Effort aims to boost healthy baby count
Birth certificates are required as proof of citizenship for everything from a U.S. passport to enrolling children in Louisiana public schools.
State government is preparing to use information gathered for the document as part of what an official says is an effort to bring healthier babies into the world.
In addition to the basic information — name of the parents and child, where the delivery occurred and when — familiar on every birth certificate, hospital officials also have been reporting to the state a multitude of other information, such as the mother’s smoking habits, education, previous pregnancies, type of delivery and complications encountered. The form, taken on every live birth in Louisiana, had been stored with the Office of Vital Records.
But by next week that state hopes to have a string of agreements in place that would allow the Office of Vital Records to share the information with the private companies contracted to handle Medicaid, the health insurance program for the poor.
“We are trying to use public health data for action,” said Dr. Rebeka Gee, director of Louisiana’s birth outcomes initiative. “It’s really time.”
The state is contracting with Medicaid, and Medicaid is sharing the information with the five private health insurance companies that participate in actually providing coverage for up to 900,000 Medicaid recipients, most of them pregnant women and children. The program is called Bayou Health. The personal birth certificate data will not be shared with commercial insurance companies because of federal privacy regulations.
“If we can get health plans that information, we can see whether a woman was a smoker, whether she has a chronic disease, all the data that would be helpful in better care management,” Gee said, who is also an LSU medical school assistant professor. “You can target the patients early.”
One in seven Louisiana babies are born prematurely with medical problems that drive up health care costs. About 7,000 of the premature births in this state each year are covered by Medicaid with an excess cost to taxpayers of $200 million annually, according to a recent March of Dimes report.
Information on Louisiana’s two-page certificate includes information such as whether a woman has delivered a premature infant in the past and what kind of problems arose for the baby. It can also give a heads-up about risk factors in the pregnancy, including if the woman had diabetes or hypertension; had a prior preterm birth or other previous poor pregnancy outcome; had complications associated with labor and delivery; whether she smoked cigarettes prior to and during pregnancy; and whether there was alcohol any use during pregnancy.
Gee said the information can help the Medicaid insurers to work with women on treatment of medical problems that contribute to problem pregnancies as well as personal habits such as smoking which leads to “small babies. Obviously it’s not good for babies who are born either.”
“The goal is to make sure that every woman is healthy and that’s not an easy task,” Gee said. “Our goal is to improve their health before they even get pregnant.”
The state is starting an anti-smoking initiative aimed at mothers and mothers-to-be. Called Health Assessment Reference and Treatment, or HEART, the goal is to gather data, refer women to a “quit line” and provide counseling services. So far, about 800 women have been screened through physicians’ efforts. “We still have a long way to go,” Gee said.
The birth certificate initiative is part of a multi-pronged approach to reduce premature births — an area in which the state fails miserably in national surveys.
The state, with the Louisiana Hospital Association, first tackled cutting down on deliveries prior to 39 weeks to stop early “elective” deliveries for no medical reason.
“Letting it happen naturally is healthier for her,” Gee said.
In a year, there has been a 12,000 day decrease in hospitalizations, allowing more babies to go home more quickly.
The next target is reducing the number of C-sections. “We are highest in the nation — 49th or 50th. It’s the next step in our work. C-sections increase maternal mortality, especially those who have had multiple C-section births,” said Gee.
“We need to work on all factors that lead to prematurity,” Gee said.