Health Organization defines PTB as babies born alive before 37 weeks of pregnancy are completed.

Many factors can contribute to PTB including smoking, hypertension, unhealthy weight and diabetes.

The infant mortality rate in West Virginia increased in the last decade. Infant mortality is defined by the CDC as “the death of an infant before his or her first birthday.” In 2021, 117 babies died before their first birthday in West Virginia. 

The Medical Director of West Virginia University’s Neonatal ICU, Autumn Kiefer, said the report shows the state has more work to do to improve outcomes.

“I think there is a need for education of the community in general about things like what preterm labor looks like, what can be done in a healthcare setting to help treat and improve outcomes for moms that do experience preterm labor or have a history of preterm birth,” Kiefer said.

Outcomes are even worse for babies born to Black birthing people. The PTB rate for Black babies is 1.4 times higher than the rate among all other babies while the infant mortality rate among babies born to Black birthing people is 1.6 times higher than the state rate.

According to the report, from 2019 to 2021, the leading causes of infant death in West Virginia were birth defects, PTB or low birth weight (LBW) and maternal complications.

“Making sure that folks are aware that if they have that concern that they could be in preterm labor or if they’re not feeling well, and there’s different with the moms with preeclampsia, all kinds of reasons that they may need to deliver preterm,” Kiefer said. “It’s so important to get checked out because there are things that can be done for mom and baby that can improve the chances of a good outcome is born preterm.”

The primary causes of infant mortality include birth defects, preterm birth and low birth weight, sudden infant death syndrome, accidents and injuries, and maternal pregnancy complications, according to both the CDC and March of Dimes.

In West Virginia, unhealthy weight was reported in 42.9 percent of all births and smoking in 17.9 percent of all births.

According to the National Center for Health Statistics, from 2018 to 2021, 25.4 per 100,000 births resulted in the death of the birth giver during the pregnancy or within six weeks after the pregnancy ends. 

The March of Dimes also reported that West Virginia also has inadequate prenatal care. According to the report, almost 13 percent of birthing people received care beginning in the fifth month or later, or less than 50 percent of the appropriate number of visits for the infant’s gestational age.

The March of Dimes concludes the report by listing policies and funding that would improve and sustain maternal and infant health care. West Virginia does not have paid family leave or a doula reimbursement policy. 

“The March of Dimes has suggestions of some additional legislation that can be helpful, based on current national information, like more options for paid family leave,” Kiefer said. “In general, having a new baby is a stressful experience and so having a family feel like they’re supported and have a means to bond with baby and have time to put things in place to get a good system going can help on the infant mortality side of things.”

The state’s expansion and extension of Medicaid scored well alongside a maternal mortality review committee, fetal and infant mortality review and a federal perinatal quality collaborative.

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Charleston Area Medical Center and Marshall Health.

W.Va. Faces Shortage Of OB-GYNs And Places For Them To Work

Only 18 of the state's 55 counties have hospital birthing centers.

In 2015, Nicole Nichols was pregnant with her third, a little girl. It was a pregnancy with multiple high-risk complications.

At the time, she lived in Looneyville, a small community in rural Roane County and about 19 miles from the county’s hospital. But that year and into the next, she had to drive to a hospital in Charleston for checkups, which is an hour each way.

She scheduled visits around her other kids’ school schedules, and she didn’t always have a reliable vehicle to travel while her husband worked out of town.

I had to go just about every week. Toward the end I had to go two to three times a week for regular non stress tests because I had a pretty rough pregnancy with her,” Nichols, 31, said.

West Virginia is facing a shortage of obstetricians and places for them to work. Only 18 of its 55 counties have hospital birthing centers.

Roane County is located in the center of the state, an area that is a desert for OB-GYNs. Its local hospital once had a labor and delivery unit but it closed in 2006 due to declining use.

Nicole Nichols
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Courtesy
Nicole Nichols, 31, and her 6-year-old daughter.

Nichols went into early labor multiple times, which includes risks for mom and baby.

