Reducing Pre-Term Births: Bless Neonatal Nurses, Nurse Practitioners and Neonatologists!

Caring for micro-preemies and their parents must be among the most stressful areas of medicine. I got a taste of this as a pediatric resident and when practicing general pediatrics in a small hospital, and I still wake troubled with memories of the NICU to this day. Over the years much has been done to improve the outcome for infants born prior to term, but premature birth remains a major cause of death and disability in infants, and accounts for over 85% of all perinatal morbidity and mortality — second only to birth defects.

A premature birth is defined as when a baby is born before 37 weeks gestation. This amounts to approximately one in every ten newborns, or 10%. Because the baby grows and develops throughout the term of the  pregnancy, any degree of prematurity may be associated with developmental problems, but chance of complications increases as the weeks of gestation decreases. In infants born at 24 weeks gestation the mortality rate is 50%, with a 20-50% chance of disability in the survivors. Clearly the longer that the infant remains in the mother’s womb, the less risk for the myriad complications of prematurity.

What Can Pre-Natal Moms Do to Avoid Premature Births?

Although many causes of prematurity are beyond our control, there are many things that a woman can do to help prevent premature births.

• Early Prenatal Care: A key factor is to start prenatal care early.  A good time to call for an appointment is as soon as you have a positive pregnancy test. This will assure that you get an appointment between 8-10 weeks after your last menstrual period. Certainly, if you have heart or kidney disease or another chronic medical condition, you might want to let your primary care physician know that you are pregnant and be seen by your obstetrician sooner.
• Eliminate Smoking: Of the risk factors causing prematurity that are controllable, smoking is the most important. Smokers have a 40% higher risk of delivering prematurely and the more you smoke, the higher the risk.
• DON’T DO DRUGS!: Women who use alcohol and street drugs, especially cocaine, have a profound effect on pregnancy. As many as 27% of cocaine using women deliver prematurely.
• Hormone Therapy: If you have had a previous premature birth, ask your doctor about 17 Hydroxyprogesterone (17-OHP). This is a hormone that may delay the onset of labor in women who have previously delivered prematurely.
• Avoid Elective C-Sections: A preventable cause of prematurity is scheduling a cesarean section for non-medical reasons. As a father of six and grandfather of nine, I recall the times that my wife and daughters have, as their 40 weeks dragged on, wished for delivery to come soon. Unfortunately, due dates may of off by as much as 2 weeks, so an elective C-section done at 38 weeks can run the risk of actually being at 36, resulting in a premature infant. Elective c-sections should never be done prior to 39 weeks.

Yes, the medical professionals who take care of premature infants are special people, treating very special patients.  Both need all of the help and support they can get – and by creating self-awareness and an empowered patient population that has the confidence in actively engaging in in their own self-care,  we can do just that.