A "D" grade may be nothing to brag about — unless you're talking about Florida's grade for preterm births.
After three straight years of "F" grades on a national report card, doctors see the D grade, announced today, as a sign that the state is making progress in its efforts to make sure as many babies as possible are born after 37 weeks' gestation, giving them a better chance at a healthy start in life.
All told, 13.5 percent of Florida babies arrived too early last year. That's down from 13.8 percent a year ago, but Florida still ranked ninth-worst in the country.
The report by the March of Dimes noted the state's improvement in two categories — declines in the proportion of women of child-bearing age who smoke and the percentage of late-preterm births, defined as 34 to 36 weeks' gestation.
But the number of Florida women who don't have health insurance increased as the economic downturn continued, and that was a mark against efforts to provide proper prenatal care, key to healthy pregnancies.
The modest progress "shows we're starting to turn the corner, but we still need an incredible amount of work," said Dr. Lewis Rubin, chief of neonatology at the University of South Florida and medical director of newborn services at Tampa General Hospital.
Nationally, the preterm rate fell just slightly, from 12.3 percent to 12.2 percent.
"The decline is small, but it translates into more than 100,000 babies a year nationally that are not being born prematurely," Rubin said.
It was enough to improve the nation's grade from a D to a C. Still, the United States trails behind other Western nations; in 2009, one in eight births in the United States was preterm, compared with 1 in 18 births in Ireland and Finland, according to the Centers for Disease Control and Prevention.
In 2005, the United States ranked 30th in the world for infant mortality.
Babies born before 37 weeks gestation are more likely to die in infancy, or face increased risk of breathing problems, cerebral palsy, learning disabilities and other problems.
Rubin praised efforts by health care providers, public health officials and groups such as the March of Dimes to cut smoking in women of child-bearing age. The rate went from 19.2 percent in 2010 to 17.3 percent this year, according to the CDC.
But he lamented the poor economy's continued impact — women ages 15-44 who lack insurance increased from 27.9 percent in 2010 to 28.5 percent this year.
The uninsured are less likely to get prenatal care and treatments that can help them carry to full term, he said.
Still, there are resources available, including expanded Medicaid eligibility for pregnant women in Florida.
MomCare, run by the state's Healthy Start program, provides care for pregnant women with household incomes up to 185 percent of the federal poverty level. That's $26,964 a year for a single mother-to-be, or $33,876 a year for a mother-to-be and her partner.
"Many women think that if they're working, they're not eligible," said Cindy McNulty, community liaison for the Healthy Start Coalition of Pinellas Inc.
The program served more than 131,000 low-income pregnant women in the past year.
"But many are not taking advantage of it," McNulty said. "I think they're just overwhelmed, or they're embarrassed and don't know how to ask for help."
Dr. Washington Hill, medical director of labor and delivery at Sarasota Memorial Hospital, said he sees the state's improved grade as a sign that the hard work of health care workers and advocates has just begun.
"If you take home a D on a report card, you'd be grounded," Hill said. "We still have a ways to go."
Richard Martin can be reached at firstname.lastname@example.org or (813) 226-3322.