I had my son at 35 weeks (after being put on bed rest at 32 weeks because I was having Braxton Hicks contractions). I have awesome health insurance, was eating right, exercising, seeing the doctor, etc. I was baffled as to why I gave birth early. When I asked my doctor he said it could be any number of things. Needless to say it wasn't the definitive answer I was looking for.
The only reasons I could think of were work stress and the fact that I'm over 30. I guess with the next pregnancy I'm just going to take it super easy.
Oh, and, be happy we're in America. Viability is defined as about 22 weeks here. In Europe and Asia, it's several weeks more than that. Maybe the fact that we have a lower threshold at keeping babies alive has some influence on the prematurity rate. Not sure if that's taken into account.
@DoctorJezebel: It's not that euro docs are incompetent, they just have the option to think about ACTUAL viability and not keeping all kids alive at all costs (quality of life? What?)
@Kali Mama: Agreed. A 23 weeker who is very likely to develop retinopathies, brain bleeds, etc. causing CP-- you'll see them in the fancy wheelchairs moving vaguely spastically. It's sad, and traceable to this insult. I think the '22 week' thing demonstrates the fact that we can do something for kids that age. Now at what point do we go up and say "we can build a NICU for infants 27 weeks+" and exclude anyone younger. It's hard to set criteria for 'actual' viability, but I totally agree with your point.
I'm not sure that I understand Neergaard's statement that "different factors fuel prematurity in rich countries and poor ones." That's followed in the AP article with a discussion of the superior medical technology in places like the US. Premature infants have better chances of survival in rich countries, but that has nothing to do with women giving birth prematurely in the first place. I know that they don't understand the causes as well as they'd like, but it seems pretty clear that poor women without access to adequate medical care, regardless of whether they live in a rich or poor country, are at a higher risk of giving birth prematurely. So, um, how about some freaking healthcare reform already?
@theKP: The implication is that some of the factors that contribute to premature births in rich countries (older mothers and multiple births, both ostensibly due to access to fertility treatments) are not issues in poorer countries. Because we in the US also have shitty access to healthcare, we share lack of prenatal care as a contributing factor with poorer countries.
@theKP: There are many women who are not poor who also have an increased risk of premature births. African American women have an increased risk of premature births regardless of income level.
@yvanehtnioj: Thanks, that helps me understand what she was talking about. My first thought was to wonder whether enough people were using fertility treatments for it to account for the high rate of premature births in the US, but now that I think about it, I know quite a few people who have used IVF to have children. It's really freaking expensive, so as much as the cost would seem prohibitive, people are willing to find ways to pay for it. So maybe it really is prevalent enough to account for a statistically significant number preemies in the US.
@Lymed: Yes, that's an important point, and I can see that I was overgeneralizing. Not all premature births are the result of inadequate neonatal care; they can happen even with the best of doctors and monitoring. The list of risks also include women having children closer than two years together, which isn't related to income level (although I guess it could be if the women are getting pregnant due to lack of affordable birth control). But I do wonder whether the statistic about African American women is unrelated to class. The article didn't say whether they had investigated whether the higher rate in African American communities had any correlation to income level (At least I don't see that, but maybe I missed it?). I wish I could figure out if they checked whether the rate of premature births among African American women was higher than white women of their same class level, or if the higher rate of premature birth among African Americans is the result of the disproportionate number of African Americans who are below the poverty line. (I know the "African Americans are more likely to be below the poverty line" generalization gets thrown around a lot, but if my college sociology classes drilled anything into me, it's that class and race are interrelated in this country.) Not getting prenatal care can obviously be the result of a lot of things, not just poverty, but pregnant women without health insurance are a lot less likely to get it.
@curiousgeorgiana: I would if I had a time machine and could go back in time to your infancy, and also if biting premature babies wasn't so socially unacceptable.
My twins were born at 28 weeks and we did kangaroo care every day that they were in the hospital (one for 6 weeks, the other for 7)... we would sit in the NICU's LazyBoy recliners and hold the babies on our bare chests. I loved it and would suggest it for all new parents, not just preemies.
