Indiana State Health Improvement Plan (I-SHIP) - State of Indiana

Reduce Infant Mortality
Prematurity is the leading cause of death among newborn babies. Being
born premature is also a serious health risk for a baby. Some babies will
require special care and spend weeks or months hospitalized in a neonatal
intensive care unit (NICU). Those who survive may face lifelong problems
such as intellectual disabilities, cerebral palsy, breathing and respiratory
problems, vision and hearing loss, and feeding and digestive problems.
In 2008, the March of Dimes (MOD) announced that Indiana had a failing
grade on its premature birth report card due to a number of perinatal
indicators including late preterm births. The consistent escalation of
Indiana‘s preterm rate has created major concerns in the public health
community and prompted a Maternal and Child Health (MCH) investigation
into the patterns of preterm births and the potential contributing factors.
In September, 2009 MCH released results for the study Trends in Preterm
Birth, Cesarean Delivery, and Induction of Labor in Indiana: Statistics from
the Live Birth Data, 1990-2006. The purpose of this report was to study the
patterns and trends in rates of preterm births, cesarean delivery, and
induction of labor in Indiana between 1990 and 2006 and to explore the
relationship of rising preterm rates with cesarean delivery and induction of
labor.
Over the last two decades, there has been a marked shift in the gestational
age distribution of Indiana live births towards earlier ages between 1990 and
2006. During this period, very preterm (less than 32 weeks) and moderately
preterm (32-33 weeks) births have increased modestly (by 16 and 15
percent, respectively) whereas late preterm (34-36 weeks) and near term
(37-38 weeks) births have risen sharply (by 38 and 63 percent, respectively).
In contrast, births at 40 weeks or more have noticeably declined.
Cesarean delivery accounted for 29.3% of all births in 2006, up by 48%
since the lowest rate of 19.8% in 1997. The upward trend in cesarean rates
between 1997 and 2006 was evident across all gestational ages with the
largest increases for late preterm and near term births. Primary cesarean
rates in Indiana doubled (1997-2006) even for singleton full term vertex
position births to women with no indicated medical risk factors (birth weight