Hospital Statistics Point to Baby Boomlet

By JAMES KINSELLA
Gazette Senior Writer

Delight courses through Althea D'Antonio's voice as she talks about giving birth last week to twin boys at the Martha's Vineyard Community Hospital.

"It went really, really, really well," Ms. D'Antonio said Wednesday, in between to cooing to her newborns. "I'm up and having fun."

Her newly arrived twins - Lazlo Edmond D'Antonio and Lucas Carlo D'Antonio - are part of a bit of a baby boomlet at the Island hospital, where the number of births has been increasing in recent years.

Last year, 152 births were recorded at the hospital, situated off Linton Lane in Oak Bluffs. Ten years ago, 125 births occurred at the hospital, with the totals falling to 110 in 1998 and 107 in 2000. Last year was just a bit behind 2002, when 154 births were recorded.

The increase is just part of the current picture of pregnancy, prenatal care and birthing on the Vineyard that emerges from data collected by the Martha's Vineyard Community Hospital.

Dr. S. Patrick Donegan, the obstetrician-gynecologist at the Center for Women's Health at the hospital, said recent Island births reflect the evolving face of the Vineyard. "This is the next generation," he declared.

Information gathered and tracked by the hospital and its employees as part of its reporting to the state Department of Public Health shows that a rising proportion of Island births are coming to parents born in Brazil. The data also shows that many births last year were the first for the mothers, that most mothers were breast-feeding when they left the hospital, that many saw a nurse practitioner for prenatal care and that a small percentage of mothers drank and smoked during their pregnancy.

Dr. Donegan said he has seen a steady increase over the past three years of births to mothers born in Brazil. Dr. Donegan said the percentage has risen from about eight per cent three years ago to about 15 per cent two years ago to about 20 per cent last year. The hospital can identify these births through the birthplace of the mother and her preferred language.

Catherine Chase, a nurse midwife who practices at the center with Dr. Donegan, confirmed the assessment; she estimated that close to one-third of the Vineyard births now are coming to Brazilian parents. "Our Brazilian population is increasing steadily," Ms. Chase said.

The rising number of births to Brazilian mothers has counteracted what hospital officials anticipated would be a decline in births at the hospital, given the high cost of Island living can push young couples to relocate off the Vineyard.

U.S. Census figures for Dukes County, which includes the Vineyard and the Elizabeth Islands, show that the number of county residents aged 20 to 34 - traditionally the prime childbearing cohort - fell from 2,433 in 1990 to 2,303 in 2000.

In contrast, the cohort aged 35 to 59 grew from 3,907 in 1990 to 6,311 in 2000, creating by far the largest of all census cohorts for the county.

Dr. Donegan said the non-Brazilian births often are coming to young couples whose roots on the Vineyard go back three or five or even 10 generations.

Another population of non-Brazilian mothers identified by Ms. Chase are women in their late thirties or early forties. "We've had a lot of very successful outcomes" with mothers of that age, she said.

But Ms. Chase also said that a number of Islanders are less insistent than in years past that their babies be born on the Island.

The Vineyard births represent less than .2 per cent of the 77,500 births last year in Massachusetts. Girls accounted for a slight majority of births last year on the Island, accounting for 54 per cent of the births. In Massachusetts, 51 per cent of the births were male.

Information gathered by the hospital for 2005, along with accompanying state data, shows that:

* English was the preferred language for 79 per cent of the mothers and 76 per cent of the fathers, with Portuguese the preferred language for 21 per cent of the mothers and 19 per cent of the fathers.

In Massachusetts last year, English was the preferred language of 88 per cent of the mothers and 82 per cent of the fathers, with Portuguese the preferred language for three per cent of the mothers and two per cent of the fathers.

* The self-identified race of the mother was white for 89 per cent and other for nine per cent. The self-identified race of the father was white for 76 per cent and other for 13 per cent. The information is required for an infant's birth certificate.

In Massachusetts, the race was white for 71 per cent of the mothers and 66 per cent of the fathers.

* Seventy-six per cent of the mothers were married. The state percentage was 70 per cent.

Since she began practicing, Ms. Chase said, she has seen increasing numbers of Vineyard parents who are unmarried.

