Preterm Labor and Birth

9% of babies are born between the “age of viability” (about 26 weeks) and 37 weeks. These babies are born prematurely; before they are completely mature enough to function fully outside the mother.

Modern medicine in the U.S. has not been able to significantly reduce the rate of premature delivery below about 9%. However, modern medicine has done wonders to keep extremely premature infants alive, and to improve the long-term health of premature babies overall. However, although the success of health improvement for premature babies is a considerable achievement, the potential dangers of being born prematurely cannot be overemphasized. Of all the risks to your unborn child, premature delivery is one of the most significant.

There are great differences among the degrees of prematurity. A “26-weeker” and a “36-weeker” are usually very different in the symptoms of prematurity which they exhibit. A 26-week infant may have very severe lung immaturity, and be unable to oxygenate its body, while a 36-week infant may only have problems maintaining body temperature or problems with feeding.

Of all the complications of prematurity, lung maturity is often the most significant. After all, it is the ability to oxygenate the body that is the physiologic essence of life. The primary problem with prematurity is that a crucial substance, lung surfactant, is not produced by the fetus until late in pregnancy. Lung surfactant keeps the lungs from collapsing. The unborn fetus does not use its lungs. Oxygenated blood comes from the placenta and bypasses the fetal lungs. Not until that first breath of life are the lungs called upon to do their job. But when this happens there must be adequate surfactant to keep the lungs inflated and flexible.

In an intensive care unit, higher concentrations of oxygen (air is 21% oxygen) are often needed to keep the premature infant well oxygenated. However, too much oxygen can harm the retina of the eyes and can cause blindness. Science is making great inroads into the problem of lung surfactant. Already animal and synthetic lung surfactants are showing great promise in the treatment of lung immaturity.

Problems with premature infants may include more than just lung immaturity. The lungs are not the only body system which may be underdeveloped. The immune system, the body’s defense against germs, may be immature. If the premature newborn develops an infection from even a relatively harmless germ, the result can be “sepsis”. Sepsis is an infection involving the entire body, and can result in “shock”, a collapse of the cardiovascular system. Sometimes, the cause of premature labor is an infection in the mother or an infection transmitted from the mother to the baby. These babies can be born in a state of shock.

Premature infants are also sometimes unable to clot their blood effectively. Because of this, and possibly due to the fragility of the brain, the baby may develop intracranial bleeding. This is a hemorrhage into the tissue of the brain. Necrotizing fascitis, which can destroy lengths of the baby’s intestines, is another serious problem of prematurity.

Less serious problems of prematurity include a poor sucking reflex and temperature regulation. A baby with a poor suck may be unable to nurse from either a breast or a bottle. In this case, breastmilk or formula must be introduced through a feeding tube placed into the baby’s stomach. Temperature regulation may require that the baby stay in a heated bed or incubator, preventing the baby and mother from optimal early attachment and bonding.

Premature labor

Although the small, premature baby is a wonder to behold and even cute, prematurity has no redeeming qualities. The costs of prematurity can run into the hundreds of thousands of dollars and may involve permanent damage to the baby, including blindness, deafness, mental retardation and cerebral palsy. The impact and very real possibility of premature birth should motivate new parents to learn about the risk factors, the signs of premature labor, and what action to take should the mother show signs of labor.

If the woman who will ultimately deliver a premature baby can get to the hospital with enough time to allow some crucial steps to be taken, the chance of a good outcome may be significantly increased.

This point deserves repeating in other words: 24 to 48 hours of pre-delivery treatment, and giving birth in the correct hospital can significantly improve a premature baby’s chances of a normal life.

Did you get that?

It’s a very important thing for a pregnant woman to know………if you are going to have a premature baby, what-you-do and where-you-are in the previous 24 hours may affect your baby’s life more than anything else.

Here’s the scoop.

  • Steroids given to the mother before the birth may help a premature baby produce lung surfactant.
  • Level III Neonatal Intensive Care Units are THE PLACEs to give birth to an infant who is less than 34-35 weeks gestation.

So, if you are going to give birth to a premature baby, and you can get a dose or two of a common steroid drug 24-48hours before you deliver, your baby’s lungs may be better able to function properly once it is born. And, if you are in a hospital where a neonatalogist and neonatal nurses can care for the very special needs of your premature baby FROM THE FIRST BREATH, your baby will have a better chance of a normal life.

How do you know if you are in premature labor? It isn’t easy. Unfortunately, many of the signs of premature labor are common even in normal pregnancy. So, how will you know? You won’t. If you have any feeling that you may be in premature labor, call your doctor, midwife or hospital…..morning, noon, night, weekday, weekend or holiday. The only way to really know for sure is to go into the hospital and be examined.

Here are some of the symptoms associated with premature labor:

  • uterine contractions, more than 4 in a hour, that do not stop with rest and hydration
  • sudden increase in vaginal discharge, or a sudden watery discharge
  • pain in the lower abdomen, back or sides
  • a feeling of pressure in the pelvis or vagina
  • bleeding from the vagina
  • fever, body aches, and uterine contractions

What are the risks factors for giving birth prematurely? There are some, and maybe you should be aware of them. However, what is important to realize is that the major risk factor for premature delivery is pregnancy. Any pregnant woman is at risk of premature delivery and should consider herself so until she passes 37 weeks gestation. Here are the risk factors:

  • first pregnancy
  • previous premature delivery
  • multiple gestation (twins, triplets, etc…)
  • cigarette smoking
  • illegal drug use
  • low pre-pregnant weight
  • poor weight gain in pregnancy
  • age less than 18 or greater than 40
  • poor nutrition
  • poor socioeconomic status
  • strenuous, physical work
  • high stress
  • anemia
  • previous cervical surgery
  • urinary tract infection
  • sexually transmitted infection

Can one prevent premature birth? Look at the list above and see if there’s something there you could do something about. Do you smoke? Try to quit or cut down. Are you using cocaine or crank? Stop…..if you can’t, at least talk to your doctor or midwife about it. How is your nutrition? Are you gaining some weight? Are you severely “stressed out”, or is your job physically demanding? Talk to your doctor or midwife.