Kristie McNealy, MD

In a time when the preterm birth rate in the rest of the United states is steadily climbing, a carefully coordinated prenatal care program at UT Southwestern Medical Center’s Parkland Memorial Hospital has cut it’s number of preterm deliveries by more than half!

In 1988, 10.4% of babies were born premature, which is close to the national average at that time.  However, while the US preterm birth rate had climbed to 12.8% in 2006, only 4.9% of babies born at Parkland Memorial were preemies that same year.

How did they do it?

Parkland Memorial Hospital has one of the busiest obstetric departments in the United States, delivering 1 in 250 babies born in the US.  With a large population of indigent and uninsured patients, including a significant minority population, women at Parkland Memorial have particularly high risk for delivering their baby too soon.

Parkland Memorial combatted these risk factors by providing highly coordinate, easy-to-access prenatal care.  They have developed specific procedures and standards of care for caring for their pregnant patients.  Women from satellite clinics who are found to be high risk are automatically sent to the main hospital for more advanced care.  A large team of nurse midwives and nurse practitioners see healthy obstetric patients, freeing up more doctors to handle the care of high risk patients.  In addition, many indigent patients benefit from the fact that Parkland Memorial delivers all of their care, keeping all of their records easily accessible to the pregnancy care providers.

What Does This Mean?

In talking to moms of preemies, it is pretty shocking how much prenatal care under similar high risk circumstances can vary in different places and with different doctors.  Some practice take an extremely agressive approach, while others tend to “wait and see.”

Parkland Memorial has demonstrated that a systematic approach to care can dramatically reduce the incidence of prematurity, even in high risk populations (assuming that part of their system wasn’t sending everyone in preterm labor to a hospital across town . . .).   They have shown that good utilization of nurse midwives and nurse practitioners can benefit all patients, by allowing doctors to place more of their emphasis on the care of women and babies who truly have medical problems.  After all, a healthy pregnancy is not an illness that need curing.

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