BTW - mine were early because of HELLP syndrome. It sucked.
@Theacracy: Mine was on time, but we both had a difficult experience. We did kangaroo care while in NICU also and I found it to be an amazing experience. My baby's dad felt like it really helped bond them, and I agree; not everyone is able to have that breastfeeding thing, and I think the kangaroo cuddle is just as good! :)
So, at first I was like--wouldn't 36 weeks (9 x 4 = 36) be 9 months? Then I remembered to add the extra days for non-February months, which is about two and a half. So that means that 38-39 weeks is "normal," except that from what I understand (by people who are part of the natural birth movement, and are thusly biased) the 9 months timeline was basically what some guy in the 19th century decided was a normal timeline of pregnancy, and it makes a number of assumptions about women's bodies that aren't really accurate (like the 28 day cycle). And some people take 41 weeks (my mom with my brother) and some babies are like "get me outta here." So wouldn't the term "premature" need to be decided on a case by case basis? Because what was healthy as hell for me would have been premature for my brother (who was born bright blue like an alien with a whole in his heart, which has never healed and that's why he's a republican).
So is this study determining what constitutes premature by looking at things like health and birthweight, or is it just that all babies born before 37 weeks are preemies, even if they're healthy? Is there such thing as a healthy baby born before 37 weeks? Or is it a study of babies who could have used the extra week or five in utero to finish getting pudgy?
@Cimorene: Pregnancy and timing are really weird, but I think it might be more accurate to say that they're talking about babies born before they're developmentally ready.
@Cimorene: There are other problems related to premature birth besides low birth weight. Respiratory problems, multiple kinds of organ system problems, jaundice, anemia, you name it.
While I can see your point about the cutoff for premature birth potentially being arbitrary, it really isn't. 34-36 weeks is considered "late pre-term," and that accounts for most premature births. Fewer than 31 or 32 weeks means a baby will have serious problems.
There are hallmarks of development for fetuses just like there are for children, and that's where these timelines come in.
Now, the issue I think you're kind of getting at is that it's sometimes hard to pinpoint the conception date, so maybe we're just off by a week and that 36-week "preemie" is really a 38-week full gestation baby or something.
@Cimorene: My mother was encouraged to have a c-section with me but after I was born, the doctors conceded that I wasn't actually overdue (i.e. I just took a little longer to reach the right size.) My mother was glad she refused to have one.
@katekate is squared: Just want to poke my head in here and say that earlier than 31 or 32 weeks doesn't always mean serious problems. My nephews were born at 29 weeks and 30 weeks and they had no serious problems. They are 5 and 8 years old now with no consequences from their early births. Lucky, I know-- but it's important to note that under 32 weeks is not necessarily a tragedy.
I was a preemie-- 27 weeks (Mom has Type 1 diabetes). Mom was in labor for 36 hours. I was breech and in a really bad position making an emergency c-section impossible; all this complicated by the fact that my mother was struggling not to give birth, afraid that I wouldn't survive. They were afraid I wouldn't have lungs, but once I finally emerged, I let out a weak cry and my Mom promptly fainted.
I have no major health problems as a result of the amazing preemie care I received. I was in the hospital for 4 months before my parents got to take me home. I can't imagine what challenges there are for premature babies born in areas where hospitals are not close or not even available.
Every single one of my sister-in-law's pregnancies have been early.
The last one by a full six weeks. And yes, a lot of this has to do with shitty prenatal care. She goes to the doctor like she's supposed to, but the doctor's don't really seem to care.
I do not have children, but three of my good friends and my sister have had babies in the last 18 months, and one is due in 2 weeks. In every. single. instance. their doctors tried to schedule an elective c-section or set the date of the induction before 37 weeks. Only one woman (due in 2 weeks) fought back hard enough to be allowed (!!) to wait for labor to come naturally. Is this a common occurrence? I'm pretty much flabbergasted by it.
@southwer: Yes, that is a huge problem. I was wondering how many of those births were "elective"/strongly recommended C-sections for the doctor's convenience.
