Friday, April 17, 2009

The Dangers of Prematurity

I have really wrestled with what to write about from the Controversies in Childbirth Conference. We've been so busy around here lately, it's given me time to mull things over.

I will reference a talk given by Lucky Jain, MD, MBA from the Conference. I feel that the information he gave was so astounding, all should be made aware. Briefly, a short biography of Dr. Jain: He is currently the Richard W. Blumberg Professor and Executive Vice Chairman for the Department of Pediatrics at Emory University School of Medicine. He also serves as the Medical Director of the Emory Children's Center. In addition, he is an investigator at the Center for Cell and Molecular Signaling and holds a joint appointment in the Department of Physiology.

Obviously, a smart and well-educated fellow.

The information he gave was so well researched, clear, and concise, they let him go over on his time. He is the only individual that was allowed this privilege. I believe that if pregnant women had this information, they would make wiser decisions during pregnancy.

The topic Dr. Jain was speaking on was "Are C-sections Causing Premature Births and Adding to NICU Costs? I think we all know the answer to that question.

Babies are presumed to be "mature" at 34 weeks. He posed the question, is it safe to deliver a baby after this time? The answer is yes and no. 50% of babies born at 34 weeks will be in NICU. While we have decreased the rate of stillbirths in this country, prematurity has dramatically risen.

What are the long term effects of prematurity? Dr. Jain had a very distinct picture of a baby's brain at 35 weeks versus the brain at 40 weeks. There was a HUGE difference. The 40 week brain was significantly more developed.

Studies have found that 74% of handicapped adults were born between 33 and 37 weeks gestation. In addition, babies born before 37 weeks are five times more likely to be in special education by the time they are in kindergarten through fifth grade.

While the baby's body looks fairly well developed in the last trimester, this is the time when the brain is developing. Cholesterol, yes, you heard me right, and good foods, including proteins, are essential in the baby's brain growing and developing. Each week, day, even hour, that a baby stays in the womb is invaluable.

Another interesting item Dr. Jain addressed was Fetal Lung Fluid. I must admit, this was the first time I've heard of this. I took comfort in seeing that most of the other people in attendance didn't seem to know much about it either! According to Dr. Jain, fetal lung fluid is produced to inflate the lungs and pours out into the amniotic fluid. This is how the lungs are checked for maturity during pregnancy by checking the amniotic fluid. When labor is allowed to start on its own (no induction!), the valve that releases this fluid is shut off. The fetal lung fluid levels gradually decrease over the course of days leading up to labor. It really is true that the baby triggers labor. If a C-section is done without the onset of labor, the baby does not receive this message. This is a contributing factor to C-section babies having a more difficult time breathing. According to Dr. Jain, a C-section should NEVER be scheduled to take place before 39 weeks and it is crucial that the dates are correct. He felt strongly that it should be later than that, if done at all. The average in the US is 38.2 weeks, however. Remember, the average means that there are many babies being born on the lower end of that number. According to United Healthcare, if a baby is born before 38 weeks, he is twice as likely to be admitted in the NICU.

I hope you will ponder this information and share it with your friends and family who might be pregnant. The womb really is the best place to grow a baby -- not an incubator in the NICU.


April said...

After having my first 2 children prematurely, I feel very strongly about this subject. In both of these births, my water broke and labor began on it's own relatively soon after. The horror of having your child in the NICU is something that no parent should have to endure. It is an emotional roller coaster that doesn't slow down. I feel that all pregnant women should be given a tour of the NICU, so they can see what they would be up against. There is nothing that can prepare you. It is a hidden world that no one tends to speak of. The pain of having to leave the hospital without your child cannot be expressed in words.
When pregnant with my 3rd child, I often heard people say how great it would be if I could have her as early as the other 2. This made me so angry! My greatest desire, during that time, was to carry my child full term. I did NOT consider myself "lucky" to have had my babies early.
I have seen babies in the NICU who were born at 37 weeks, considered full-term to most, who were not doing well, at all. These babies were struggling to survive.
I truly cannot understand why someone would willingly go into that situation just because they were tired of being pregnant. I'm sure that most women have no idea what could happen to their child. They are not given all of the information, before making the decision to have an elective c-section.
The real tragedy here is that the doctors know exactly what the risks are, but they don’t seem to care. I have had an ob tell me that “we shouldn’t worry about doing anything differently in my pregnancies to try and avoid another preterm delivery. My babies turned out ok - right?” How sad is that?

J-Momma said...

Donna, I'm so grateful for your blog. Checking in from time to time really reaffirms my convictions for the birth of baby #2. Peoria, IL is not the most natural birth friendly place, so I forsee some bumps along the road but Corey and I are both willing to fight for what's best for our child! Thank you thank you!!!
Jen Daniels

Anonymous said...

I came across you blog and noticed you had an entry on Premature infants. This is a subject that is very important to me. My oldest son now 8 was born 13 wks early. One thing you forgot to mention was how these doctors in the NICU save these dear sweet babies lives everyday. Without the NICU there would be many more babies dead. The NICU is not a fun place I know my son spent more than three months in there fighting for his life. Now he is a very happy 8 year old and we are looking forward to his baptism. I don't think we should classify all the babies in the NICU as patients because their moms were sick of being pregnant. Sometimes it is better I think it is nieve to classify all babies in there into one pot. And sometimes no matter how much we want to keep our children inside where it is safe, it does not turn out this way.
I am sorry to be a downer but this is not the first blog I have read where someone is dogging the Hard work the doctors and nurses do to keep children alive. I will always be grateful for the many hours the doctors and nurses worked on behalf of our son. And yes it was hard seeing our son with machines and lines keeping him alive. But the time in the NICU is short as compared to the rest of his wonderful life.

Donna Ryan said...

I just reread this post I wrote more than a year ago, and I must say, I don't think I was down on NICU doctors and nurses at all. I'm not sure what you read to interpret that (incorrect) message.

Obviously, sometimes babies come when we'd rather them not -as annonymous's case - but we have way too many people in this country who believe that 36 weeks is a perfectly safe time to have a baby. Prematurity is a problem in the US. Babies struggle and even die. I didn't even mention the NICU docs and nurses. Feeling confused and perhaps even a bit defensive.

Krista Eger said...

I love your posts seriously! I want to be a child birth educator so bad and you're just making me want to do it more!
My best friend is a student midwife (she caught my baby actually) and she had her baby 2 months ago at 28 weeks (a month after my daughter was born sadly) and she found out that most of the NICU nurses were against this issue as well! Because they are the ones that have to take care of the babies that were born too early! If I was a nurse at all I'd be a NICU nurse!
Also, I'm glad both my babies told me when their birthday was. I wanted my daughter to be born 10/10/10, but I just really love October 18th. I don't know why, it just fits her well.