A few weeks ago, we reported that the premature birth rate in the San Joaquin Valley is rising, and that it’s especially high in Fresno County. The numbers are concerning because premature babies are born with a higher risk of health complications like breathing difficulties, heart problems and chronic disease. Decades of work have proven preterm births are tough to prevent, but a new research initiative appears to be up for the challenge. This story begins, though, in a Fresno living room, where a mother and son enjoy some quiet time together.
Reading is an everyday activity in Nicole Hutchings’ home. Right now, she’s working through “Take a Stand, Rosa Parks” with her six-year-old son Adrian Lee. This bonding time between her and Adrian is calm, peaceful—very different from the circumstances around Adrian’s birth in 2011.
Hutchings had been pregnant for about 32 weeks when she realized something was wrong. She noticed some strange symptoms, and thought maybe her water had broken. “So I went in the hospital and they tested me and they said yes, it's your amniotic fluid—and so the doctor said to prep you for an emergency C-section,” she says.
Adrian’s due date was still eight weeks away. He wouldn’t be considered full term for another five. But Hutchings’ doctors told her he’d be in danger if he wasn’t delivered now. “I asked for a moment to pray,” she said, then went in for the surgery.
Adrian was born just over four and a half pounds. Hutchings barely met him before he was whisked into the neonatal intensive care unit. “I thought that I did something wrong,” she says. “And I was questioning: ‘What did I do?’”
Hutchings learned only later that premature births occur at a higher rate here in the San Joaquin Valley than almost anywhere else in the state. And she, as an African American woman, was at especially high risk. Local preterm birth rates have been problem for years, but a cloud of mystery still surrounds the cause. And that uncertainty has spurred some new efforts to understand what’s happening.
According to state data, across California, about 9 percent of all live births are preterm, or earlier than 37 weeks. That’s on par with the national average. Fresno County’s preterm birth rate is more than 11 percent—the highest of any California county. Kern, Kings and Merced Counties aren’t far behind.
Within that data are other concerning trends. Shantay Davies is with the March of Dimes, a non-profit that supports research into maternal health and birth outcomes. “What’s really alarming and what’s really a call to action is that we’re seeing an increase in disparities between race and ethnicity,” she says.
This is true across the country. But the disparities are pronounced in Fresno County, where black women may be as much as 75% more likely to have a preterm baby than white women. That rate stands out far beyond California. “When we compare ourselves to other countries, particularly some regions in Africa, we have very poor birth outcomes in the Central Valley,” Davies says.
This comparison comes up frequently. It’s difficult to confirm precisely because every country calculates gestational age differently, but data do suggest Fresno County’s African American preterm birth rate is in the ballpark of some of the poorest countries in the world.
So why are we in such bad shape? Theories abound: For instance, women are waiting until later in life to get pregnant, and increased use of fertility technology can lead to more risky pregnancies. But that still doesn’t explain what’s different here. Enter UC San Francisco obstetrician Dr. Larry Rand. “It was very clear we have a massive epidemic on our hands, one that has seen no progress,” he says, “And one that very clearly affects children’s health, because it’s the very beginning of life.“
In 2015, he and a number of colleagues launched the Preterm Birth Initiative, a massive UCSF-sponsored partnership between health experts, clinicians and community members. They’re in the very early stages of a 10-year program that aims to reduce preterm births through focused research and community interventions. In 2016, Fresno became one of the initiative’s six focus areas in both California and sub-Saharan Africa.
For decades, health agencies around the country tried to solve the problem by expanding mothers’ access to health care. And overall it hasn’t worked. So, Rand says, the initiative is shifting its research focus to preconception and the more complex social determinants of health, including “where you live, how you live, what you’re exposed to, where you work, how hard do you work, how many jobs do you work, how do you get to those jobs,” says Rand. “Frankly, all of it works out to, what is your level of chronic stress?”
Fresno State’s Sandra Flores is program director of the initiative’s Fresno County arm. She’s excited about this research because it’s not just about crunching numbers in a database—it’s about real people. Researchers are bringing parents of preterm babies into their workflow wherever they can. “That was a key distinction with the steering committee,” says Flores: “That every facet of this initiative would have that expertise and the experience of a preterm birth.”
One of those experts is Nicole Hutchings. She sits on three committees that guide the Fresno County Preterm Birth Initiative. Through that work, she hopes she can ultimately help other moms be more informed than she was.