Have you read the book Pushed? You'd probably find it useful and interesting. It's all about the C-section rate in the US and history behind that movement.
@southwer: None of them even wanted it, and the one who fought back only got her doctor to listen when she told him, "You have to stop speaking to me like I am an idiot. I do want to hear your opinion, but this decision is mine to make." His arguments for elective c-section included making sure he was at work that day and NOT ENDING UP WITH A GIANT VAGINA. What kind of obstetrician?!
@yvanehtnioj: It is mind-boggling, but true. A lot of OB/GYNs seem unwilling to believe that women are capable (and some of us are even GOOD at) giving birth without help. I'm not crunchy enough to believe that everyone should give birth without drugs, blah blah blah. But the average (read: NOT induced) first pregnancy goes 41 weeks 1 day. And that's strictly going by the "You can only ovulate on day 14" bullshit. Ugh, I could rant on this forever!
@SharonTaint: Yes, WTF. Do they really think that seven in ten pregnancies is "abnormal?" That's what a C-section is for! There goes the arrogance of biomedicine again. I'm the doctor and I know what's best for you. Listen to me, then listen to your body.
@spamanda: It's not about the woman's capability. It is about the doctor's convenience. The more planned C-sections, the fewer women going into labor at times that are inconvenient for the doctor. Doctors also feel they have more control over a C-section, therefore reducing the chances of births going wrong and resulting in malpractice suits.
I also wouldn't be surprised if it has something to do with the number of ob/gyns dropping the ob part of their practice. Perhaps fewer doctors delivering babies mean those that do feel a need to schedule the births.
@Lymed: The doctor who delivered my second son is a very good friend of mine. She's family practice. It's amazing how few "normal" births they see during residency. OBGYNs are surgeons -- most of them LIKE doing surgery. We are a country of malpractice suits. If something goes "wrong" during birth, doing a cesarean is considered doing everything possible to save the baby and the mom.
It's crazy, but a lot of doctors really DON'T think we are capable of delivering babies. My friend had a cesarean with her first and it was only when she was pregnant with #2 that she learned WHY (and a total bullshit reason involving an induction with pitocin and then a bad midwife). Her first doctor told her she wouldn't be able to deliver vaginally. Her new midwife helped her have a succesful VBAC -- with no pain meds.
The thing I resent about this sort of attitude is that it presents this fairly modern attitude towards/understanding of motherhood as a universal truth, as though it transcends time, geography and culture. Which...it doesn't.
Before the invention and ready availability of modern science/medicine, the infant (and mother!) mortality rate was much higher and women had WAY more kids (200 years ago it was common for women to give birth to A DOZEN children within her lifetime, many of which would not survive to adulthood). Children were a practicality, they assisted in the running of the household and the family business. There was no birth control, no choice over when to get pregnant. It just happened as a natural course of a sexually active adult life. They weren't precious little miracles to be doted endlessly upon. In fact, childhood as we understand and practice it was invented during the Victorian Era.
I'm not saying that there isn't a strong emotional bond between mother (or even father!) and child, but Roiphe and her camp need to realize that they are operating under very specific cultural circumstances that allow this connection. If you had this sort of bond with 12 children and had to watch 9 of them die before the age 10, you would go insane with grief. Modernity plays a huge role in this supposedly transcendental bond.
@KATE!: I remember reading a book once that said back in the olden days women were actually DISCOURAGED from growing attached to their babies until they were at least 2 or so just to prevent them the heartache of high infant mortality.
@KATE!: HOLY GOD THANK YOU. You summed this up perfectly.
It's wonderful that mothers today, in many parts of the world, have the opportunity and means to deeply bond with a newborn infant, dote upon them, and feel as intoxicated as they do. But it isn't some timeless thing - it's a tradition that has a short history and is pretty much rooted in wealth.
Things change - motherhood is not the same for all people right now, and it won't be in the future, either.
