The state is asking Cumberland County to bring down its number of babies born early. Here’s why that’s a challenge

About one in every 9 pregnancies in Cumberland County resulted in a preterm birth last year. The figure isn’t new. It’s been about this number since 2019. 

Yet, the county is being asked to decrease its stagnant preterm birth rate to meet the goals of North Carolina’s Perinatal Strategic Plan. The initiative aims to bring the state’s average preterm birth rate down by over three percentage points by 2026. Cumberland County Department of Public Health Director Jennifer Green said the county’s overall health would need to improve to see the preterm birth rate decrease.

“There is not one thing that I can think of that, ‘If we just do this, then we will lower our preterm birth rate,’” she said. “It really is going to take sort of this multifaceted approach to help pull those numbers down.”

Preterm birth occurs when a baby is born before 37 weeks of pregnancy; an average pregnancy is around 40 weeks. The earlier a baby is born, the greater the risk of death for the newborn. Complications such as problems with vision, hearing, cognition and motor skills are also more likely the more premature a birth is, explained Dr. Kristen Coggin, a NICU neonatologist at Cape Fear Valley Health Medical Center. 

Coggin said many of the preterm births at the medical center stem from common chronic health conditions found in populations across the southeastern region of the state. One condition is high blood pressure, also known as hypertension, which impacts 37% of county residents according to an analysis of Centers for Disease Control data. Almost 21% of people who gave birth in 2023 had hypertension, according to the state’s Maternal and Infant Health Data Dashboard.

Another prominent condition is diabetes. About 12% of adult residents in Cumberland County have diabetes.

“Even though, over time, we have identified risk factors that would seem modifiable, I don’t think we’ve seen a huge change in the overall rate of preterm birth,” Coggin said.

Nationally, substance use before and during pregnancy is also a common cause of preterm birth and is often, though not always, a reason babies land in the Medical Center’s NICU, said Coggin.

“You could walk through the NICU right now and multiple babies have had some in-utero exposure to some illicit substance,” she said.

Opioid use is steadily declining in Cumberland County. The number of visits to the county emergency departments for opioid overdose is decreasing and with them the number of newborns diagnosed with drug withdrawal symptoms. 

Eight and a half percent of babies born in Cumberland County in 2022 were diagnosed with neonatal abstinence syndrome, or withdrawal from substances they were exposed to during pregnancy, according to the state’s Maternal Infant Health Data Dashboard. The following year, the rate was only 3.5% — a five-point drop. 

However, Green said drug use during pregnancy is still a concern. She said the county health department is designing a childbirth education class around moms who may have substance use disorders. It will be offered at the C-FORT Recovery Resource Center. 

“A pregnant person doesn’t come to the hospital in a vacuum,” Green said. “A mom smoked before or had high blood pressure before. That doesn’t go away. Those things happened and existed before pregnancy in a lot of instances. So if you’re thinking about impacting preterm birth, you got to back up maybe a lifetime ago.”

Factors that impact health, like a person’s socioeconomic status, also affect preterm birth rates. Cumberland County is a Tier 1 county, designating it among the 40 most economically distressed counties in North Carolina. The county’s median household income — $61,643 — is about $9,000 less than the state average.

Many resources offered by the Cumberland County Department of Public Health help pregnant people with lower socioeconomic status. Green said the department’s Maternity Clinic staff is trained to direct clients to other maternity services like the Care Management for High-Risk Pregnancy Program — which connects Medicaid recipients with high-risk pregnancies to a team of social workers and nurses to prevent preterm births — and non-maternity services like Medicaid that can improve a pregnant person’s general health.

“It’s about how we address all of these social needs that are around you [a pregnant person] that are going to impact your health,” Green said.

Research also suggests that race plays a large role in preterm birth. A study published in the American Journal of Obstetrics and Gynecology found that Black and mixed-race, non-Hispanic women with high socioeconomic status were still more likely to have preterm births than white women of high socioeconomic status. 

Racial inequities are a large focus of the state’s Perinatal Strategic Plan. In Cumberland County, Black women were around 1.5 times more likely to give birth preterm than white women between 2019 and 2023, according to data from the Maternal and Infant Health Data Dashboard.

In addition to addressing chronic county health issues and racial disparity issues, Green said more OB-GYN providers are needed to bring down the county’s preterm birth rate. 

Cape Fear Valley Health and Methodist University hope the new medical school will help bring in and keep physicians, including OB-GYNs, into the region. Dr. Donald Maharty, Cape Fear Valley Health’s vice president of medical education, said the system has retained seven of its 11 OB-GYN residents over the past three years.

In the meantime, Green said the county is seeking doula services as a short-term solution to improve the county’s preterm birth rates and overall maternal health. Pregnant people who use doula services have been found to have lower rates of preterm births.

“We know there’s a shortage of providers, and that’s going to take some time to get new providers in here,” Green said. “But we can fund some doula services right now. That’s a tangible strategy that we can work on now.”

CityView Reporter Morgan Casey is a corps member with Report for America, a national service program that places journalists into local newsrooms. Morgan’s reporting focuses on health care issues in and around Cumberland County and can be supported through the CityView News Fund.