Recently, one of the infants at the hospital where I am an OB-GYN was born at just 24 weeks. For unknown reasons, her mom went into labor. Though efforts were made to stall the contractions, the labor continued and we took measures to accelerate the maturity of the fetal lungs and brain, and prevent pulmonary complications of prematurity.
At 24 weeks, a premature infant is really tiny, with fragile skin and bones. After safely delivering via C-section (which are often medically necessary for extremely preterm births), we handed the infant off to the neonatologist and their team, and they worked their magic while we sewed mom up.
While both mom and baby face long roads ahead to recovery and physical and emotional health, I know their strength and resilience will carry them through.
How I talk with parents about preterm birth
Preterm birth — defined as birth before 37 weeks of pregnancy — is a leading cause of neonatal morbidity and mortality. The U.S. preterm birth rate is among the worst globally, at 9.9% as of 2017 — meaning around 1 in 10 babies are born prematurely each year.[1]
Understanding and managing the risks for preterm labor is one of the core challenges for both expecting mothers and physicians. The stark reality is that preterm birth can happen to any expecting parent. But there are ways to help prevent it.
Here’s some of the guidance I provide my patients to help manage the things they can control:
- Seek early and ongoing prenatal care.
- Wait at least 6 months between pregnancies.
- Don’t smoke, and avoid alcohol and illicit drugs — especially during pregnancy.
- Try to maintain a healthy lifestyle by getting adequate sleep and rest, prioritizing good nutrition, and managing stress and anxiety.
Other risk factors, however, are entirely out of an individual’s control. There are racial, ethnic, geographic, and socioeconomic disparities for preterm birth which point even further to our need for more equitable healthcare for women and families. In 2017, the preterm birth rate was nearly 50% higher among black women (14%) compared with white women (9%).[2]
Plus, an individual’s job is a risk factor: working more than 40 hours a week has been associated with a 38% higher risk of miscarriage and 21% higher risk of preterm birth, and working night shifts has also been linked to a 21% higher risk of preterm delivery.[3] Of course, we can make recommendations for a pregnant woman to work with their employer to change shifts or cut down on overtime, but options may be limited based on their job function or industry, and certain social determinants may prevent them from being able to do so.
Understanding the hardships
Premature infants often face long NICU stays, which can mean challenging emotional journeys for families.
There are financial tolls, too, for parents and employers. The average cost for infants hospitalized in neonatal intensive care units is around $3,000 per day. To put that in context: the average cost to an employer for a healthy baby born at full-term, or 40 weeks’ gestation, is $2,830; and the average cost for a premature baby is $41,610.[4]
While the majority of preterm labors are in the moderate- to late-preterm range (meaning birth between 32 to 37 weeks), the costs of extremely premature births — like this one — can run in the $100,000s. And still, these exorbitant numbers don’t include healthcare costs later in life due to complications that may result from premature birth like cerebral palsy, sensory deficits including retinopathy or hearing loss, learning disabilities, or respiratory illnesses.
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