Hawaii received a "D" for premature births in a new report card released on Wednesday. The state ranked 22nd in the first nationwide study on preterm births by the March of Dimes. The nation also received a "D."

Families dealing with premature babies can be in for quite an ordeal. The Otto boys are happy and healthy now but all three were premature babies. The oldest, Devin, weighed less than 2 pounds at birth.

"We didn't know if he was gonna live or die or if we'd be taking home a baby with special needs," said Donna Otto of Kaneohe.

Three years later, twins Blake and Carsen were born six and a half months into the pregnancy.

"They had a machine breathing for them for eight weeks and surgeries," said Otto.

Otto said her doctors were never able to figure out why she gave birth prematurely. Every year, an estimated 2,100 Hawaii families understand her struggle. 1 out of every 8 babies is born too soon.

"They can have lifelong health problems like cerebral palsy, mental retardation, vision, hearing problems, chronic lung disorders, learning problems in school," explained Carmella Hernandez, state director of the Hawaii chapter of the March of Dimes.

Hawaii's preterm birth rate was 60 percent higher than the Healthy People 2010 goal set by the federal government, according to the March of Dimes. There are several factors that can contribute to the problem. Ten-point-four percent of women of child-bearing age have no health insurance and 17.3 percent are smokers, according to the study. The state health department's figures, which only count pregnant women, are 2.4 percent with no health insurance and 8.6 percent who are smokers.

State officials are also worried about the rising number of Cesarean-section births and a shortage of obstetricians.

"I think the 'D' is a fair grade looking at how we compare to the rest of the nation. I think we can do much better," said Loretta Fuddy, family health division chief at the Hawaii Department of Health.

Vermont earned the highest grade. It was the only state to get a "B."

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