When the March of Dimes released its annual report card on the frequency and causes of premature births in November, Kentucky got an ‘F’. The country as whole got a ‘D’. It cited factors such as smoking during pregnancy and a lack of prenatal care, but as WFPL’s Stephanie Crosby reports, something else has been influencing the data recently.
A number of medical conditions can cause a woman to go into labor before she’s carried a baby a full forty weeks. But the thing doctors have been noticing over the last several months is more women asking to go into labor early.
“Can’t you get this over? I’m just so uncomfortable. My back hurts, my legs hurt, etc. etc. etc.,” says Dr. Jeffery King, professor of obstetrics and gynecology at the University of Louisville and Director of Maternal Fetal Medicine there.
He’s seen it in his own practice. He says many doctors can feel pressured to comply.
“Physicians don’t want to lose their patient, because they don’t cede to their desires, so it puts the physician and patient in conflict many times,” says King. “Because the patient does have other options. If you won’t induce me or deliver me, maybe the guy down the street will.”
Chris Summerfield has worked with her share of expectant moms as an RN and now as the women’s health community education coordinator at Baptist Hospital East. She says while there are some women who simply grow tired of pregnancy, there are others who want inductions as a matter of convenience, especially working mothers who want to plan their maternity leaves.
“Folks want to schedule things,” she says, “They want to pull out their Blackberry and they want to schedule, and mother nature may not always want us to do that.”
Summerfield says those babies may not be ready for life outside mom’s womb, even if they look robust and healthy on an ultrasound.
“At 35 weeks, that baby’s brain is only two-thirds developed, important things have to happen in that last month,” says Summerfield. “The biggest transfer of antibodies from mom to baby happens in that last month.”
It doesn’t stop there. Pulmonary infection, temperature instability, jaundice, hypoglycemia, and long-term behavioral problems are more likely for what doctors are now calling late, pre-term babies, infants born between 35 and 40 weeks.
The American College of Obstetrics and Gynecology has recommended for the past ten years that doctors and hospitals refuse elective labor and delivery before the 39th week of pregnancy, for these very reasons. But Dr. Ruth Shepherd with the Kentucky Cabinet for Health and Human Services says a growing number of doctors are ignoring those guidelines.
“Well, I think what happens is that doctors, and in fact the general public, have a little bit of a sense of complacency about these babies because the babies that are just a few weeks early mostly survive,” she says.
Shepherd is the Division Director for Maternal and Child Health. She says that complacency is the result of medical advances over the past few decades, and doctors and patients alike are starting to take advantage of it, even when it isn’t in the best interest of the child.
“Even babies just a few weeks early do have significantly more problems both at birth and in the long run than babies that have been born at term, and that’s information that has not been widely disseminated until the last couple of years,” says Shepherd.
So agencies like the March of Dimes and the health cabinet are now urging doctors and hospitals to go back to their recommendation to not even consider an elective pre-term labor and delivery until week 39 of gestation. At Baptist East, they’ve added material explaining why in their pre-natal classes.
But advocates say there’s still a lot of work to do. A study last year by the New England Journal of Medicine found that in some hospitals, as many as a third of all elective pre-term deliveries were done before the 39th week of pregnancy.