Welcome West Virginia Perinatal Partnership Welcome to Your 2018 Summit! Welcome to the Summit: Many people have been instrumental in the Perinatal Partnership. Let me introduce the Steering Committee members here today. Also, we have an group of experts who serve diligently on the Central Advisory Council. They are:

State of Perinatal Health total births Year # of Births Born in WV # of Births Born in WV to In-State Residents # of Births Born in WV to Out-of-State Residents 2006 (Initial Year) 21,137 18,592 2,545 2012 21,154 18,494 2,660 2013 21,127 18,410 2,717 2014 20,556 17,890 2,666 2015 20,426 17,461 2,965 2016 19,889 16,906 2,983 2017 (Preliminary) 19,256 16,356 2,900 Here is A quick over view of the State of Perinatal Health in WV. Total Births in the state 2013 There were 21,124 WV occurrence births in 2013. Data Source: WV Health Statistics Center, Vital Statistics System

Locations of WV Birth Facilities WV has 28 birthing facilities in operational. 27 hospitals and 1 birthing center. 3 tertiary care centers and 2 level 2 NICU’s. We have Total Births in the state 2013 Locations of Level I and II obstetric services Level III Perinatal Referral Centers

Trimester Prenatal Care Began West Virginia Resident Births, 2006-2017 Year Total Births with Known Prenatal Care First Trimester Second Trimester Third Trimester No Care Number Percent 2006 20,450 16,669 81.5% 3,001 14.7% 639 3.1% 141 0.7% 2010 19,260 16,009 83.1% 2,609 13.5% 531 2.8% 111 0.6% 2011 20,268 16,958 83.7% 2,711 13.4% 488 2.4% 0.5% 2012 20,565 17,296 84.1% 2,653 12.9% 504 2.5% 112 2013 20,529 16,729 3,061 14.9% 607 3.0% 132 2014 19,849 15,346 77.3% 3,381 17.0% 928 4.7% 194 1.0% 2015 19,405 15,253 78.6% 3,125 16.1% 824 4.3% 203 2016 18,924 15,047 79.5% 2,851 15.1% 767 4.1% 259 1.4% 2017* 18,443 15,044 77.8% 2,900 15.7% 924 5.0% 263 The percentage of Births among unmarried women continue to increase in relation to all births. 46.2% of babies born in 2013 were to unmarried women. Data Source: WV Health Statistics Center, Vital Statistics System *Preliminary data

West Virginia Occurrence Births by Marital Status of Mother Mother’s Marital Status 2006 2013 2014 2015 2016 2017 (Prelim.) Married 61.0% 53.8% 55.3% 55.7% 54.6% 54.0% Not Married 39.0% 46.2% 44.7% 44.3% 45.4% 46.0% Data Source: WV Health Statistics Center, Vital Statistics System The percentage of Births among unmarried women continue to increase in relation to all births. 46.2% of babies born in 2013 were to unmarried women.

The State of Perinatal Health in West Virginia 2006-2017 Pre-Term Births (<37 Weeks Gestation) Among WV Residents 2006 – 12.4% 2011 – 11.3% 2012 – 10.7% 2013 – 10.5% 2014 – 10.8% 2015 – 11.3% 2016 – 11.8% 2017 – 12.0% Data Source: WV Health Statistics Center, Vital Statistics System

The State of Perinatal Health in West Virginia 2006-2017 Low Birth Weight (<2,500 GMS) Among WV Residents 2006 – 9.7% 2011 – 9.6% 2012 – 9.2% 2013 – 9.4% 2014 – 9.1% 2015 – 9.6% 2016 – 9.7% 2017 (Preliminary) – 9.6% Data Source: WV Health Statistics Center, Vital Statistics System

The State of Perinatal Health in West Virginia 2006-2017 Very Low Birth Weight (<1,500 GMS) Among WV Residents 2006 – 1.5% 2011 – 1.6% 2012 – 1.5% 2013 – 1.2% 2014 – 1.4% 2015 – 1.4% 2016 – 1.4% 2017 (Preliminary) – 1.6% Data Source: WV Health Statistics Center, Vital Statistics System

