Hawaii has drawn a D for the second year in the annual March of Dimes Premature Birth Report Card with isle pre-term births increasing to 9.1 percent last year from 8.6 percent.

Rising rates of Caesarean sections and early labor inductions are believed related to increasing pre-term births, the organization said.

The nation earned a D grade, “;demonstrating that more than a half-million of our nation's newborns didn't get the healthy start they deserved,”; March of Dimes said.

Vermont topped all states with the only B in the report, issued yesterday on the Fifth Annual Prematurity Awareness Day. Eight states earned a C, five received an F and the rest had D's.

Lin Joseph, director of program services for the March of Dimes Hawaii Chapter, said any birth before 37 weeks of gestation is premature. Late pre-term is between 34 and 36 weeks. Full term is 39 or 40 weeks.

More than 540,000 babies nationally are born too early each year, resulting in serious health problems that cost more than $26 billion annually, March of Dimes said.

“;We want babies to have a healthy start in life, and when they're born pre-term there is an increased risk for respiratory problems, mental retardation, cerebral palsy and lifelong issues for the baby,”; Joseph said.

She said March of Dimes is looking at the reasons for the increased premature births to try to address the problem. “;There is not a single cause.”;

While Hawaii's premature births are increasing, she pointed out, the rate of uninsured women slipped to 10.1 percent from 10.4 percent, and female smokers decreased to 14.9 percent from 17.3 percent.

“;Prematurity has many, many factors,”; said Loretta Fuddy, chief of the Health Department's Family Health Services Division. More effort is needed to reduce smoking, alcohol use and stress for pregnant women, she said.

The last Legislature passed a resolution at the March of Dimes Hawaii Chapter's request asking the Health Department to survey hospitals and physicians about their policies on elective C-sections and labor inductions.

Sometimes they are necessary for the health of mom and baby, Fuddy said, suggesting sometimes they might be due to scheduling issues for births, especially on an island where special services are not available.

“;We're trying to see if that's true and ... what we can do educationwise to avoid that situation.”;

The Health Department put together a task force with representatives of March of Dimes Hawaii Chapter; the Healthy Mothers, Healthy Babies Coalition; and the Healthcare Association of Hawaii to conduct the survey.

One of the questions is whether women are requesting elective inductions for labor or C-sections early and how physicians and hospitals respond, Joseph said, noting there is some controversy about that.

Jackie Berry, executive director of Healthy Mothers, Healthy Babies, said she is “;very curious to see what the survey is going to tell us about doctors and their belief about why this (increased premature births) is happening.”;

Hawaiian babies top preemie list

An average of 367 babies are born each week in Hawaii, and 39, on average, are born prematurely, according to the state Health Department's “;Family Health Services Profiles 2009.”;

In 2007, the report said, Hawaiian mothers had 29.7 percent of pre-term deliveries, compared with 27.7 percent of all births; Filipino mothers had 21.8 percent of pre-term births and 18.4 percent of all births; Japanese mothers had 12.4 percent of pre-term deliveries and 10.9 percent of all births.

Caucasian mothers had 15.6 percent of pre-term deliveries, compared with 22.7 percent of all births.

The Healthy People 2010 objective is that no more than 7.6 percent of all births be premature (before 37 weeks' gestation) and no more than 1.1 percent be earlier than 32 weeks.