“I was in full panic mode in labor very early and scared I was going to lose her,” she said. “That really put her at risk having to travel an hour and an hour and a half to get that labor stopped … had I not made it there in time I don’t know where she would be.”

West Virginia has 20 birthing hospitals after St. Mary’s Hospital in Huntington closed its labor and delivery unit earlier this month. The state has one freestanding birth center.

Nationwide and in the state, births saw a slight increase in 2021 for the first time in seven years, but the overall drop in births coupled with West Virginia’s aging and declining population have made it difficult to sustain birthing centers.

The shortage means there’s a declining number of places for OB-GYNs to work, and this all leads to poorer outcomes for mothers and babies, according to Dr. Angela Cherry. She’s a family medicine physician in Harpers Ferry.

“If there’s not a birthing center there, moms are having to drive more than 30 minutes to a birthing center, which may limit the care they receive even prior to delivery,” Cherry said. “There is an increased risk of having more complications … if they have less prenatal care.”

Cherry said that while telehealth could help fill in the gaps for prenatal care, the state’s internet gaps keep it from being an option for all pregnant women.

West Virginia has some of the country’s worst birthing outcomes, including its rate of infant deaths and preterm births, which can cause a number of serious complications like breathing problems or heart issues.

The state is also having an increase of mothers dying in childbirth, which is connected to the state’s drug epidemic.

“What we’ve seen is those women are just not getting care,” she said.

Cherry presented these concerns to lawmakers in November during legislative interim meetings.

West Virginia isn’t the only state struggling; there’s a national shortage of OB-GYNs.

Cherry said the state’s rural towns struggle to attract OB-GYNs because they’re too far from hospitals and lack local economy. West Virginia University School of Medicine offers a fellowship program that trains family medicine doctors to perform cesarean deliveries, or C-sections, in rural areas that don’t have a birthing hospital and increase obstetrical care. But, Cherry said the program has struggled to place program graduates in West Virginia towns, and those doctors choose to practice in rural communities in other states.

The state could also struggle to recruit OB-GYNs following its recent abortion law, which is one of the most restrictive abortion bans in the country.

Nationally, doctors and a health care recruiting firm have said states with restrictive abortion measures have trouble recruiting OB-GYNs because doctors fear they could be prosecuted for health care decisions.

State Sen. Hannah Geffert, D-Berkeley, said her area is struggling to recruit OB-GYNs. During a presentation on maternal health, she asked Dr. David Didden with the state Office of Maternal, Child and Family Health if the abortion law would further impact recruitment.

Didden responded, “I think we can send the message that we are in support of reproductive health for women, and that this is a promising place to come and practice medicine. But, it’s a tough sell and it’s not just in medicine … We are going to continue to establish best practices and standards of care, and I hope we’ll be able to convince more providers that this is a good place to practice medicine.”

Nichols’ daughter is now six years old and thriving, and the family has moved from Roane County.

She hopes state leaders will focus on bringing OB-GYNs to rural areas as she knows other mothers from Roane who have struggled to get necessary appointments for mother and baby due to travel distance, money and transportation challenges.

“For people who can’t get to Charleston, it’s a lot easier for them to find a ride that’s 10 to 20 minutes compared to an hour or hour and half,” Nichols said.

W.Va. 2014 Rate of Late Preterm Births at 9.1% in March of Dimes Report Card

West Virginia once again earns a “C” on the 2014 March of Dimes Premature Birth Report Card.

This year, the rate of late preterm births in West Virginia is at 9.1%.

West Virginia’s preterm birth rate was 12.5% percent in 2013, down from 14% in 2006. The state has received a “C” again this year on its report card.

The national preterm birth rate fell to 11.4 percent in 2013 – the lowest in 17 years — meeting the federal Healthy People 2020 goal seven years early.  Despite this progress, the nation as a whole still received a “C” on its annual report card.  

The US has the highest rate of preterm birth of any high resource country.

West Virginia is part of a national trend toward improved preterm birth rates.

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