Elizabeth Villarreal, 6 months, poses for a photo with her mother Ashley Villarreal Saturday, July 8, 2023.
Sunday, Aug. 13, 2023 | 2 a.m.
Ashley and Jose Villarreal were excited to welcome their second child into the world last December.
But they wished little Elizabeth, who was born premature at 28 weeks, would have waited until the expected due date in March.
But on Dec. 9, Ashley Villarreal suddenly went into early labor and was rushed to the Southern Hills Hospital for an emergency cesarean section to save her and little Elizabeth — who was born severely underweight at 2 pounds, 8 ounces.
Elizabeth was born with inflamed lungs, a blood clot in her heart and brain bleeding, her mother said. The infant had to stay in the neonatal intensive care unit at Sunrise Children’s Hospital for two months. “Leaving the hospital without my baby in my arms the way I experienced that with my son, I cried the whole way to the car,” Ashley Villarreal said. “It was very different (and) traumatizing for us to have to deal with that.”
The Villarreals weren’t the only family dealing with a premature birth. The preterm birth rate in Nevada is 11.2%, according to the March of Dimes’ 2022 Report Card, an increase from 10.1% in 2017.
It exceeds the nation’s 10.5% rate of premature births, a number that has been growing for the past decade.
Pregnancies normally last around 40 weeks, and a delivery that occurs between 20 and 37 weeks is classified as a premature birth, said Dr. Joseph Adashek, associate professor at UNLV’s Kirk Kerkorian School of Medicine and physician at Desert Perinatal Associates.
Clark County has the worst preterm birth rate in the state, with 11.6% of births in the county occurring before full-term pregnancy. The next closest county is Nye, which has a preterm birth rate of 10.9%. Nye County’s rate improved in the past year as Clark County’s worsened.
Black, Indigenous and Asian women respectively have higher rates of preterm births than any other race, the report said.
The statistics do not directly specify the causes for premature births.
Premature babies born around 24 weeks can deal with heart and lung issues as well as brain bleeding in the first weeks of their birth, Adashek said.
But long-term issues, like cerebral palsy or vision problems, can also develop, said Adashek, who is also secretary of the Nevada State Medical Association. However, the risk for serious complications lessens the longer a baby has been in the womb.
“The earlier they are, the more chance of chronic problems or neurological problems,” Adashek said.
Many factors can contribute to a premature birth, including inadequate prenatal care; recent surgeries, especially around areas like the cervix; a history of premature labor; and obesity.
Women can begin receiving prenatal care six weeks into their pregnancy, but not seeking care or beginning it late can increase a mother’s chance of having a baby with health problems, according to Nevada’s State of Babies Yearbook 2022.
Babies are five times more likely to die and three times more likely to be born underweight if their mother doesn’t receive prenatal care, the study said.
And while the state’s infant mortality rate has decreased from 6.1% in 2018 to 4.3% in 2020, Nevada still exceeds the national average percent of low-risk cesarean births and women receiving inadequate prenatal care, March of Dimes reported.
About 9.4% of women got late or no prenatal care during their pregnancy in Nevada during 2022, according to the State of Babies report. This was especially true for women of color, specifically Native Hawaiian or Pacific Islander and Indigenous women, the study added.
“Number one thing by far, in a way, (is) that the lack of prenatal care significantly increases the risk of preterm birth and delivery,” Adashek said. “I just don’t think people realize how important (prenatal care) is.”
Some people have a lack of access to prenatal care, which Adashek said was a problem he’s seen here in Las Vegas. Financial issues, like struggles with Medicaid, and a shortage of doctors can greatly impact whether someone is able to seek prenatal care, he said.
One woman he spoke to this month said she had waited weeks before seeing a neonatologist for care because her Medicaid hadn’t kicked in yet, leaving her and Adashek with less time to address or fix any problems she may have with her baby.
A lack of obstetrician-gynecologists — also referred to as OB-GYNs — also may be affecting women in Nevada, Adashek said.
Nevada had 37.4 obstetricians, gynecologists and midwives per 100,000 women ages 15 and older in fall 2021, according to America’s Health Rankings. The state ranks 46th in women’s health providers, only beating out only Oklahoma, Mississippi, Alabama and Arkansas.
Because Medicaid reimbursement rates are so low, Adashek believes it is hard for Nevada to attract doctors and compete with states like neighboring California. The state also doesn’t have any residency programs for medical students interested in obstetrics or gynecology, Adashek said.
Fewer doctors means longer wait times, which can lead to later access to prenatal care for pregnant people, he explained.
“We certainly will be worse than other states because it’s so hard to get a doctor here,” Adashek said. “We need more doctors, and more doctors means more access for patients and more access means we can get them in.”
‘What ifs’ accompany preterm births
Ashley Villarreal said she had begun receiving prenatal care six weeks into her pregnancy and went to all of her doctors appointments, where they found no reasons to suspect an early labor.
Although she had gotten her gallbladder removed a month prior to Elizabeth’s birth, doctors told Ashley Villarreal that she simply entered “spontaneous early labor.”
Some of Elizabeth’s medical issues are still affecting her six months later, and the list of doctors she has to see is long — a cardiologist, neurologist, pulmonologist, hematologist and general practitioner in addition to a physical therapist Elizabeth visits twice a week.
What’s worse is these doctors won’t know whether she has healed until she grows older, Ashley Villarreal said.
“Still to this day, we go to the doctors, and she has been cleared from some things, (but) we’re always being told the possibilities of ‘what if’ because of having a premature baby,” Ashley Villarreal said. “Like, her brain bleed, they can’t scan her brain until she’s a little bit older, so we still have to — (if) we see any kind of red flags — we might have to take her to the emergency room right away.”
Preterm births can not only have detrimental effects on the baby and mother’s health, but also cause financial stress as well.
With her daughter in the hospital, Ashley Villarreal said she had to decrease her hours as a preschool teacher to drive between her home and the hospital to be with Elizabeth. Jose Villarreal also had to take time off his work as a dental assistant in a surgical office.
The couple also had to balance caring for their son, 2-year-old Jaxon.
Elizabeth has now been home since February and is gradually being cleared of her prior ailments, but the medical bills from constant doctor visits has brought the family financial strain.
They received support from Medicaid to help cover Elizabeth’s hospital bills, and Ashley Villarreal gets supplemental income through disability due to the cesarean section she had, she said.
But the payments don’t compare to the biweekly paychecks Ashley Villarreal was getting before, she added.
The experience has even scared the couple so much that they’ve reconsidered having more kids, Ashley Villarreal said.
Spending two months away from Elizabeth while she was in the hospital was so difficult that they’re not sure “if mentally (they) could go through something like this again.”
“It’s hard mentally, but we just kind of have to, like, be grateful that she’s here and be glad that she’s doing well (and) that she’s at least hitting the milestones,” Ashley Villarreal said.
