By Sarah Winfrey, CD(DONA), with contributions from Heidi Horner
Every day in utero counts. Pregnancy lasts between thirty-eight and forty-two weeks, with preterm labor occurring before thirty-seven weeks. Every day a baby spends in the womb allows him to develop and mature more fully, so preemie health often correlates to gestational age.
According to the March of Dimes, the leading non-profit organization for pregnancy and baby health, about 90 percent of babies born at twenty-eight weeks will survive, but many will face serious health issues. Development between twenty-three and twenty-six weeks increases the likelihood of survival by 2-4 percent daily. Babies born before twenty-three weeks have little chance of survival, usually too underdeveloped to exist on their own. Preemies who do survive an early birthday face numerous problems, including low birth weight, difficulty breathing, digestive complications, underdeveloped organs, and learning and developmental disabilities.
United States statistics on preterm birth are shocking, and have been a long-time focus of federal government and advocacy agencies alike. About 12 percent of births in the U.S. are to premature infants. That’s one in eight births, nearly 500,000 births a year, according to a National Institutes of Health (NIH) report following a June 2008 Surgeon General’s Conference on preventing prematurity.
Despite decades spent working to fight this problem, prematurity rates have increased, the impetus for this recent NIH report and conference. Acting Surgeon General Steven K. Galson hopes “the agenda developed at this conference will provide the first step for reducing the considerable emotional and financial toll that preterm birth exacts in lost lives, disability, and increased health care costs." (Read the NIH report - http://www.nih.gov/news/health/jun2008/nichd-19.htm).
The Surgeon General’s initiative to educate and understand prematurity hasn’t come a moment too soon, as only about half the mothers that give birth preterm fall into identifiable risk categories. March of Dimes states that women at highest risk fall into three categories: mothers with a previous preterm birth, women pregnant with multiples, and women with certain abnormalities in the cervix or uterus. Women younger than seventeen and older than thirty-five are also at increased risk. Lifestyle and environmental factors, as well as certain medical conditions may also put a woman at risk. Because only around half of mothers fall into any known risk category, all women should educate themselves on the signs of preterm labor.
Although women may experience different signs of preterm labor, everyone should be familiar with the most common. “Uterine contractions, especially more than four in one hour, menstrual-type cramps, pelvic pressure, backache, intestinal upset, and vaginal discharge of blood, mucus, or water,” are among the most usual signs, listed on The University of Virginia’s (UVA) website (http://www.healthsystem.virginia.edu/uvahealth/peds_hrpregnant/ptl.cfm). A woman should call her caregiver if she experiences any of these symptoms.
If preterm labor is confirmed, the course of action may include bedrest, hospitalization, medications to stop contractions, medications to mature fetal lungs, cerclage to suture the cervix shut, or administration of antibiotics if infection is suspected. Delivery, possibly by cesarean, is likely if baby or mother is in danger, or the treatment doesn’t halt the contractions. It cannot be overstressed that women need to contact their caregivers if they experience any signs.
The first step against prematurity is prevention. Mayoclinic.com offers ways to increase the chances of full-term pregnancy. Regular prenatal care throughout pregnancy provides access to a caregiver’s expertise. Women should also follow care provider’s recommendations regarding sex and activity level, which are usually not limited in healthy pregnancies. Expectant mothers need to manage chronic medical conditions, such as diabetes and high blood pressure, with the help of a caregiver. Mothers should set limits on stress, and never smoke, drink, or use recreational drugs. Over-the-counter medications should be used with caution, and only after consulting with a caregiver. Pregnant mothers can do much for unborn babies by making wise and responsible choices.
Good nutrition is essential in preventing premature birth. Traditional Midwifery of Northern Virginia, a practice of two certified homebirth midwives, has a 0% preterm birth rate. Lori Orme, CPM, says she and her partner expect at least 40 weeks of pregnancy, even with moms carrying twins. “I can’t stress to clients enough how important good nutrition is at preventing a variety of pregnancy-related complications, including preterm labor,” says Lori, who typically recommends a diet established by Dr. Thomas Brewer. Brewer, who blamed prematurity rates on “the failure of our doctors to recognize the role of nutrition in pregnancy,” has a website devoted to promoting good nutrition. Blueribbonbaby.org has tools to help women apply the Brewer Diet, including a Personal Nutritional Profile, a hotline, checklists for specialized diets (including vegetarian and vegan diets), and supplemental plans for women carrying multiples. Lori says the typical prenatal visit with homebirth clients is one hour, with ten minutes for clinical evaluation and much of the remaining time spent discussing nutrition. When mothers commit themselves to good nutrition and collaborate with caregivers, they are taking an invaluable step to ensure full-term pregnancy.
Partnership with a good care provider is essential when discussing induction of labor, which can contribute to prematurity. The Lamaze Institute for Normal Birth emphasizes the inaccuracy of due dates in the 2003 paper “Care Practices That Promote Normal Birth #1: Labor Begins on Its Own.” Inductions carry an elevated risk for “mild prematurity,” since due dates aren’t exact. “If there is a 2-week error in calculating a due date, a woman scheduled to be induced at 38 weeks might only be 36 weeks pregnant.” True medical reasons for induction include rupture of membranes without start of labor, when pregnancy has reached 42 weeks, when high blood pressure or uterine infection are present, and when a woman has health problems that could harm the baby. Likewise, a cesarean section should be scheduled with the same caution. Induction should only happen when it’s more dangerous for a baby to remain in a mother’s womb than to be born.
The prematurity epidemic is affecting more American families then ever before. While national initiatives and non-profits continue to conduct research and offer support, women should increase their awareness and enhance their health. Sensible lifestyle choices and good nutrition are easy commitments that go a long way in preventing preterm birth. When women and care providers collaborate to ensure healthy pregnancy and birth, they give a baby the best possible start. In spite of all the unknowns surrounding preterm birth, one thing is certain: every small step taken is a big help in the fight against prematurity.
Lifestyle and Environmental Risks, As Listed by the March of Dimes
- Late or no prenatal care
- Drinking Alcohol
- Using illegal drugs
- Exposure to the medication DES
- Domestic violence, including physical, sexual, or emotional abuse
- Lack of social support
- Working long hours with long periods of standing
The March of Dimes website - http://www.marchofdimes.com/pnhec/188_1080.asp
Medical Risks, As Listed by the March of Dimes
- Urinary tract infections, vaginal infections, sexually transmitted infections and possibly other infections
- High blood pressure
- Clotting disorders (thrombophilia)
- Bleeding from the vagina
- Certain birth defects in the baby
- Being pregnant with a single fetus after in vitro fertilization (IVF)
- Being underweight before pregnancy
- Short time period between pregnancies (less than 6-9 months between birth and the beginning of the next pregnancy)
Watch “Take Action: Signs of Preterm Labor” by the March of Dimes on youtube.com today.
How to Help the March of Dimes in the Fight Against Prematurity
- Monetary donations
- Donate old cell phones and electronics
- Set up a coin collection kit in your office, place of worship, etc…
- Buy a “virtual band” online
- Participate in special events such as the “March for Babies”
- Shop the online store
- Donate to support local NICUs