As doulas, it is important we help support families not just during birth but throughout pregnancy. Being aware of the growing disparities in preterm birth rates can help us better support our clients. A new study published in the journal JAMA Network Open, highlights an increase in preterm birth rates. However, not only was there an increase in the rate of preterm births, there was an increase in disparities.
The International Doula Institute provides comprehensive training. Our doulas learn how to truly serve the individuals they work with in an equitable way. Doulas are not likely to change the whole of the maternity system. However, by staying up to date with what is happening within systems, they can support clients in a way which increases their likelihood of a safe birth.
Study Finds Growing Disparities in Preterm Birth Rates
Preterm birth is any birth occurring before 37 weeks gestation. Infants born before 37 weeks are at an increased risk of short- and long-term health and developmental conditions.
In the last decade, preterm births have increased by more than 10% with racial and socioeconomic disparities persisting over that time. The recently published study looked at over 5 million births.
The study also found increases in diabetes, sexually transmitted infections, and mental health conditions which can increase the risk of preterm birth. At the same time, there was a decline in factors which reduce the risk of preterm birth.
“Our findings not only show that preterm births are on the rise, but provide clues as to why this may be the case,” said Laura Jelliffe-Pawlowski, the study’s lead author shared. She continued, “Understanding patterns of and factors related to preterm birth is important for informing clinical care and the development of public health programs to address this critical need.”
We do not understand the cause of every preterm birth, some have known causes, many do not. However, we do know some risk factors, including:
- High blood pressure
- Diabetes
- Smoking
- Infection
We also know that some populations are at an increased risk of preterm birth. Black, Native American, and Hawaiian and Pacific Islander are at an increased risk of premature birth which is believe to be driven by structural racism faced by these populations.
Preexisting health conditions impact birth outcomes. Structural racism impacts birth outcomes. This study highlighted both factors.
Why Are Studies About Preterm Birth Important?
As doulas, we want to be able to support the families we serve in a tailored fashion. When we know more about risk factors, preventative measures, etc., we can help each individual client have their best pregnancy and birth experience.
As mentioned above, lead author Jelliffe-Pawlowski said understanding patterns is important for seeing what areas of public health need to be addressed.
As doulas, we can use information to help our clients make informed decisions about their care providers, lifestyle choices, and any potential protective measures they can take. Also, when one is aware of risk factors, they can be better prepared to tackle something should they unfortunately experience complications. Informed parents can tackle preterm birth better than someone completely caught off guard.
Prematurity is a leading cause of infant mortality and morbidity as well. Each day, week, month a baby stays in utero is important. When we learn who is at an increased risk, we can address some of the ‘whys’ behind it and how we can better reduce their risks.
Major Concern – Why is Preterm Birth Increasing?
The study found preterm birth increased by 10.6% over the decade studied. Preterm birth went from 6.8% in 2011 to 7.5% in 2022. Their results echoed a report from the Centers for Disease Control and Prevention (CDC) which saw a nationwide rise from 2014-2022.
The rate of preterm birth grew among all groups. However, some racial/ethnic and socioeconomic groups saw a higher increase. The highest rate of preterm birth was 11.3% in Black mothers with public health insurance. The group with the lowest rate, 5.8%, were white mothers with private insurance.
There was a slight decrease in preterm birth among Black mothers with private insurance, going from 9.1% to 8.8%. However, it was still significantly higher than the rate of white mothers with private insurance. This echoes other studies which find rates of pregnancy complications remain higher among Black women regardless of socioeconomic factors. In contrast, preterm birth rates jumped from 6.4% to 9.5% among Native American mothers.
“We found stark differences in terms of what it looks like to be a Black or Native American pregnant person compared with a white individual who is of middle or higher income,” said Jelliffe-Pawlowski.
We are seeing an increase in preterm birth nationwide across all groups. One factor is changes in overall health (e.g., diabetes, high blood pressure). We are also seeing an increase in disparities in birth outcomes for some populations, which is likely tied to structural racism, and biases in care.
What Can We Do About Increases and Disparities in Preterm Birth Rates?
Understanding the trends and risk factors is the first step in improving birth outcomes. Next, we look at what changes we can make. What can we do right now? What can we do in the future?
“We need to do a better job of sharing information with pregnant people about risk factors for preterm birth and interventions that may be able to help them address this risk. Some providers report not wanting to scare or overwhelm pregnant people, but pregnant people tend to report wanting to have this information,” said Jelliffe-Pawlowski.
“For those who are at increased risk due to factors like hypertension or previous preterm birth, for example, providers should be having conversations about how taking low-dose aspirin might be helpful to them and their growing baby. This also extends to things like screening for sexually transmitted infections and offering mental health care in a non-judgmental, supportive way.”
“There is also important work to be done to improve structural issues.”
For doulas, being part of change can look like staying up to date with trends and risk factors in the communities you serve. It can also look like taking our Diversity, Equity, and Inclusion for Birth Workers course to be better equipped to serve each individual family seeking your support.
Author: Maria Silver Pyanov, CPD, CCE
Maria Silver Pyanov, CPD, CCE has been serving prenatal and postpartum families since 2007.