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.
Since anti-choicers always use the horrible aborted fetus pictures to twist the argument in their favor, why can't pro-choice develop a visual response?
I'm thinking a lifelike animated vagina, proudly standing in line at a voting booth?
Nothing terrifies anit-choicers more than the thought of an educated, free-thinking vagina!
I feel like there's a finer point here that's not being made--the difference between what's *morally* right and what's *legally* possible. Is it moral to terminate a viable fetus at such a late stage that it could be helped to live outside the womb? Should it be legal, if you have, for example, incredibly invasive lung cancer and need chemo right away?
There are plenty of morally questionable things that are perfectly legal, and plenty of morally impeccable things that are outside the law. I'd like to see some more discussion along these boundaries.
Personally, although I find late term abortions heartrending, and would be upset if someone *did* terminate a viable fetus "on a whim," I still think these options should be legal and open to all.
@sciencerules: actually I don't think the state has a right to make a moral judgement because once you start doing that you open the door to all kinds of madness.
2. Can we stop insisting that there are people out there terminating 'viable' fetuses late term. There are people out there terminating fetuses late term for a variety of health reasons concerning mother and unborn child. I've never heard of a single case where someone did it 'on a whim'
3. The argument about viable or not viable fetuses taken to its logical conclusion is really one for outlawing early abortion not late term abortion because it is those fetus which are aborted early which are most likely to be viable had they not be aborted.
4. Abortion is a personal decision and an moral qualms are between the woman involved and the father should she wish him to have a say.
@emilyanne: Right, that was my point. I used the example of late term non-medical abortions to illustrate my point, which is that although these procedures could be morally condemned I believe they ought to be legal.
1. late term abortions for conditions of the fetus that are incompatible with life are discovered late due to a lack of good prenatal care. making gold standard prenatal care available to all women would reveal the tragic cases earlier, and the decision to terminate, if that is the woman's choice, can be made earlier.
2. late term abortions for the sake of the mother's health may still be necessary
3. choice is a matter between a woman and her physician in all cases
@if_i_only_had_a_heart: Absolutely correct. I had a baby who died in utero, and had to have an induced delivery. She was found to have Turner's Syndrome, among other abnormalities. This was 30 years ago, and I was a young woman, so there was no chance that I would have had any testing done that would have alerted me to the problem. She died at 25 weeks, not a viable age back then anyway. I could not wish the experience on anyone, going through labor, knowing your child is already dead. Standardized testing for all pregnant women is a must to avoid this happening to anyone else. That is probably not going to happen in my lifetime. Oh, and anti-choice people would have wanted me to try to carry her as long as my body would have done, not to be induced to expel an already dead fetus. This was a planned pregnancy, and a very wanted baby, but had I known early on, I probably would have terminated, after studying Turner's and what it entails. Choice is between a woman and her God/ess, at the end of the day.
@ElviraGooch: I am so sorry you had to go through that. I can't imagine the pain and heartbreak. If it helps any now, my state does do standardized testing (although a mother can opt out) for most serious or deadly birth defects. They also offer state healthcare to COVER that testing to all pregnant women. So things have improved a little, although if this viability argument it used to ban abortions after the testing is done between 17-22 weeks, we're all SOL anyways.
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
10/05/09
10/04/09
10/04/09
10/04/09
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
10/04/09
10/04/09
10/04/09
10/04/09
10/04/09
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
10/04/09
10/04/09
SEVENTY.
What the holy fuck, right??
10/04/09
10/04/09
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
06/04/09
I'm thinking a lifelike animated vagina, proudly standing in line at a voting booth?
Nothing terrifies anit-choicers more than the thought of an educated, free-thinking vagina!
06/04/09
There are plenty of morally questionable things that are perfectly legal, and plenty of morally impeccable things that are outside the law. I'd like to see some more discussion along these boundaries.
Personally, although I find late term abortions heartrending, and would be upset if someone *did* terminate a viable fetus "on a whim," I still think these options should be legal and open to all.
06/04/09
2. Can we stop insisting that there are people out there terminating 'viable' fetuses late term. There are people out there terminating fetuses late term for a variety of health reasons concerning mother and unborn child. I've never heard of a single case where someone did it 'on a whim'
3. The argument about viable or not viable fetuses taken to its logical conclusion is really one for outlawing early abortion not late term abortion because it is those fetus which are aborted early which are most likely to be viable had they not be aborted.
4. Abortion is a personal decision and an moral qualms are between the woman involved and the father should she wish him to have a say.
06/04/09
06/04/09
06/04/09
06/04/09
1. late term abortions for conditions of the fetus that are incompatible with life are discovered late due to a lack of good prenatal care. making gold standard prenatal care available to all women would reveal the tragic cases earlier, and the decision to terminate, if that is the woman's choice, can be made earlier.
2. late term abortions for the sake of the mother's health may still be necessary
3. choice is a matter between a woman and her physician in all cases
06/04/09
06/04/09