Percentage of Very Low Birth Weight Infants (450-1,499 grams) by Place of Birth, WV Occurrences 2013-2017 The national CDC goal is to have only 10% of very low birth weight infants born outside of tertiary care hospitals. Very low birth weight infants have a better chance of survival if the mother transferred prior to delivery and the infant is born in a tertiary care center, rather than being transferred after delivery. Data Source: WV Health Statistics Center, Vital Statistics System Percentage of all births weighing 450-1,499 grams

Percentage of Elective Inductions Among Nulliparous Births, 39-40 Weeks Gestation West Virginia Occurrences 2008-2017 ACOG recommendations is to limit inductions prior to 41 weeks to cases where the cervix meets standards to be ripe for delivery. It appears that most of the inductions are being conducted between 39 and 41 weeks. The c section rate has not decreased at a significate rate, as we would have anticipated. Data Source: WV Health Statistics Center, Vital Statistics System Percentages of all Nulliparous births 39-40 weeks gestation. *Preliminary data. Note: From 2008-2013, elective inductions are defined as those having no medical risk factors or congenital anomalies.

Percentage of Elective Inductions Among Nulliparous Births, 41+ Weeks Gestation West Virginia Occurrences 2008-2017 ACOG recommendations is to limit inductions prior to 41 weeks to cases where the cervix meets standards to be ripe for delivery. It appears that most of the inductions are being conducted between 39 and 41 weeks. The c section rate has not decreased at a significate rate, as we would have anticipated. Data Source: WV Health Statistics Center, Vital Statistics System Percentages of all Nulliparous births 41+ weeks gestation. *Preliminary data. Note: From 2008-2013, elective inductions are defined as those having no medical risk factors or congenital anomalies.

Percentage of C-Sections Among Nulliparous Births, <39 Weeks Gestation West Virginia Occurrences 2008-2017 ACOG recommendations is to limit inductions prior to 41 weeks to cases where the cervix meets standards to be ripe for delivery. It appears that most of the inductions are being conducted between 39 and 41 weeks. The c section rate has not decreased at a significate rate, as we would have anticipated. Data Source: WV Health Statistics Center, Vital Statistics System Percentages of all Nulliparous births <39 weeks gestation. *Preliminary data.

Percentage of C-Sections Among Nulliparous Births, 39-40 Weeks Gestation West Virginia Occurrences 2008-2017 ACOG recommendations is to limit inductions prior to 41 weeks to cases where the cervix meets standards to be ripe for delivery. It appears that most of the inductions are being conducted between 39 and 41 weeks. The c section rate has not decreased at a significate rate, as we would have anticipated. Data Source: WV Health Statistics Center, Vital Statistics System Percentages of all Nulliparous births 39-40 weeks gestation. *Preliminary data.

Percentage of C-Sections Among Nulliparous Births, 41+ Weeks Gestation West Virginia Occurrences 2008-2017 ACOG recommendations is to limit inductions prior to 41 weeks to cases where the cervix meets standards to be ripe for delivery. It appears that most of the inductions are being conducted between 39 and 41 weeks. The c section rate has not decreased at a significate rate, as we would have anticipated. Data Source: WV Health Statistics Center, Vital Statistics System Percentages of all Nulliparous births 41+ weeks gestation. *Preliminary data.

Number and Percentage of C-Section and VBAC Among WV Occurrence Births, 2006-2017 Year Total Births with Known Method of Delivery Number of C-Sections Number of Vaginal after Previous C-Section Number Percent 2006 21,134 7,277 34.4% 139 0.7% 2010 20,758 7,412 35.7% 153 2011 20,958 7,709 36.8% 155 2012 21,152 7,606 36.0% 150 2013 21,126 7,632 36.1% 130 0.6% 2014 20,556 7,266 35.3% 243 1.2% 2015 20,425 7,148 35.0% 207 1.0% 2016 19,888 7,005 35.2% 263 1.3% 2017 (Preliminary) 19,255 6,783 293 1.5% The percentage of Births among unmarried women continue to increase in relation to all births. 46.2% of babies born in 2013 were to unmarried women. Data Source: WV Health Statistics Center, Vital Statistics System

