With 12.5 percent of all children born prematurely in the islands, Hawaii once again earned an average "C" grade for premature births even as the national rate dropped to a 17-year low of 11.4 percent.

The annual March of Dimes Premature Birth Report Card came out while a coalition of health care professionals and organizations is working to figure out why Hawaii’s rate of premature births has remained relatively stagnant eight years in a row while progress continues on the mainland.

"We’ve seen a decrease in other states in the U.S., as a whole," said Lin Joseph, director of program services for the March of Dimes Hawaii chapter. "But for some reason, Hawaii’s isn’t budging."

There are lots of theories: smoking, drinking and drug-use during pregnancy; and a lack of easily accessible prenatal care on the neighbor islands.

But those factors do not take into account premature births by typically healthy women in Hawaii, Joseph said.

"Women can take the best care of their bodies and get prenatal care and do everything right and still have a preterm birth," Joseph said. "We do know there are risk factors, and smoking is one of them, but for a lot of it, we just don’t know."

Shannon Robinson of Kihei, Maui, was 36 but healthy when her first daughter, Rachel, was born nine weeks early and weighed in at only 1 pound, 13 ounces. Two years later, when she was pregnant with her second child, Robinson again was ordered to stay in bed at Kapiolani Medical Center for Women & Children for six weeks until daughter Olivia was born six weeks early, weighing in at 3 pounds, 3 ounces.

Eight years after Rachel’s birth and six years after Olivia was delivered, both girls are doing fine, "but it was scary," Robinson said.

Doctors talked to Robinson about the possibilities of the babies having underdeveloped lungs, developmental delays and brain-bleeding — "everything that could possibly happen," Robinson said.

Since then Robinson has learned how prevalent premature births are in the islands. Now she volunteers to visit parents in neonatal intensive care units when she’s on Oahu — and meets with parents of premature children when they return home to Maui.

"When I was in the hospital, March of Dimes volunteers talked to me about what was going on and what could happen," Robinson said. "Especially not having family on Oahu, they would come and visit (while Robinson was on bed rest) to make sure my spirits were up, which was very helpful."

Even when she returned home to Maui, Robinson felt uncertain without baby monitors and health care workers constantly around. So she tries to stay in touch with moms and dads who return home to the Valley Isle.

"I found it very helpful to have that moral support from people who went through the same experience," Robinson said.

Even though the national rate of premature births has fallen, the March of Dimes still gives the current national rate a "C" grade because it fails to meet the organization’s goal of 9.6 percent.

Locally, the Hawaii chapter of the March of Dimes is working with the state Department of Health and 80 physicians, hospital administrators, insurance companies, community health centers and others to fulfill the goal of late Health Director Loretta Fuddy to have cut premature births to 11.6 percent by this year and decrease infant mortality by 4 percent.

As in Robinson’s cases with her two daughters, Joseph said, health care professionals now realize that "just having good prenatal care is not the silver bullet we thought it was. We’re still seeing preterm births and fatalities."

So a collaborative effort among agencies has evolved to educate parents on healthful behaviors — such as good nutrition and health care — even before conception. The idea is to focus parents on the year before conception through the baby’s toddler years, when they recommend good sleeping habits to prevent sudden infant death syndrome and other sleep-related infant deaths.

The state Legislature failed to pass a bill in the 2013 session that would have funded a coordinator’s position for the group, Joseph said.

But Fuddy, who died in a plane crash in December, told the March of Dimes chapter to form the group without funding anyway, Joseph said.

"She gave us our marching orders," he said. "We are trying to fulfill Loretta Fuddy’s legacy."