With the March of Dimes and all that, why is premature birth rates going up?

[AugustLia23]

What is the standard of care prenatal care even for?!?!

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5614a7.htm

[kate3]

Multiple gestations also get factored into that. Most twins and higher order multiples do not go to term. Also, with the increase in high tech IVF procedures, women who are older (>45) and women with complicated pre existing medical problems are now able to become pregnant. Both of these groups are significantly more likely to deliver prematurely.

Then there are the issues of poverty, drug abuse, adolecent pregnancy, and domestic abuse that are alive and well and increase the probability of preterm birth.

That statistic includes everyone, not just healthy moms with good prenatal care.

[alegna]

The problem is that the whole US ob. system sucks. Period. Our stats all stink.

All sorts of reasons, but the fear adds to it. The whole philosophy of ob care in the US is one of fear.

They take babies out early because they like to be in control.

-Angela

[Jane]

Now that the survival rate for premature infants has improved, there are some babies that would be better off delivered, rather than left to gestate in a bad situation. Combine that with increased age, weight, stratification of weath, etc...they still don't know why women delivery pre-term in most cases.

[alegna]

Originally Posted by Apricot

Now that the survival rate for premature infants has improved, there are some babies that would be better off delivered, rather than left to gestate in a bad situation. Combine that with increased age, weight, stratification of weath, etc...they still don't know why women delivery pre-term in most cases.

Yeah, but fact of the matter is that more babies (and moms) are dying here than in other similar countries.

-Angela

[Jane]

There's always the concern of how deaths are measured - there is a question whether the deaths of very low birthweight babies are reported in some countries. But, even trying to adjust for that, our rates are not good. We all spend a lot of money on prenatal and baby care, with a low return on investment.
Very few countries have the range of healthcare seen here - very "good" care for some women and very bad for others. While I would disagree with that the "Best" pregnancy care is really the best, I know there are women who get very bad care.

[Patchfire]

Basically, no one really knows why babies are premature, so therefore they can't even begin to make a real effort to prevent it.

The book Expecting Trouble goes into some detail about some of the issues.

[alegna]

Originally Posted by Patchfire

Basically, no one really knows why babies are premature, so therefore they can't even begin to make a real effort to prevent it.

Well they know why when they induce or section early...

-Angela

[BugMacGee]

Well they know why when they induce or section early...

Yes but this only applies to the *late* or *near term* population. IME, there are few social inductions/elective sections done before 37 weeks. And then, most have tested for fetal lung maturity. There's often a good reason for delivery prior to that (worsening PIH, IUGR, maternal health probs etc)

[alegna]

Originally Posted by BugMacGee

Well they know why when they induce or section early...

Yes but this only applies to the *late* or *near term* population. IME, there are few social inductions/elective sections done before 37 weeks. And then, most have tested for fetal lung maturity. There's often a good reason for delivery prior to that (worsening PIH, IUGR, maternal health probs etc)

Overzealous OBs. Really. Otherwise why are we having so many more than other countries with different policies and philosophies?

-Angela

[Jane]

To be the devil's advocate...Maybe our mothers and babies are sicker - maybe more of our babies need to be born sooner due to poor growth or infection?

In truth, I think that our doctors are more scared about litigation. I do understand somewhat. If my patient's baby died for no known reason at 41 weeks, I might want to start inducing everyone at 40+3. Doctors deliver 1000's of babies. They are going to see those bad outcomes (in the same way that I'd never "know" as many women with stillborn babies if I didn't post on MDC) - they have the exposure to many women. Having seen any small part of that pain would make me want to prevent that. It's a balance that many doctors get wrong.

[alegna]

Originally Posted by Apricot

To be the devil's advocate...Maybe our mothers and babies are sicker - maybe more of our babies need to be born sooner due to poor growth or infection?

Well, why?

-Angela