The importance of premature birth awareness by Dr. Candace Knight

Candace Knight, PhD, RN

November is Prematurity Awareness Month, and unfortunately, there is more bad news for Alabama on prematurity — The March of Dimes released its annual premature birth report card for 2018 on Nov. 2, and Alabama received an “F” for a preterm birth rate of 12 percent. This news follows on the heels of the announcement that Alabama currently has the highest rate of infant mortality in the nation and one of the highest rates in the developed world.

It is important to know that the prematurity rate is a significant contributor to the rate of infant mortality because prematurity is the second leading cause of infant mortality. Prematurity is also one of the most modifiable causes of infant mortality.

These statistics are cause for great sadness for the health of our state and give a glimpse into the lives of women and families in Alabama, especially given the continued disparity between non-Hispanic white and black women and infants. The preterm birth rate among black women in Alabama is 15.2 percent, but among white women the rate is 10.4 percent, according to the latest report from the March of Dimes.  The difference is even greater for infant mortality rates. In 2016 the infant mortality rate in Alabama was 15.1 per 1,000 live births while the rate for white infants was 6.5.

As a long-time labor and delivery nurse and childbirth educator, I often observed that women who came in with pregnancy complications frequently also had very complicated lives. They were frequently the women who lacked support at home, were in strained relationships and struggled with poverty and difficulty at work. That was not always the case, but it seemed to hold true a lot of the time.

Research data also shows that chronic stress and social determinants of health like income, education, the neighborhood you live in and family support actually influence a woman’s birth outcomes.

All of this made me wonder, “What is it that is really so stressful to women?,” so when I began my doctoral research, I combined the desire to understand what caused chronic stress in women with my lived experience as the child of a teen mom.

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Candace Knight and her mother, Pamela Ritchey, at a UAB Alumni night.

My mother had me when she was 16 years old, but I am happy to report that we have both succeeded with great careers in nursing and fulfilled lives. I am so grateful that my mom was resilient, determined, and had people in her life that gave her support when it was critical. Even with that support, however, she faced struggles and stresses during her pregnancy and in my early life. That is why when I got the opportunity to be a part of the Nurse Family Partnership of Central Alabama, I knew that it could make a huge difference in the lives of women and families like mine and like the ones I cared for, with complicated pregnancies and lives, when I was a labor and delivery nurse.

The nurses with Nurse Family Partnership of Central Alabama visit with first time, high-risk mothers in their home or community every other week to check in with how the pregnancy or baby is doing. Nurses are there to assess physical health, but also support emotional health and family economic success. Sometimes nurses help moms find safe housing, jobs or get back into school. Ultimately, we are there to encourage mothers to follow their dreams and help them create a way of life that will give them and their child opportunity for success.

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Nurse Family Partnership nurse Raven England (left) meets with Monica Martinez in her apartment, checking in on her and her baby.

This model of care is high touch and has an old-fashioned warmth that is all about relationships. While its simplicity might not sound like innovation, it is needed in a state that has struggled for so long with poverty and infant mortality, two leading health indicators.


If you look at areas such as Denmark, France and England, where infant mortality rates are well below the U.S. and Alabama rate, you can see the positive effect a home visiting nurse can make. This ranges from improved birth outcomes, such as a lower chance of premature birth, to long term effects such as improved school readiness and less involvement with the criminal justice system.

The state of Alabama is on the verge of making some important decisions to expand support for women and families by increasing funding for nurse home visiting and models of care like Nurse Family Partnership. This began with Governor Kay Ivey’s commitment to provide $1 million dollars to combat infant mortality, but must be expanded to reach all of Alabama’s high-risk moms and babies. What would our state outcomes look like if nurse home visiting was the norm and available to any mom who wanted the support of a nurse during pregnancy and the early childhood years? How many of us would have loved to be able to pick up the phone and call our own personal nurse when we were pregnant or parenting in the early years to ask those nagging questions or when you were scared and didn’t know what to do or if you should go to the doctor? This is the level of support that a nurse home visitor offers to all of her clients.

I’m proud that UAB School of Nursing helps prepare and support mothers through its administration of the Nurse Family Partnership of Central Alabama.

UAB School of Nursing Assistant Professor Candace Knight, PhD, RN, is a long-time labor and delivery nurse and childbirth educator, as well as program supervisor of the Nurse Family Partnership of Central Alabama, which is administered by UAB SON. She hopes to educate women on the factors that contribute to premature birth, as well as to improve birth outcomes. She also teaches in the School’s AMNP and undergraduate programs, leading the next generation of nurses to impact the lives of mothers and babies. The School’s 12th ranked Master of Science in Nursing Pediatric Primary Care Nurse Practitioner specialty (by U.S News and World Report) is also part of the solution, providing high-quality education for nurse practitioners so they can improve the lives of babies, children and families in Alabama and beyond.  


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