Date: July 1, 2008
Health care providers are growing increasingly concerned about misconceptions of preterm birth. Expectant mothers are reluctant to change risky behaviors or are requesting early Caesarean sections and inductions despite the consequences of what an early arrival means to a baby. These patients seem to view prematurity as merely having a baby that weighs a couple of ounces less and is somewhat smaller than his peers. Health care practitioners worry the real dangers and risks of preterm birth are trivialized.
According to the March of Dimes, preterm or premature birth and low birth weight are two of the biggest predictors of infant health problems, and the number of babies in this group is staggering. In 2005, one in eight infants nationally was born before completing 37 weeks of gestation. In North Carolina, that number jumps to one in seven. In real numbers, that’s 6,868 babies in 2005, or 42 babies a day born prematurely in North Carolina alone.
“The consequences of preterm birth are under-realized,” says Dr. Kate Menard, M.D., co-director of the UNC Center for Maternal and Infant Health. “I think with respect to preterm birth in general, the message should be that term is after 39 weeks. [If a baby is born] before that, we risk morbidity and mortality,” says Menard, who also is director of the Division of Maternal-Fetal Medicine at UNC Department of Obstetrics and Gynecology
Many expectant mothers know the first steps to increase the likelihood of having a healthy baby:
* Avoid cigarette smoke;
* Abstain from alcoholic beverages and drugs;
* Eat properly;
* Take a multivitamin with folic acid; and
* Keep chronic conditions like hypertension and diabetes under control.
Another piece to this puzzle is to complete a full-term pregnancy, giving birth between 37 and 42 weeks. But some moms follow this advice and still face the scenario of a preterm baby.
Risk factors for premature birth
Some women have risk factors that indicate their babies may be born before they should. According to the March of Dimes, the highest risks are for women who are pregnant with multiple babies, have uterine or cervical abnormalities, and who have previously had a baby born preterm. These women are among the known risk groups. Also, according to the March of Dimes, “Only about half the women who have preterm labor fall into any known risk group.”
Beatrice Diaz of Carrboro was one of those moms. When pregnant with her first child, a boy named Garrison, Diaz was a healthy 24-year-old who was not aware that she might be at risk of delivering prematurely and did not realize the magnitude of possible outcomes for a preterm baby. She also didn’t know that among African-American women in North Carolina, the odds of having a preterm birth are one in five, or 20 percent.
For Diaz, eating healthily, attending prenatal visits and taking good care of herself were important aspects of her pregnancy. She read a lot about pregnancy, prenatal health and childbirth to prepare for the birth of her child.
“I was doing everything right and everything was going fine until I started dilating early,” Diaz says. “The doctor put me on bed rest at home and then hospitalized me because I was still dilating.”
A few days after her hospitalization, Diaz's baby was born. He was only 24 weeks old.
For some premature babies, being born too soon is a minor hiccup on the road of life, while others have vital organs that have not fully developed and matured. Sometimes a matter of a few extra weeks or even a few more days can spell the difference between a baby who has a positive health outcome and one who faces years of therapies and interventions.
According to the National Institute of Child Health and Human Development, the risks premature babies face include:
* Low birth weight;
* Breathing problems;
* Underdeveloped lungs;
* Greater risk for infections;
* Greater risk for cerebral palsy; and
* Increased chance for learning and developmental disabilities.
Impact on children and families
But what do these risks mean to a family? What did these risks mean to Beatrice Diaz, her husband and her young son?
The first year of Garrison’s life was a roller coaster. He spent the first 170 days of his life in the neonatal intensive care unit (NICU) at Duke Hospital. In total, he was hospitalized for about eight months.
And for Garrison, now 6 years old, things are still challenging.
“As a result of his premature birth, he is developmentally delayed,” Diaz says. “He is in a wheelchair and cannot walk. He also cannot talk and has multiple disabilities. He gets speech and occupational therapy so that one day he will be as independent as he is able to be. He also laughs and he has a beautiful smile, but you can’t have a conversation with him.”
Although Menard sees many healthy women, as a specialist her practice is comprised of many expectant moms who fall into the risk categories for preterm birth. One of Menard’s goals is to recognize women who may be eligible for treatment for potential preterm birth.
Preterm prevention program
When Diaz became pregnant with a second child last year, she elected to participate in a program aimed at allowing her baby to be born full term. Diaz became one of many North Carolina moms to participate in the North Carolina 17P Project.
This program provides a weekly injection of a type of progesterone known as 17P to women who have previously experienced a preterm birth and are pregnant with a single baby. Although health care providers are not exactly certain why progesterone works this way, studies have repeatedly demonstrated that in certain women it can delay the onset of preterm labor without causing any dangerous side effects to moms or their babies.
“It’s one of those few interventions we know that makes a difference,” Menard says. “What we know is that in women with a history of preterm birth, if they get treatment [with 17P], their risk of preterm birth will be lowered by one-third. The true mechanism [for why this works] is still under investigation.”
But Menard is encouraged by the results she’s seen with 17P and by the relatively small risk of using it. “The side effect profile is that of getting a shot [bruising, redness]," Menard says. "There are no total body side effects associated with it, and there are no demonstrated birth defects or fetal effects.”
Although this use for 17P has not been verified by the U.S. Food and Drug Administration, and testing is still in process to obtain that approval, Menard says that studies have repeatedly emphasized the benefit of using 17P.
For Diaz, her second pregnancy was completely different from her first. Diaz’s daughter was born at 40 weeks. Diaz was surprised by how much louder and how bright-eyed her daughter was at birth.
She also didn’t take for granted the differences between the two pregnancy experiences. With her son, she was transported to the hospital in an ambulance and had to wait months before he could come home. With her daughter, she didn’t need the ambulance. Her baby was born on a Friday, and they both went home on the following Monday.
“It [17P] is not a cure for premature babies, but it reduces the risk, and I’m an example of a positive result for 17P,” Diaz says.
Diaz will continue to work with her son and facilitate his therapies. “He didn’t have a fairy-tale ending,” she says. “There are some babies who are born early and who catch up. He had the major consequences. Not every baby born that early will have a typical life. He’s one of the babies who has an atypical life.”
However, Diaz continues to pray for her son and his small triumphs, such as a recently discovered love of bowling. For Diaz’s second child, who is now 6 months old, the extra time in her womb means that she has the typical life her brother may never experience. And Diaz treated each day that she was able to carry her daughter as a gift.
“I got bigger, I got the waddle, and people could tell I was pregnant,” she says. “These are things that if you have full-term babies you may take them for granted. Every week after 24 weeks was an exciting time.”
And those are exciting times all mothers and babies need.
Robin Whitsell is a freelance writer and mother of three girls who lives in Chapel Hill. She can be reached at www.robinwhitsell.com.
Warning Signs and Symptoms of Preterm Labor
* Contractions (your abdomen tightens like a fist) every 10 minutes or more often.
* Change in vaginal discharge such as leaking fluid or bleeding from your vagina.
* Pelvic pressure or the feeling that your baby is pushing down.
* Low, dull backache.
* Cramps that feel like your period
* Abdominal cramps with or without diarrhea.
What if I Think I’m Having Preterm Labor?
Call your health care provider (nurse, doctor or midwife) or go to the hospital right away if you think you’re having preterm labor or if you have any of the warning signs. Call even if you have only one sign.
Your health care provider may tell you to:
* Go to the office or to the hospital for a checkup.
* Stop what you’re doing.
* Rest on your left side for one hour.
* Drink two to three glasses of water or juice (not coffee or soda).
Source: March of Dimes’ Web site
For information about the North Carolina 17P Program, check out www.mombaby.org or call 919-843-7865.