to 2006, the proportion of vaginal late preterm births for which labor was induced more than doubled, to 17.3% from 7.5%. Cesarean deliveries increased by 46% during the same period. Laura Riley, MD, medical director of labor and delivery at Massachusetts General Hospital, in Boston, said halting cesarean deliveries scheduled for the convenience of patients and physicians could decrease the number of late preterm infants. These babies are more likely to have respiratory distress, prolonged hospitalization, and higher medical costs than full-term infants. Alan Peaceman, MD, chief of maternal/fetal medicine at Northwestern Memorial Hospital, in Chicago, said the rise in late preterm births also is linked with technologies being used to assess whether the risks of staying in the womb are greater than the risks of being born. (Neither Riley nor Peaceman was involved with either report.) The March of Dimes has noted that consistent use of several measures could help reduce rates of preterm birth: smoking cessation as part of maternity care; expanded access to health care coverage for women of childbearing age; improved adherence to clinical guidelines on fertility treatment and early cesarean sections and inductions, and progesterone supplementation. Riley agreed, but said additional factors are involved in preterm births. “Genetics, having a predisposition [to give birth prematurely], environmental hits, socioeconomic factors—all of these take you down this path to a bad outcome, and it is much more complex than people realize.” “We don’t know what causes prematurity yet, and the science is very far behind to figure out what tools we need to fix the problem,” Peaceman added. Although slight, the March of Dimes report indicated that some health systems are making progress. It singled out several notable programs, including a community-based public health clinic system at Parkland Memorial Hospital in Dallas, Tex, that helps direct minority pregnant women into prenatal care. The program has helped Parkland reduce its preterm birth rate to 4.9% in 2006 from 10.4% in 1988. Howse also said she is optimistic that healthsystemreformlegislationwilleliminatepregnancyasapreexistingcondition ininsurancecoverage.Withoutinsurance coverage,pregnantwomenmaygowithoutprenatal careandbeunawareof their risks for preterm delivery.