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State of Oklahoma: To save Oklahoma babies, start before they're conceived

Oklahoma City — If you want to save Oklahoma babies, the best time to start is before they're conceived, Belinda Rogers says.

Women who have decided to get pregnant can take steps to improve their own health, reducing their babies' risk of being born too early or too small, as well as their own risk of pregnancy complications, said Rogers, who is maternal child health director at Oklahoma March of Dimes. Prematurity and low birth weight are both major risk factors for infant mortality.

“We know the health of a woman before she becomes pregnant makes all the difference for a baby,” she said.

In 2015, 383 babies in Oklahoma died in their first year of life. Oklahoma ranks 47th in the country for infant deaths, with 7.7 of every 1,000 babies born alive dying before their first birthdays. The odds are even worse for black and American Indian babies.

The state's maternal health outcomes also are below the national average. For every 100,000 births, 23.4 women die during pregnancy or in the year afterward, placing Oklahoma 32nd in the country.

Infant mortality rates have been improving nationwide for much of the last century. Technology has given babies who were born prematurely or at a low birth weight a better chance of surviving; vaccines have prevented infectious diseases that used to kill babies; and knowledge has grown about how to prevent accidental deaths.

Unfortunately, in Oklahoma, some of that progress has reversed in recent years. Infant deaths have increased annually since 2015, essentially erasing the previous five years' worth of progress, according to the America's Health Rankings report.

Smoking, prescription drug misuse and unsafe sleep settings for babies are some of the biggest factors in infant deaths, said Kelli McNeal, supervisor of the fetal infant mortality review board at the Oklahoma City-County Health Department. The review board through the health department looks into infant deaths and miscarriages after 24 weeks of pregnancy in Oklahoma County and surrounding areas.

“Some of the biggest issues we have that affect infant mortality are some of the most preventable,” she said.

High risks

Oklahoma has high rates of many of the factors that work against the health of babies and their mothers: chronic conditions like diabetes and high blood pressure; smoking; obesity; sexually transmitted infections; and uninsured women.

Some chronic conditions like diabetes and high blood pressure are more difficult to get under control during pregnancy, so it's best to treat them in advance said Dr. Katie Smith, an obstetrician and gynecologist at OU Medicine. Chronic conditions raise the risk of complications for both the baby and the mother, including the chance the baby will have to be born early because of threats to the mother's health.

About half of pregnancies are unplanned, and those mothers can't start taking prenatal vitamins and quit unhealthy behaviors like smoking in advance, Rogers said. About 21 percent of Oklahoma women of childbearing age smoke, and 12 percent of women continue to smoke while pregnant. Smoking increases the odds of premature birth, low birth weight and sudden infant death syndrome.

Oklahoma women of childbearing age also have other risk factors, including higher rates of chlamydia, which is linked to respiratory problems if infants are infected during birth. They also are more likely to be obese, which increases the odds of birth defects or that the baby will have to be born prematurely because of health risks to the mother.

Many moms are motivated to improve their health for the baby's sake, but making changes earlier increases the odds that healthy habits will stick, Smith said.

“If they quit before becoming pregnant, they're more likely to stay a nonsmoker,” she said.

No care available

Improving Oklahoma's infant and maternal mortality outcomes isn't as simple as telling women to go to the doctor, though. About 20.6 of women of childbearing age don't have insurance, which gives Oklahoma the second-highest rate in the country for that subgroup.

SoonerCare has relatively generous income requirements for pregnant women, but some women don't know how to navigate the system, delaying their care, Smith said. The requirements also become much more stringent six weeks after the birth, so women may lose access to lactation support, treatment for postpartum depression and effective birth control, she said.

That's unfortunate, because in the days and weeks immediately after birth, doctors can help parents not only by educating them about how to care for their new arrival, but also by helping delay the arrival of any future siblings, Rogers said. Birth outcomes are best if women wait at least 18 months before conceiving again, so some doctors are using the newborn visit as an opportunity to discuss long-acting reversible contraceptives, she said.

Even patients who have insurance may be confused, because they aren't sure who to call, or whether their postpartum symptoms even merit medical attention, Smith said. Mothers typically don't receive much information about their health in the aftermath of a birth, but they need to care for themselves before they can care for a baby, she said.

“They're back out in the wild, so speak,” she said.

Oklahoma has made some efforts to reduce babies' risk of dying. Hospitals have been important players in reducing infant mortality, said Joyce Marshall, director of the maternal and child health service at the state Health Department.

Most hospitals are participating in the Every Week Counts program, which discourages doctors from delivering babies early unless continuing the pregnancy would hurt the mother or baby, Marshall said, because babies that are born before the 39th week of pregnancy are at a higher risk of dying. Early elective deliveries in Oklahoma fell by about 96 percent between 2011, when hospitals started to put “hard stop” policies in place, and 2014, she said.

Hospitals also have worked with the Health Department to get information about safe sleep to new parents. Some hospitals are testing a pilot program to give portable cribs to families that don't have a safe place for the baby to sleep, Marshall said. Preliminary results suggest parents who got the cribs are less likely to put their babies in an unsafe place, she said.

While work in the health system is important, it won't fully address the problems that contribute to Oklahoma's high infant mortality rate, said Su Phipps, who leads the Healthy Women Healthy Families program in Tulsa. Problems that don't appear to aren't obviously health-related, such as a history of trauma or the stress of racism or poverty, can lead to changes in how a woman's genes express function, setting her and her children up for health problems.

“The stresses your grandmother had can affect your health,” she said. “We need to start paying attention to women and women's health in this state.”

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Meg Wingerter

Meg Wingerter has covered health at The Oklahoman since July 2017. Previously, she lived in Topeka, Kansas, and worked at Kansas News Service and The Topeka Capital-Journal, where she earned awards for business coverage. She graduated from... Read more ›