You shouldn't have to choose between parenting and achieving. But I know that if I DID have to choose, for whatever reason (and I don't have kids yet) I would choose parenting. One day you'll be gone, and I'd rather be remembered for my awesome kids than any work of programming brilliance, literature or legal accomplishment.
I do think feminism puts too much emphasis on work. Work is just not that important. Your company won't remember the job that you think is so crucial this week, that you're killing yourself over. It all filters into a bunch of numbers on a financial spreadsheet eventually. (Doctors exempted.) Even if that's not the case, you have to be seriously vain to think there aren't others who could do your job.
Family trumps all for me. Of course, those of you who disagree are perfectly entitled, I just don't get you.
@Agumen:
"One day you'll be gone, and I'd rather be remembered for my awesome kids than any work of programming brilliance, literature or legal accomplishment."
So we are supposed to believe our own existence is meaningless, because, really, we're so humble, and selfless, and could not possibly think our literary our humanitarian accomplishments were meaningful.
But are you what your parents (okay, mother, let's be real), should be remembered for? Do you in some way legitimate her existence in a way she couldn't have done for herself?
You say that you want to be remembered for your kids. What if your kid, in all seriousness, becomes a murderer or a rapist? What if your kids hates you, or you don't have a great relationship with him? What if your kid is a vain, cruel person?
I just don't get why it seems better to you to be remembered for your kids, than for yourself. Chelsea Clinton turned out to be a great kid, but I see nothing wrong with remembering Hillary Clinton for herself, and not because she procreated.
And ya know what? You say anyone can do my job? That's probably not true, but I'm sure the percentage of women who can get pregnant and raise a kid is just as high as the number of people who can do my job.
And feminism isn't all about work, btw...but that is a whole different lecture.
I may have kids someday, but it'll be because we want a family, and not because I think having kids validates my existence.
@Agumen: I don't even like working; in fact, a good deal of the time I hate the meaninglessness of a lot of what I do at work, and I do believe that lots of other people could step in and do it. I do, however, need to make a living and do believe that the ability to be economically independent is crucial to every adult. If I could accomplish economic independence through a trust fund, I would, but I don't have that option. The small subset of women who get to parent full-time, and who love it and are completely fulfilled by it, and who are treated well by their husbands and respected and financially supported and never abandoned... well, bully for them. But that's not going to be the reality for most women, so I resent stories that gloss over those facts.
@Agumen: I don't work to be remembered. I work to make a difference for someone else. I'm a conservationist. I want to make the world a safer, longer-lasting place for all living beings, your children included.
I consider my work to be one of the most important things in my life. I love it. I don't care that I won't be remembered. I am making small changes that might help others, and that is all that matters to me. That the trees I plant and take care of will grow, that the plans I help to make will pull rural farmers up from poverty and help them to make better lives.
Not all jobs are shitty office jobs, and not all shitty office jobs are meaningless. Without these people, we would have very, very different lives. Management is a huge deal. I don't think it's that "no one else can do [your] job", it's that people want to do something that makes them happy. By the way, other people can parent your kid.
Here, sitting in the garden, looking at the eyelashes, would you trade the baby for the possibility of writing The House of Mirth?
Oh, Katie Roiphe. You only say that because you know you aren't fit to carry Edith Wharton's smelling salts.
Seriously, this is the woman who dismissed statistics about sexual violence because it didn't fit into her Ivy League, 25-year-old experience of the world. Are we really shocked that she would be myopic and hyper-judgmental when it comes to motherhood?
Please, I can only hope her child is so entrancing that she never puts pen to paper again, and spares the rest of us from her reactionary gibberish.
But what bugged me about Roiphe's assertion that "you" would choose a baby over The House of Mirth is its combination of exceptionalism and universalism. It implies both that motherhood is totally unique — no intellectual endeavor can compare to it — and yet somehow the same for everyone.
The other thing that bugs me about this: the idea that you have to choose one or the other. Just because Wharton didn't have both a baby and an acclaimed novel doesn't mean she couldn't.
