A preemie is any baby who is born before 37 weeks of pregnancy, according to the March of Dimes. While the baby is small, the issue is not. “Preterm birth is the single leading cause of infant mortality. Those babies are at the greatest risk for having complications from being born early or less than 34 weeks of gestation,” says Louis Muglia, M.D., a professor of pediatrics and obstetrics and gynecology at Cincinnati Children’s Hospital Medical Center. Doctors acknowledge there is a lot of work to be done among Cincinnati families and obstetricians alike.
The fact that the warning signs come in different forms makes premature labor hard to diagnose. “You will have patients who have contractions that are early or preterm, which is before completing 37 weeks, and about 50 percent go away. It is not a problem and they end up going to term,” says Michelle Federrer, M.D., an obstetrician/gynecologist with Mercy Health. The March of Dimes releases an annual report on how states are doing in eradicating preterm births. In 2013, Ohio earned a “C,” the same grade as 2012. That may sound bad, but Ohio is making progress. While the preterm birth rate stayed the same from 2012’s report card, at 12.1 percent of live births, the percentages of uninsured women of childbearing age (17 percent) and of women of childbearing age who smoke (27.3 percent) went down from 2012. As well, the percentage of infants born between 34 and 36 weeks gestation (8.1 percent) dropped as well. “Ohio is below the national average in preterm birth rate,” says Muglia.
Know Your Risk Factors
You may have heard that preemies are more likely to be boys than girls and that can be true. “When we put someone in preterm labor we look at the sex. If it is a boy born to a Caucasian family, we get more worried because they do not do as well,” says Federrer. Other factors that put moms at risk include expecting twins or triplets, African American status, or a previous preterm birth. “If we know the mom has had a preterm delivery before, one of the things that has been shown to help with treating or preventing another is giving a weekly injection of progesterone earlier in the pregnancy until they get closer to term,” she says.
The final major hurdle is smoking and drug use. “The current drug use that is out there whether it is tobacco, marijuana or prescription drugs has been disturbing and can cause pre-term birth or your placenta to abrupt,” says Federrer.
What You and Your Doctor Can Do
Bed rest and fluids are not that effective, unfortunately. Some of it is genetics, as some women are simply disposed to having babies preterm. Expecting moms are advised to focus on modifiable risk factors. “One modifiable risk factor is appropriate spacing between pregnancies, so at least 18 months, [along with] normal pregnancy weight gain and going into the pregnancy with a healthy body mass index,” says Muglia.
There is still a lot that remains unknown about what triggers preterm birth. “Right now we measure something called cervical length as an indicator but even that is not very sensitive or specific,” says Muglia. This tool indicates the women that are more likely to have a preterm birth and reflects those that should probably receive progesterone supplementation during pregnancy. “We need better markers of the women that are likely to deliver preterm well before they start into labor and get more effective interventions for the women who have contractions,” he says.
If you know you are at risk, make sure your obstetrician knows it, too. “Women that have risk factors should be having cervical length measurements around 24 weeks of gestation, and women that had a previous preterm birth should talk to their doctor about whether he thinks she should receive progesterone supplementation to reduce risk of preterm birth,” said Muglia. There has to be good communication between the mom and obstetrician. But even the best of communicators can run into the shock of preterm labor.
Discover the Signs
There are two broad classes of preterm delivery and birth. “One is spontaneous where the mom starts into labor for reasons that more than half the time we do not understand. About 25 percent of the time it may be due to an infection. But for more than half, maybe up to three-quarters, we do not have the cause,” says Muglia. The other cause is medically indicated, which means the mom or baby is having a problem with the pregnancy where their health is compromised such that the pregnancy has to be stopped by the physician.
Knowing the signs of premature labor can make a difference. Low back pain and abdominal pressure should alert women that there could be a potential problem. “Many women will not recognize signs like low back discomfort or other non-specific abdominal complaints, while others clearly will recognize forceful contractions,” says Muglia. Some women deliver acutely but have had some labor symptoms without recognizing them ahead of time. “Moms should have a high index of suspicion that preterm labor is happening because it is such a common event — about one in nine pregnancies end up in a preterm delivery, and an even greater fraction of those have signs suggestive of preterm labor,” says Muglia.
The earlier the baby is born, the more chance of problems. “You could have a baby at 26 weeks and it doesn’t seem like there are any problems at all and then seven to eight weeks later, he could have a significant problem with the lungs. It is always individualized,” says Federrer. Some preemies have to spend time in the neonatal intensive care unit (NICU), which is the part of the hospital that takes care of sick newborns. Other possible health complications include respiratory distress syndrome, anemia, infections, jaundice, apnea, problems with vision and heart and lung issues.
Caring for Your Preemie
Do your best to give the baby a healthy start. Muglia says that moms with babies likely to be born early should receive prenatal steroids at least 48 hours before birth to help promote maturation of the lungs, and to minimize complications after birth.
You can expect that the baby will not go home until the time that he was normally due to be born. “If the baby is born two moths early, he will be in the hospital for two months. So make sure you are connected with services in terms of developmental assessment and long-term outcomes … because early intervention is critically important,” says Muglia. And moms need to remember to take care of themselves, too. “A lot of times they do not rest like they should and are overdoing it when they have a pre-term,” says Federrer.
Obstetricians recognize prematurity as a problem and have adopted a mindset accordingly. “One of the biggest pushes in the obstetric world in the last five years is that we do not want to deliver at 37 weeks; we want to get them to 39,” says Federrer. Elective deliveries used to be fairly accepted. “Everybody wants to have their baby and deliver early but most moms are reasonable, want to help their baby, and will go into natural labor,” she says.
Thanks to medical advances, preemies are surviving and going on to lead normal, productive lives. “There is a blood pressure medication called Procardia that is starting to be used and has helped some,” says Federrer. More Cincinnati families are becoming aware of premature birth in general. “We want to make sure moms and babies are as healthy as they can be going into pregnancy to have the best opportunity to have healthy babies,” said Muglia.
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