Smoking Status During Pregnancy West Virginia Resident Births, 2006-2017 Year Total Births with Known Smoking Status Mothers Who Reported Smoking During Pregnancy Mothers Who Did Not Smoke During Pregnancy Number Percent 2006 20,815 5,696 27.4% 15,119 72.6% 2010 20,402 5,361 26.3% 15,041 73.7% 2011 20,640 5,389 26.1% 15,251 73.9% 2012 20,779 5,481 26.4% 15,298 73.6% 2013 20,763 5,320 25.6% 15,443 74.4% 2014 20,189 5,602 27.7% 14,587 72.3% 2015 19,714 4.949 25.1% 14,765 74.9% 2016 18,999 4.798 25.3% 14,201 74.7% 2017* 18,628 4,599 24.7% 14,029 75.3% The percentage of Births among unmarried women continue to increase in relation to all births. 46.2% of babies born in 2013 were to unmarried women. Data Source: WV Health Statistics Center, Vital Statistics System *Preliminary data

Smoking and 2nd Hand Exposure During Pregnancy West Virginia Occurrence Births, 2006-2017 Year Mothers Who Reported Smoking During Pregnancy Mothers Exposed to 2nd Hand Smoke During Pregnancy Number Percent 2006 5,912 28.1% N/A 2010 5,559 26.8% 2011 5,641 26.9% 2012 5,670 2013 5,445 25.8% 2014 5,820 28.4% 3,877 19.1% 2015 5,259 3,267 16.2% 2016 5,101 25.7% 2,940 14.9% 2017* 4,898 25.5% 2,627 13.7% The percentage of Births among unmarried women continue to increase in relation to all births. 46.2% of babies born in 2013 were to unmarried women. Data Source: WV Health Statistics Center, Vital Statistics System *Preliminary data Note: 2nd hand smoke exposure data came into effect beginning in 2014.

Smoking in Pregnancy by Medicaid Status 2000-2017 Percentage of West Virginia Resident Births to Mothers Who Smoked During Pregnancy Among Those with Medicaid or Other Healthcare Coverage Medicaid covered pregnant women smoke at a higher rate than women who are not covered by Medicaid. Even with the decreases in smoking rates, WV still has the highest rate of smoking among pregnant women. Nationally less that 10 % of pregnant women smoke. Data Source: WV Health Statistics Center, Vital Statistics System Percentages are calculated excluding unknown smoking status * Preliminary data ** Cumulative and unedited data

Infant Mortality Rates West Virginia and United States Residents, 1970-2016 Data Source: WV Health Statistics Center, Vital Statistics System Note: 2016 data is preliminary

Infant Mortality Rates Mortality Rates by Cause, 2012-2016 *Some causes were not reportable (n<10) and incorporated into the all other cause category; labels contain proportions of mortality by cause for categories contributing 5% or more. Bold=Significantly higher than U.S. Total, p<0.05 Source: Region III Infant Mortality Data Infant Mortality Collaborative Improvement and Innovation Network, NICHQ Source: CDC Wonder www.cdc.gov

Maternal Deaths to West Virginia Residents, 2010-2017 *CDC defines maternal death as one who has died within one year after giving birth

Teen Pregnancy Rate Ages 15-19 Rates per 1,000 Females Ages 15-19 By County of Residence 2013-2017 WV Rate: 32.9 Lowest – Monongalia County (11.2) Rates per 1,000 Females Ages 15-19 40.1 – 63.4 33.0 – 40.0 26.7 – 32.9 11.2 – 26.6 Highest – Mingo County (63.4) Source: West Virginia Health Statistics Center, Vital Statistics System

Maternal Drug Use - Known or self-reported maternal non-prescribed and/or illicit drug use during pregnancy 2014 – 5.2% 2015 – 5.9% 2016 – 7.7% 2017 – 8.3%* Source: West Virginia Health Statistics Center, Vital Statistics System * Preliminary data

Neonatal Abstinence Syndrome (NAS) 2014 – 2.7% 2015 – 3.0% 2016 – 4.6% 2017 – 4.6%* Source: West Virginia Health Statistics Center, Vital Statistics System * Preliminary data

