SIOUX CITY -- Alicia Hansen and Dustin Williams' daughter, Daylynn, entered the world Oct. 13 weighing just 2 pounds, 1 ounce.

Thirty-six days later, Daylynn remains in an incubator at St. Luke's Regional Medical Center, but she has gained weight and is happy and healthy.

Hansen, of South Sioux City, said she didn't anticipate that her first child would arrive at 30 weeks. Typically, pregnancy reaches full term at about 40 weeks.

"I had absolutely no idea," Hansen said Wednesday as she sat with Williams in Daylynn's room at the neonatal unit. "I was terrified. I was worried about her."

After experiencing minor pain, Hansen went to the hospital, where ultrasound revealed that the baby was lying on her umbilical cord and lacked amniotic fluid.

Hansen was given steroids to help develop the baby's lungs.

After Daylynn was born she was placed on a ventilator but was soon breathing on her own. She also spent nearly seven days under a special light to treat jaundice.

Daylynn, now 3 pounds, 11 ounces, will go home in about two weeks.

For the second consecutive year, Iowa earned a D on the March of Dimes Premature Birth Report Card released Tuesday.

Although the state lowered its late-preterm birth rate from 8.4 percent to 8.1 percent and reduced the percentage of women of child-bearing age who smoke -- a contributing factor to premature birth -- from 23.6 percent to 20.3, Iowa's rate of uninsured women increased from 13.1 percent to 14.7 percent.

The March of Dimes graded states by comparing each one's rate of premature birth to the nation's objective of 7.6 percent or less by 2010. The national average grade was a D. No state received an A, and only Vermont received a B

"Here in Iowa we are proud of our hard work in decreasing smoking in women of childbearing age and late-preterm births, and we hope that it will be the start of a decline in our preterm birth rate," Iowa March of Dimes state prematurity chairman Dr. Stephen Hunter said in a statement. "We have a long way to go before all babies in America get a healthy start in life, and we are committed to working with state health officials, hospitals and health care providers to continue to fight for preemies."

Linda Drey, nursing director for the Siouxland District Health Department, said she is encouraged that Iowa continues to score above the national state average.

"When I looked at the whole ranking of Iowa compared to all of the states and territories, we're 15th," she said. "I'm not saying we're good, but we certainly aren't at the bottom of the batch. We're much better than many states, which I think is encouraging."

Nebraska is ranked 19th and South Dakota, 27th. Both states also got D's from the March of Dimes.

In the United States, more than 540,000 babies are born too soon each year. In Iowa, more than 4,500 babies are born preterm, and premature birth is the leading cause of death in children 17 years and younger. Preterm birth is a serious health problem that costs the United States more than $26 billion annually, according to the Institute of Medicine, the health arm of the National Academy of Sciences. It is the leading cause of newborn death.

Peggy Mace, St. Luke's Birth Center manager, said premature babies face challenges of maintaining their body temperature and blood sugar, have trouble feeding and develop slower.

"Plus there's just the morbidity of the factor that you're in an intensive care unit, where you're being poked and prodded and having IVs started and invasive things done, which always increases the risk of infections," she said.

The March of Dimes lists respiratory problems and mental retardation as potential long-term health complications for preterm birth.

The organization has asked hospitals and health professionals to implement quality improvement programs that can help prevent unnecessary early inductions and Caesarian sections and follow American College of Obstetricians and Gynecologists guidelines.

In 2007, Mace said St. Luke's joined a national program to end elective inductions and Cesarian sections before 39 weeks.

"It took us a while to hardwire that because it was a big cultural change for the community, for our physicians, for our patients," she said.

Data collected for two months in 2006, Mace said, showed that 48 percent of the hospital's births were scheduled as repeat elective Cesarians or elective inductions. Of those births, about 5 percent resulted in the baby being admitted to the Neonatal Intensive Care Unit. In the fall of 2007, another two-month study showed that the hospital had dropped the rate of elective Caesarians or elective inductions to 36 percent of births, and slightly less than 1 percent of babies were going into intensive care for respiratory distress.

A six-month study conducted in spring 2009, Mace said, found that 37 percent of the hospital's births were being scheduled as elective Cesarian sections and elective inductions, and only 2 percent were being admitted to intensive care with respiratory distress.

"Those numbers are very encouraging," she said. "We're very, very happy to see that."