* In terms of education, the largest percentage of mothers, 42 per cent, had at least a high school diploma or its equivalent. A total of 28 per cent had a bachelor's degree. A total of 42 per cent of the men had at least a high school diploma or its equivalent, and at least 22 per cent had a bachelor's degree.

* Of the mothers, 64 per cent had no previous births that now were living, with 28 per cent having one, and eight per cent having two or three. In contrast, 44 per cent of mothers last year in Massachusetts had no previous births now living.

Dr. Donegan said the Vineyard percentage reflects the increasing youth of the mothers now delivering at the Vineyard Hospital. Many are the daughters of baby boomer parents. He said the boomer mothers tended to have births later in their lives.

* Sixty-four per cent had not had either spontaneous or induced terminations. In contrast, the state percentage was 81 per cent. A total of 22 per cent of the Vineyard mothers had had one and 11 per cent had had two or three.

* The Vineyard hospital apparently is a mecca for breast-feeding, at least in the early going. A total of 88 per cent were breast-feeding at time of discharge, compared with 79 per cent in Massachusetts.

Dr. Donegan said the Vineyard hospital encourages breast-feeding as the most nutritious way to feed an infant. He said that although the percentage tends to drop in the weeks following discharge, about half the Vineyard mothers continue to breast-feed six weeks after discharge.

* At the Vineyard hospital, a far higher percentage of mothers saw a nurse practitioner or midwife as part of their prenatal care compared to Massachusetts mothers as a whole. On the Island, 59 per cent saw a nurse practitioner and 36 per cent saw a midwife, compared to 14 and .31 per cent, respectively, in Massachusetts.

Dr. Donegan said he is comfortable working with a midwife in the practice, having participated in the 1980s in a program at Boston University Medical Center that helped pioneer ob-gyns and midwives working together.

He said some patients are more comfortable with a midwife and that some prefer an ob-gyn. He said his participation is required only for births with complications.

Ms. Chase, who has been a nurse at the hospital since 1980 and a midwife since 1997, estimated that she delivered about 80 of the babies who arrived on the Vineyard last year and participated in the delivery of another 25 or so.

* Despite the health risks to their fetus, seven per cent of Vineyard mothers smoked up to 10 cigarettes a day during their pregnancies, and seven per cent had up to three drinks a week.

Dr. Donegan said the Vineyard hospital discourages any smoking or drinking by expectant mothers, and has gone so far as to require mothers to sign a contract promising to abstain as a condition of their continued care. He said a number of mothers curtail their smoking and drinking as their pregnancies evolve.

* A total of 44 per cent of the infants were circumcised at the hospital, compared to a similar percentage, 45 per cent, in Massachusetts.

* A higher percentage of Vineyard births, 37 per cent, were funded through Medicaid/MassHealth, than in the state at large, 24 per cent.

About another 40 per cent on the Island, Dr. Donegan said, were funded through private insurance, with self-payers accounting for the remainder. He said the payment plan percentages reflect the economic mix on the Island.

The hospital now is planning a $42 million renovation and expansion at its Linton Lane campus. Chief executive officer Timothy Walsh said that although the hospital is not expecting much of an increase in the number of births on the Island, the institution does plan to improve its women's health facilities.

In particular, Mr. Walsh said, the hospital plans to build four labor-delivery-recovery-postpartum rooms. He said the rooms will allow families to share the birth experience in what is more akin to a private room, with a trip to another delivery room necessary only in more complicated births. At present, births at the hospital occur in the delivery room next to the operating room.

"For a regular birth, it's a pretty nice concept," Mr. Walsh said of the labor rooms, which the hospital now lacks.

Mr. Walsh said the hospital also plans to enlarge its nursery, whose equipment is limited by its small size.

Ms. D'Antonio, 33, who gave birth last week to the twin boys, applauded her experience at the Vineyard hospital. The wife of Milo D'Antonio of West Tisbury - they already have two girls and a boy, ages 11 to five - she is a former Vermont resident who has lived on the Island 14 years.

Ms. D'Antonio called Dr. Donegan, who handled her delivery, awesome, and said she was willing to stay longer at the hospital, since "they were doing such a nice job."