Preventing Pre-Term Births

At Sinai Hospital, we have a Level IIIB neonatal intensive care unit (NICU) – one of the highest levels of care for premature babies available. However, we hope that our NICU will be used less and less.

That’s because we’d like to see more and more babies born at full term, at 39 weeks gestation or more. Currently, about 1 in 8 babies is born premature. November is the March of Dimes’ National Prematurity Awareness Month, meant to educate potential moms about the dangers babies face by being born too soon and what pregnant women can do to increase their chances of carrying to full term.

With the recent rise of elective deliveries either by scheduled induction or c-section, the average baby’s gestational age was dropping and more and more babies were being born between 37 and 39 weeks – which is still considered early term.

Stephen Contag, M.D., perinatologist and attending physician at Sinai’s Institute of Maternal-Fetal Medicine, says that the costs for caring for babies born in this time period were outstripping the costs for babies born prior to 37 weeks. Over the past two or three years, hospitals have recognized the problem and have adjusted their policies accordingly.

At the BirthPlace at Sinai, “[n]obody can do elective deliveries prior to 39 weeks,” says Dr. Contag. That’s the case even if it can be shown that a baby’s lungs are fully developed. Dr. Contag explains that the full time in the uterus is beneficial to babies for other reasons and they are not to be delivered early “unless there’s a clear medical indication.”

Other than artificial means, the two reasons for premature births are pre-term labor (about 2/3 of the time) and premature rupturing of membranes, i.e., early water breaking (about 1/3 of the time). While it’s not easy to predict which moms will have a pre-term birth, having already had a baby born prematurely is a risk factor. In some cases, pregnant women are given a weekly progesterone shot between 16 and 36 weeks to prevent pre-term labor.

For those women who seem to be in the throes of pre-term labor, Dr. Contag says that they are thoroughly evaluated when they come to the hospital. If they are indeed in labor, steroid injections can prepare the fetus for life outside the uterus and reduce the risk for complications of the lungs, eyes, brain and intestines. For premies born at 24 to 34 weeks, there is new evidence that magnesium sulfate can reduce the risk of cerebal palsy.

Dr. Contag stresses that in cases of pre-term labor, it’s important that a mother be at a birthing facility that has a NICU prepared to handle the gestational age of the fetus. Sinai’s Level IIIB NICU can treat babies born as early as 24 weeks after conception, or as soon as a fetus is viable.

While sometimes there’s nothing that can be done to prevent a baby from being born early, there are some steps moms-to-be can take to increase their chances of carrying their babies to full term:

  1. Seek out and get quality prenatal care. Keep your prenatal appointments, and get all the tests done that your OB-GYN prescribes. Because genital herpes is a risk factor for preterm labor, tell your health care provider if you have it or think you could.
  2. Take a daily prenatal vitamin and a folic acid supplement; they could help lower the risk for early labor.
  3. Avoid tobacco, drugs and alcohol. If possible, quit smoking and drinking before getting pregnant. If you have one of the half of all U.S. pregnancies that are unplanned, quit using these substances as soon as you find out that you’re pregnant.
  4. Stay healthy through exercise and eating right. During your pregnancy, you’ll need extra protein and iron, and be sure to stay hydrated by drinking at least 8 glasses of water per day.
  5. Take extra precautions to avoid infections in the vaginal area, infections such as yeast, bacterial vaginosis and even urinary tract infections, which can all cause early labor.If you suspect you may have an infection, seek a doctor’s treatment right away.
  6. If your water leaks or breaks or you feel any premature labor (back contractions or pain, vaginal bleeding, or more than five Braxton Hicks contractions in an hour), call your OB-GYN right away and go to the hospital. There, measures can be taken to prolong your pregnancy as much as possible.

Did you or someone you know have a pre-term baby? What was your experience like?

- Holly Hosler

 

 

To schedule an appointment with one of our highly trained physicians and find out why LifeBridge Health is Baltimore's premiere health care organization, call 410-601-WELL.

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