Is Florida failing its children? More babies are born early, at low weight and high risk of death

Little Liberty Belle Garcia arrived in the world at a Hollywood hospital in August weighing only 1 pound 5 ounces. A month later, Cheyenne Tomblin was born at a Boca Raton hospital weighing 12 ounces, about the size of a can of soda.

By being born tiny and months early, they both faced incredible odds to survive. In Florida, the difficult struggle of such babies is happening more often with the number of low birthweight newborns rising and surpassing the national average.

In 2021, 9% of babies born in Florida weighed less than 5½ pounds, an increase from 8.7% in 2019, a troubling trend considering birthweight is one of the strongest predictors of an infant's health.

"Florida is a state where a lot more work needs to be done to help children and families," said Norin Dollard, senior policy analyst and Kids Count director for the Florida Policy Institute.

Florida ranks 31st in the country in child "well-being," doing well in education but lagging in health issues, according to an annual report released recently by the Annie E. Casey Foundation.

The 2023 KIDS COUNT Data Book report measures states on a series of indicators, with Florida ranking fifth in education, 37th in economic well-being, 33rd in health and 32nd in what the foundation calls family and community. The state has seen worsening patterns in child and teen deaths, as well as in children and teens who are overweight or obese, but there has been some improvement in the rate of teen births and children living in high poverty areas.

Florida worse off than the US average

When it comes to low-birthweight babies, Florida's 9% rate exceeds the national rate of 8.5%. By arriving into the world so small, a baby may have a harder time eating, gaining weight, and fighting infections.

"These babies are more likely to have to do a NICU stay, where they might be on a ventilator or need additional interventions to make sure their organs are where they need to be," said Caroline Valencia, director of maternal infant health for March of Dimes, South Florida. "But there also are long-term implications, potential cognitive delays and health risks that can be with them rest of their lives."

Liberty Belle Garcia spent four months in the Neonatal Intensive Care Unit (NICU) at Joe DiMaggio Children's Hospital and Cheyenne Tomblin went home after six months in the NICU at West Boca Medical Center. Both underwent multiple surgeries, physical therapies, and needed help breathing.

Valencia said there is a critical connection between infant health, maternal health and the health of a family. A March of Dimes Florida report card released in November found nearly a quarter of mothers in Florida had inadequate prenatal care. In addition, for each of the last five years, the state lagged the nation in the number of doctors who care for pregnant mothers.

Do Florida moms have nowhere to go?

Some women may be at particular risk for pregnancy complications if they have conditions such as high blood pressure, obesity, and diabetes.

"It's important to make sure we get maternal health ramped up," Valencia said. "When the mom is at risk for her health, it also increases the risk for the baby to be born pre-term. It starts with mom."

March of Dimes will release a report on Aug. 1 that identifies areas of Florida with little or no access to maternal and reproductive care—where women have to go long distances to get care or give birth. Nationally and in Florida, labor and delivery units are shutting their doors, and fewer doctors are going into the demanding, high-risk profession.

In Broward County, Rose McKelvie, administrator of women's & children's services at Broward Health, said her health system already has identified such an area in Broward. Specifically, Broward Health learned a Lauderdale Lakes region had no obstetrics care, which is why the hospital system is building a family health center.

"We know there are areas of Florida and in Broward where we need to get more providers on the ground so women can access prenatal care," McKelvie said. "I think most of these babies born pre-term are because mom has a complication."

Pregnancy visits by phone

In its 2023 budget, the state allocated $12.7 million to improve maternal health outcomes in Florida through telehealth care. McKelvie said Broward will be one of 20 counties that gets some of the money and will look at how pregnant woman can get early care from a doctor by phone. "It will take time but we think we will see a difference. We have got to try something different."

Dr. Thresia Gambon, president of the Florida Chapter of the American Academy of Pediatrics, said pregnant women in the state often are uninsured and don't realize they can receive health coverage for prenatal and postpartum care through Medicaid. "That thinking decreases access. I would like mothers to be seen in their first trimester and throughout pregnancy."

As a Hialeah pediatrician, Gambon said babies born pre-term or with a low birthweight need close monitoring throughout their childhood for signs of delayed development. However, she said, their first year is most critical. "If you are looking at extremely low birth rate babies, they have higher morbidity and mortality in the first year of life."

Like McKelvie, Gambon sees where the focus needs to be: "It almost always goes back to mom didn't have adequate prenatal care."

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