@egg cream is here, is second tier, get used to it: For reals. And besides, her assertion doesn't take social differences into consideration. Back then, a woman got married and had babies and that was her life. It's not exactly shocking to see that many high-achieving women opted against taking the Mommy Route. Now, things are a bit more flexible. A woman can have kids and a creative career if she's got a partner who is willing to shoulder his or her part of the load.
But then that would require nuanced thinking, and we know that is a skill Ms. Roiphe has not been particularly gifted with.
10/04/09
The only reasons I could think of were work stress and the fact that I'm over 30. I guess with the next pregnancy I'm just going to take it super easy.
10/04/09
10/05/09
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10/04/09
@Lymed: Yes, that's an important point, and I can see that I was overgeneralizing. Not all premature births are the result of inadequate neonatal care; they can happen even with the best of doctors and monitoring. The list of risks also include women having children closer than two years together, which isn't related to income level (although I guess it could be if the women are getting pregnant due to lack of affordable birth control). But I do wonder whether the statistic about African American women is unrelated to class. The article didn't say whether they had investigated whether the higher rate in African American communities had any correlation to income level (At least I don't see that, but maybe I missed it?). I wish I could figure out if they checked whether the rate of premature births among African American women was higher than white women of their same class level, or if the higher rate of premature birth among African Americans is the result of the disproportionate number of African Americans who are below the poverty line. (I know the "African Americans are more likely to be below the poverty line" generalization gets thrown around a lot, but if my college sociology classes drilled anything into me, it's that class and race are interrelated in this country.) Not getting prenatal care can obviously be the result of a lot of things, not just poverty, but pregnant women without health insurance are a lot less likely to get it.
10/04/09
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10/04/09
10/04/09
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10/04/09
BTW - mine were early because of HELLP syndrome. It sucked.
10/04/09
10/04/09
So is this study determining what constitutes premature by looking at things like health and birthweight, or is it just that all babies born before 37 weeks are preemies, even if they're healthy? Is there such thing as a healthy baby born before 37 weeks? Or is it a study of babies who could have used the extra week or five in utero to finish getting pudgy?
10/04/09
10/04/09
While I can see your point about the cutoff for premature birth potentially being arbitrary, it really isn't. 34-36 weeks is considered "late pre-term," and that accounts for most premature births. Fewer than 31 or 32 weeks means a baby will have serious problems.
There are hallmarks of development for fetuses just like there are for children, and that's where these timelines come in.
Now, the issue I think you're kind of getting at is that it's sometimes hard to pinpoint the conception date, so maybe we're just off by a week and that 36-week "preemie" is really a 38-week full gestation baby or something.
10/04/09
10/04/09
10/04/09
10/04/09
Seriously though, it still shocks me that this is as much of a problem. Is it maybe because it's not totally clear why it happens?
10/05/09
10/04/09
I have no major health problems as a result of the amazing preemie care I received. I was in the hospital for 4 months before my parents got to take me home. I can't imagine what challenges there are for premature babies born in areas where hospitals are not close or not even available.
10/04/09
The last one by a full six weeks. And yes, a lot of this has to do with shitty prenatal care. She goes to the doctor like she's supposed to, but the doctor's don't really seem to care.
10/04/09
10/04/09
10/04/09
Have you read the book Pushed? You'd probably find it useful and interesting. It's all about the C-section rate in the US and history behind that movement.
10/04/09
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10/04/09
SEVENTY.
What the holy fuck, right??
10/04/09
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10/04/09
I also wouldn't be surprised if it has something to do with the number of ob/gyns dropping the ob part of their practice. Perhaps fewer doctors delivering babies mean those that do feel a need to schedule the births.
10/04/09
It's crazy, but a lot of doctors really DON'T think we are capable of delivering babies. My friend had a cesarean with her first and it was only when she was pregnant with #2 that she learned WHY (and a total bullshit reason involving an induction with pitocin and then a bad midwife). Her first doctor told her she wouldn't be able to deliver vaginally. Her new midwife helped her have a succesful VBAC -- with no pain meds.
