Thoughts from our Medical Director: What everyone should know about preterm birth

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Recently, one of the infants at the hospital where I am an OB-GYN was born at just 24 weeks. For unknown reasons, her mom went into labor. Though efforts were made to stall the contractions, the labor continued and we took measures to accelerate the maturity of the fetal lungs and brain, and prevent pulmonary complications of prematurity.

At 24 weeks, a premature infant is really tiny, with fragile skin and bones. After safely delivering via C-section (which are often medically necessary for extremely preterm births), we handed the infant off to the neonatologist and their team, and they worked their magic while we sewed mom up. 

While both mom and baby face long roads ahead to recovery and physical and emotional health, I know their strength and resilience will carry them through. 

How I talk with parents about preterm birth  

Preterm birth — defined as birth before 37 weeks of pregnancy — is a leading cause of neonatal morbidity and mortality. The U.S. preterm birth rate is among the worst globally, at 9.9% as of 2017 — meaning around 1 in 10 babies are born prematurely each year.[1]

Understanding and managing the risks for preterm labor is one of the core challenges for both expecting mothers and physicians. The stark reality is that preterm birth can happen to any expecting parent. But there are ways to help prevent it. 

Here’s some of the guidance I provide my patients to help manage the things they can control: 

  • Seek early and ongoing prenatal care. 

  • Wait at least 6 months between pregnancies. 

  • Don’t smoke, and avoid alcohol and illicit drugs — especially during pregnancy. 

  • Try to maintain a healthy lifestyle by getting adequate sleep and rest, prioritizing good nutrition, and managing stress and anxiety.

Other risk factors, however, are entirely out of an individual’s control. There are racial, ethnic, geographic, and socioeconomic disparities for preterm birth which point even further to our need for more equitable healthcare for women and families. In 2017, the preterm birth rate was nearly 50% higher among black women (14%) compared with white women (9%).[2]

Plus, an individual’s job is a risk factor: working more than 40 hours a week has been associated with a 38% higher risk of miscarriage and 21% higher risk of preterm birth, and working night shifts has also been linked to a 21% higher risk of preterm delivery.[3] Of course, we can make recommendations for a pregnant woman to work with their employer to change shifts or cut down on overtime, but options may be limited based on their job function or industry, and certain social determinants may prevent them from being able to do so. 

Understanding the hardships

Premature infants often face long NICU stays, which can mean challenging emotional journeys for families.

There are financial tolls, too, for parents and employers. The average cost for infants hospitalized in neonatal intensive care units is around $3,000 per day. To put that in context: the average cost to an employer for a healthy baby born at full-term, or 40 weeks’ gestation, is $2,830; and the average cost for a premature baby is $41,610.[4] 

While the majority of preterm labors are in the moderate- to late-preterm range (meaning birth between 32 to 37 weeks), the costs of extremely premature births — like this one — can run in the $100,000s. And still, these exorbitant numbers don’t include healthcare costs later in life due to complications that may result from premature birth like cerebral palsy, sensory deficits including retinopathy or hearing loss, learning disabilities, or respiratory illnesses.

How Maven is working to reduce preterm births

At Maven, we’re on a mission to reduce preterm labors and premature births by increasing access to comprehensive and holistic women’s health and prenatal care — lifting the emotional burden on families, and reducing the financial costs to individuals, employers, and health plans. 

How? Maven’s high-touch care delivery model, coupled with our clinical and patient-centered approach, means that we assess and manage members’ risks early and often in a pregnancy, and provide quality care tailored to best meet their needs. By providing empathetic, easy-to-access, end-to-end care, Maven empowers individuals with the information they need to be their healthiest selves during pregnancy. 

 

We’re on a mission to reduce preterm labors and premature births by increasing access to comprehensive and holistic women’s health and prenatal care — lifting the emotional burden on families and reducing the financial costs to individuals, employers, and health plans.”

 

Let’s dive a bit deeper into how Maven works with high-risk members starting from the moment they join: 

  1. Assessing risks early and often: Our onboarding assessment — which a Maven member is guided through on our app as soon as they join and check the box saying “I’m Pregnant” — helps identify risk factors for preterm labor, such as age, family history, if you’ve had a preterm birth before, or if you’re pregnant with more than one baby. Plus, Care Advocates’ continuous engagement with our members means we can manage risks as they emerge during pregnancy — like preeclampsia or elevated blood pressure diagnoses.

  2. Creating specialized clinical tracks for risks: When individuals are part of Maven’s high-risk pregnancy track, they receive personalized care plans that address their specific needs like managing hypertension or monitoring a shortened cervix.

  3. Coordinating high-touch care through personalized plans: For a Maven member in the high-risk pregnancy track, their Care Advocate is with them every step of the way: answering their questions and providing 1:1 support through on-demand video or messaging chats; working with them to create a personalized care plan; and helping steer them to in-person doctors in their network who specialize in their specific condition(s). Care Advocates sit at the center of a member’s Maven care team, coordinating their appointments with specialists in our network to ensure they’re speaking with the right providers at the right moments in their pregnancy. 

  4. Filling gaps in holistic care with providers across 20+ specialties: Maven’s network of more than 1600 providers across 20+ specialties are available on-demand for video and messaging appointments with no out-of-pocket costs for members — which can make a huge difference in managing risks. For instance, a high-risk member’s care team on Maven might consist of: a Maternal Fetal Medicine Specialist (an OB-GYN who is an expert in high-risk pregnancies), a Nutritionist, a Diabetes Coach, a Physical Therapist, a Career Coach, and a Mental Health Provider. 

The bottom line 

Preterm birth can be scary, emotional, expensive, and stressful. If you know a mom who has given birth prematurely, bring her dinner. Take care of her older kids so she can visit the NICU as often as she wants. Check-in on her partner to offer emotional support or a helping hand.

If a new parent who has experienced preterm birth is your employee, work with them to set a flexible schedule for their return to work, and provide Maven as a benefit to meet their holistic needs throughout their postpartum period and transition back to work. 

 We’ve all heard the saying ‘it takes a village’, and this is one of those times when the village is needed more than ever. 

Dr. Jane van Dis is Maven’s Medical Director, a board-certified OB-GYN, and a frequent writer and speaker about gender equity in medicine. Follow her @JaneVanDis

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References:

  1. March of Dimes 2018 Premature Birth Report Card

  2. Centers for Disease Control and Prevention Preterm Birth Data

  3. American Journal of Obstetrics & Gynecology, accessed via Reuters

  4. U.S. Institute of Medicine data, accessed via Managed Care Magazine