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Indiana lawmakers act to ensure pregnant women, newborn babies receive most appropriate care

State Sen. Ed Charbonneau, R-Valparaiso, speaks to the House Public Health Committee on Feb. 21, 2018. He is sponsor of legislation approved by the General Assembly that directs the State Department of Health to certify perinatal levels of care for hospitals and birthing centers across the state.

Dan Carden, The Times

INDIANAPOLIS — Pregnant women across Indiana soon may be more likely to deliver their babies at a facility that's best suited to meet the health needs of both mother and child.

The General Assembly last week advanced to the governor's desk Senate Enrolled Act 360, which directs the State Department of Health to establish a program to certify the perinatal levels of care available at Indiana hospitals and birthing centers.

National medical groups have established four levels of care: Level I, basic care of an uncomplicated pregnancy; Level II, specialty care for higher risk pregnancies; Level III, advanced care for complex maternal or fetal conditions; and Level IV, regional comprehensive perinatal health center.

"Most babies and mothers are fine with a Level I delivery unit and nursery," said Dr. Kristina Box, Indiana's state health commissioner and a practicing OB-GYN.

"But if there are complications that could impact the health of the mother or her baby, or if that baby has a particular condition that needs specialized care at birth, the delivery should occur at a facility certified for a higher level of care."

Currently, the 90 Indiana birthing facilities self-identify their level of care. But Box said a recent State Department of Health survey found significant gaps between the care they say they offer and what actually is available.

The legislation, sponsored by state Sen. Ed Charbonneau, R-Valparaiso, is aimed at ensuring perinatal level of care designations are accurate by having the state health department regularly certify them.

It's important, Box explained, because 22 percent of Indiana's very low birth weight babies, and 37 percent of low birth weight babies, were born in 2016 at facilities lacking the resources to provide the specialized care needed by those babies.

"That's a significant problem and that puts babies' lives at risk," she said.

The state's goal is for at least 87 percent of at-risk babies to be delivered in an appropriate facility.

Charbonneau acknowledged that with some births there's only time to get to the nearest hospital or sometimes complications develop during the birthing process.

But he said by having certified levels of care: "If a pregnant lady shows up at a hospital and it's the wrong level, (the hospital) will know immediately where to send that person to get the appropriate care."

The need for appropriate care is particularly acute in Indiana which ranks 42nd in the country for infant mortality.

In 2016, there were 623 babies born in Indiana who died before their first birthdays, according to state records. That's 7.5 infant deaths for every 1,000 births.

Studies show states that certify perinatal levels of care have lower infant mortality rates, reduced health care costs and improved health outcomes, Box noted.

Charbonneau said he's seen the effects of quality perinatal care firsthand as the former CEO of Methodist Hospitals in Northwest Indiana.

"When I was there I used to love to go over and visit that unit just to see miracles happening," he said. "There's babies hardly as big as your hand that are going to be able to live a full, healthy life because of the service they're getting."

Reducing Indiana's infant mortality rate is a top priority for Republican Gov. Eric Holcomb.

In his State of the State address last month, Holcomb said he wants Indiana to have the lowest infant mortality rate in the Midwest by 2024. He believes this is one way to get there.

"I commend lawmakers for unanimously advancing this bill, and I look forward to signing it," Holcomb said.

The measure also is supported by the Indiana State Medical Association, March of Dimes, American Academy of Pediatrics, the American College of Obstetricians and Gynecologists and the Indiana Minority Health Coalition.


Dan is Statehouse Bureau Chief for The Times. Since 2009, he's reported on Indiana government and politics — and how both impact the Region — from the state capital in Indianapolis. He originally is from Orland Park, Ill.