10/04/09
08/28/09
Before the invention and ready availability of modern science/medicine, the infant (and mother!) mortality rate was much higher and women had WAY more kids (200 years ago it was common for women to give birth to A DOZEN children within her lifetime, many of which would not survive to adulthood). Children were a practicality, they assisted in the running of the household and the family business. There was no birth control, no choice over when to get pregnant. It just happened as a natural course of a sexually active adult life. They weren't precious little miracles to be doted endlessly upon. In fact, childhood as we understand and practice it was invented during the Victorian Era.
I'm not saying that there isn't a strong emotional bond between mother (or even father!) and child, but Roiphe and her camp need to realize that they are operating under very specific cultural circumstances that allow this connection. If you had this sort of bond with 12 children and had to watch 9 of them die before the age 10, you would go insane with grief. Modernity plays a huge role in this supposedly transcendental bond.
08/28/09
08/28/09
It's wonderful that mothers today, in many parts of the world, have the opportunity and means to deeply bond with a newborn infant, dote upon them, and feel as intoxicated as they do. But it isn't some timeless thing - it's a tradition that has a short history and is pretty much rooted in wealth.
Things change - motherhood is not the same for all people right now, and it won't be in the future, either.
08/27/09
I do think feminism puts too much emphasis on work. Work is just not that important. Your company won't remember the job that you think is so crucial this week, that you're killing yourself over. It all filters into a bunch of numbers on a financial spreadsheet eventually. (Doctors exempted.) Even if that's not the case, you have to be seriously vain to think there aren't others who could do your job.
Family trumps all for me. Of course, those of you who disagree are perfectly entitled, I just don't get you.
08/27/09
"One day you'll be gone, and I'd rather be remembered for my awesome kids than any work of programming brilliance, literature or legal accomplishment."
So we are supposed to believe our own existence is meaningless, because, really, we're so humble, and selfless, and could not possibly think our literary our humanitarian accomplishments were meaningful.
But are you what your parents (okay, mother, let's be real), should be remembered for? Do you in some way legitimate her existence in a way she couldn't have done for herself?
You say that you want to be remembered for your kids. What if your kid, in all seriousness, becomes a murderer or a rapist? What if your kids hates you, or you don't have a great relationship with him? What if your kid is a vain, cruel person?
I just don't get why it seems better to you to be remembered for your kids, than for yourself. Chelsea Clinton turned out to be a great kid, but I see nothing wrong with remembering Hillary Clinton for herself, and not because she procreated.
And ya know what? You say anyone can do my job? That's probably not true, but I'm sure the percentage of women who can get pregnant and raise a kid is just as high as the number of people who can do my job.
And feminism isn't all about work, btw...but that is a whole different lecture.
I may have kids someday, but it'll be because we want a family, and not because I think having kids validates my existence.
08/28/09
08/28/09
I consider my work to be one of the most important things in my life. I love it. I don't care that I won't be remembered. I am making small changes that might help others, and that is all that matters to me. That the trees I plant and take care of will grow, that the plans I help to make will pull rural farmers up from poverty and help them to make better lives.
Not all jobs are shitty office jobs, and not all shitty office jobs are meaningless. Without these people, we would have very, very different lives. Management is a huge deal. I don't think it's that "no one else can do [your] job", it's that people want to do something that makes them happy. By the way, other people can parent your kid.
08/27/09
Oh, Katie Roiphe. You only say that because you know you aren't fit to carry Edith Wharton's smelling salts.
Seriously, this is the woman who dismissed statistics about sexual violence because it didn't fit into her Ivy League, 25-year-old experience of the world. Are we really shocked that she would be myopic and hyper-judgmental when it comes to motherhood?
Please, I can only hope her child is so entrancing that she never puts pen to paper again, and spares the rest of us from her reactionary gibberish.
08/27/09
The other thing that bugs me about this: the idea that you have to choose one or the other. Just because Wharton didn't have both a baby and an acclaimed novel doesn't mean she couldn't.
08/27/09
But then that would require nuanced thinking, and we know that is a skill Ms. Roiphe has not been particularly gifted with.