Hepatitis C Infection During Pregnancy 2014 – 2.3% 2015 – 2.8% 2016 – 3.4% *2017– 3.6% Source: West Virginia Health Statistics Center, Vital Statistics System * Preliminary data

Syphilis Infection During Pregnancy 2014 – 0.02% 2015 – 0.01% 2016 – 0.04% 2017 – 0.11%* Source: West Virginia Health Statistics Center, Vital Statistics System * Preliminary data

Mother’s Pre-Pregnancy BMI Percentage of WV Resident Births 2014-2017 The national CDC goal is to have only 10% of very low birth weight infants born outside of tertiary care hospitals. Very low birth weight infants have a better chance of survival if the mother transferred prior to delivery and the infant is born in a tertiary care center, rather than being transferred after delivery. Data Source: WV Health Statistics Center, Vital Statistics System 2017 data is preliminary

Hepatitis Immunization Percentage of WV Resident Births 2014-2017 The national CDC goal is to have only 10% of very low birth weight infants born outside of tertiary care hospitals. Very low birth weight infants have a better chance of survival if the mother transferred prior to delivery and the infant is born in a tertiary care center, rather than being transferred after delivery. Data Source: WV Health Statistics Center, Vital Statistics System 2017 data is preliminary

Number of Home Births West Virginia, 2000-2017 Medicaid covered pregnant women smoke at a higher rate than women who are not covered by Medicaid. Even with the decreases in smoking rates, WV still has the highest rate of smoking among pregnant women. Nationally less that 10 % of pregnant women smoke. Data Source: WV Health Statistics Center, Vital Statistics System *Preliminary data

Intentionality of Home Births Percentage of WV Home Births 2014-2017 The national CDC goal is to have only 10% of very low birth weight infants born outside of tertiary care hospitals. Very low birth weight infants have a better chance of survival if the mother transferred prior to delivery and the infant is born in a tertiary care center, rather than being transferred after delivery. Data Source: WV Health Statistics Center, Vital Statistics System Preliminary data

Number of Home West Virginia Births, 2006-2017 Mother Had a Previous C-Section Medicaid covered pregnant women smoke at a higher rate than women who are not covered by Medicaid. Even with the decreases in smoking rates, WV still has the highest rate of smoking among pregnant women. Nationally less that 10 % of pregnant women smoke. Data Source: WV Health Statistics Center, Vital Statistics System *Preliminary data

Intentionality of VBAC Home Births Percentage of WV VBAC Home Births 2014-2017 The national CDC goal is to have only 10% of very low birth weight infants born outside of tertiary care hospitals. Very low birth weight infants have a better chance of survival if the mother transferred prior to delivery and the infant is born in a tertiary care center, rather than being transferred after delivery. Data Source: WV Health Statistics Center, Vital Statistics System Preliminary data

WV Resident Birth Outcome Rankings, 2017* U.S. WV Rank Cesarean Delivery 35.3% 32.0% 5th Preterm Births 12.0% 9.9% 4th Low Birth Weight 9.6% 8.3% 7th Very Low Birth Weight 1.6% 1.4% 9th Teen Birth Rate (Age 15-19) 27.1 per 1,000 18.8 per 1,000 8th Data Source: WV – West Virginia Health Statistics Center, Vital Statistics System US – CDC Wonder *Preliminary data

INITIATIVES AIM Patient Safety Bundles (WV ACOG) Long Acting Reversible Contraceptives Help2Quit – Tobacco Cessation Training Project Continuing Zika Education Breastfeeding – WVBFA + CLC training Maternal Risk Screening Bereavement Support Childbirth Instructor Training Oral Health Care Preterm Birth Prevention Substance Use in Pregnancy – DFMB programs and NAS Education Fetal Monitoring Hospital Guidelines and Levels of Care Self Assessment Maternity Care Provider Shortage

Amy Tolliver, MS Director, WV Perinatal Partnership 1018 Kanawha Boulevard East Charleston, WV 25301 (304) 558-0530 ext. 5 atolliver@wvperinatal.org www.wvperinatal.org Coordinated by the West Virginia Higher Education Policy Commission, Division of Health Sciences