Premature Delivery

Margaret Smith was 17 weeks pregnant when she found out at a doctor’s visit that she was dilated and at risk of going into labor. She was checked into the hospital on November 3 and then sent home and placed on strict bed rest. With two young children at home, she gets teary when she remembers telling them that when spring came – and after the baby’s April 1 due date – she would be able to get up again. However, her struggle to get to that date was arduous and required the help of a caring team of medical professionals and loving support from neighbors and friends.
An Expectant Mother’s Greatest Fear
By Jenni Veal
Today, with healthy 5-year-old Maggie at her side, Margaret knows that the successful outcome of her premature birth experience was rare and that for many premature babies, complications from their early entry into the world can last a lifetime.
Each year in the United States, 13 percent of babies (more than half a million) are born prematurely or before 37 weeks of gestation. Preterm labor can happen to any pregnant woman. Only about half of the women who have preterm labor fall into any known risk group.
In Margaret’s case, she had two other normal pregnancies, was in good health and regularly visited her doctor for prenatal checkups. “I don’t know if anyone will ever be able to tell me why this happened to me,” she says.
“A lot of research is being done to try to understand the underlying causes of premature birth,” says Dr. Joseph Kipikasa, a maternal fetal medicine specialist with Regional Obstetrical Consultants in Chattanooga. “Premature labor is a multifactorial process – it is probably not one thing, but a multitude of things.”
According to the March of Dimes, a national nonprofit organization that works to improve the health of babies by preventing birth defects, premature birth and infant mortality; three groups of women are at greatest risk of preterm labor and birth:
• Women who have had a previous preterm birth
• Women who are pregnant with twins, triplets or more
• Women with certain uterine or cervical abnormalities
Certain medical conditions can also increase the risk of preterm labor including: diabetes; high blood pressure; clotting disorders; infections; obesity; certain birth defects in the baby; being pregnant with a single fetus after in vitro fertilization; being underweight before pregnancy; sexually transmitted diseases and a short time period between pregnancies (less than 6 to 9 months).
Additionally, advanced maternal age, a common trend today, can result in a greater number of high-risk pregnancies.
In Tennessee, one out of every eight babies born is premature. The March of Dimes recently released its annual Premature Birth Report Card and Tennessee received an “F” for the second consecutive year. The United States as a whole didn’t do much better, receiving a “D” for its score.
“If we could improve health in general in the community, we could improve premature labor statistics,” says Dr. Woods Blake, a neonatologist with Pediatrix Medical Group in Chattanooga. “If you could overlay poor nutrition, diabetes, hypertension and obesity issues with premature birth and infant mortality issues, we would find they are related.”
Research has found that many lifestyle and environmental factors can also put a woman at greater risk of preterm labor, including: late or no prenatal care; smoking and drinking alcohol; using illegal drugs; exposure to the medication DES, a synthetic form of estrogen; any kind of physical, sexual or emotional abuse; lack of social support; stress and long working hours with long periods of standing.
“As a general rule, if a woman is not concerned about her own health, pregnancy has little impact on getting her to take care of herself,” says Dr. Lisa Lowery- Smith, a neonatologist with Pediatrix Medical Group in Chattanooga. “It is important to live a healthy lifestyle that begins prior to becoming pregnant. Don’t wait until you are pregnant to change your lifestyle.”
Unfortunately, premature births are on the rise in the United States and according to the March of Dimes, have increased 36 percent since the early 1980s. The vast majority of premature births, about 75 percent, are between 34 and 36 weeks gestation (called late preterm).
Although many preterm deliveries are medically necessary or cannot be prevented, some late preterm births have actually been elective, says Dr. Kipikasa. “Up until two years ago, there was an increase in preterm births in the 34 to 36 week window because doctors and moms were scheduling elective deliveries for convenience,” he says. Research has shown that these late preterm births can have the same preterm complications, so that trend seems to be diminishing. “There has been a push in the last two years to maintain pregnancies through 38 completed weeks of gestation, unless there is a medical emergency,” Dr. Kipikasa says. “In Chattanooga, the hospitals have embraced this and are holding physicians to it too.”
“A baby born in the 34 to 36 week window is still considered premature,” says Dr. Victor Thomas, a neonatologist with Regional Neonatal Specialists in Dalton, Ga. “Those babies can experience breathing difficulties, feeding difficulties and increased risk of severe jaundice.”
All premature babies have a higher risk of hospitalization and long-term health problems. Babies born extremely preterm are at a high risk for brain problems, breathing problems, digestive problems and even death in the first few days of life. Unfortunately, they also are at risk for problems later in life, such as delayed development and learning problems. New research is showing that even late preterm babies are at risk for long-term problems, including learning diffi culties, memory problems and increased incidence of attention deficit disorders.
Premature babies are also at high risk for cerebral palsy, according to Dr. Lowery- Smith. “The more premature the baby is, the higher the risk of moderate to severe cerebral palsy,” she says. “Babies born at 28 weeks or less and babies who weigh less than 1,000 grams are extremely premature. That is the population that is most at risk for signifi cant long-term complications. But even babies born just 3 to 6 weeks before their due dates are at risk for having complications, such as prolonged hospital stays or intensive care support.”
Preventing premature birth begins with a healthy lifestyle during childbearing years and prenatal care during pregnancy. For women who have experienced a premature delivery, treatments with a form of the hormone progesterone may help prevent premature birth in subsequent pregnancies.
If preterm labor begins, the sooner medical help is received, the better for the baby. Preterm labor can sometimes be stopped with a combination of medication and bed rest. Medications sometimes slow or stop labor if they are given early enough.
Additionally, drugs called corticosteroids, if given 24 hours before birth, can help the baby’s lungs and brain mature, which can help prevent some of the worst health problems in a preterm baby. In Margaret’s case, she was given a steroid shot to help develop Maggie’s lungs at 28 weeks.
“I was put on bed rest on November 3 and had Maggie on February 28 – it was a psychologically challenging time trying to take care of my family, take care of myself and worrying about the baby,” Margaret remembers.
Throughout her pregnancy and bed rest, Margaret found comfort in the support of another woman who had been through the same experience. Through the nonprofit group Sidelines, a national high risk pregnancy support network (www.sidelines. org) she met her mentor. “I would talk to my mentor once a week,” she says. “I felt like I could ask her anything because she had been through what I had been through.” Today, Margaret is on the other side, serving as a Sidelines mentor to other women experiencing premature labor.
“Ultimately, the longer a baby stays in utero, the better,” says Dr. Lizbeth Kennedy, a neonatologist with Regional Neonatal Specialists in Dalton, Ga. “Our job as health care professionals is to prevent these babies from being born early.”
In something of a miracle, when Margaret’s body went into labor at 35 weeks, Maggie was born healthy, weighing 5 ½ pounds and never had to enter the neonatal intensive care unit. She remembers how anxious she and her husband were during the birth – and how grateful they are today to have their little girl. “It was the most beautiful ending to something that was so difficult. I think about that every day when I look at her,” she says. “We would never have made it without our doctors – the medical professionals that surrounded us were amazing.”
Jenni Veal is a journalist and editor based in Chattanooga, specializing in outdoor education and the natural landscape of the Southeast. She has a degree in journalism from the University of Tennessee at Knoxville, as well as a strong background in conservation and outdoor recreation.