Sunday, May 21, 2006

More Babies Born Preterm, Sometimes Due to Mother's Choice

The Washington Post has an article today, "As Babies are Born Earlier, They Risk Problems Later." According to the piece:

"The percentage of babies born slightly early has been increasing steadily for more than a decade and is now at an all-time high. So many babies are being born a few weeks early -- more than 350,000 annually -- that the average U.S. pregnancy has shortened from 40 weeks to 39."

"The increase is driven by a combination of social and medical trends, including the older age of many mothers, the rising use of fertility treatments and the decision by more women to choose when they will deliver. At the same time, medical advances are enabling doctors to detect problem pregnancies earlier and to improve care for premature babies, prompting them to deliver more babies early when something threatens their lives or those of their mothers."

"Although most of these babies fare well and face far less risk than very premature infants, researchers have begun to realize that they are nevertheless more prone to short-term complications, such as problems breathing and feeding, and jaundice. And because so many are being born each year, even a small increased risk translates into thousands of sick babies. Studies are also starting to suggest that these children may tend to not develop as well as full-term babies, leading to behavioral, learning and other difficulties."

"Nearly 9 percent of all babies delivered in the United States were born late-preterm in 2003, according to the most recent federal data. That is up from 7.6 percent a decade earlier and the highest since the government started tracking such births -- and translates into about 50,000 more of these babies each year."


The piece talks about several risk factors for preterm birth, including maternal obesity, fetal complications, fertility treatments resulting in multiple gestation, etc. Here's the kicker, though:

"But some specialists question whether the increase in Caesareans and inductions is the reason for the drop in stillbirths. And they worry that too much of the increase may be due to women hastening delivery for nonmedical reasons -- they want to make sure their mother will be in town, their husband has a business trip pending, or they are just fed up with being pregnant.

'It's a common request,' said Mark Lollar, an obstetrician in San Ramon, Calif., who routinely honors such requests for the wives of professional athletes so their husbands can be present. 'I have no problem arranging that for them.'

Lollar and other obstetricians insist that they make sure that the fetus is at least 38 weeks old. "We never compromise the mother or the baby's safety," Lollar said.

Other experts, however, say it can be difficult to calculate the precise gestational age of a fetus.

'If a woman comes in late in the pregnancy and only has one ultrasound, you can have an error of up to two weeks, which can be significant,' Tonse said."


The piece goes on to address the issue of whether a week or two miscalculation in gestational age can cause significant developmental and other complications. Typically, I'm all for women's reproductive choice. But are the obstetricians agreeing to what seem to be very selfish requests doing both the parents and the babies a disservice by weighting scheduling issues more heavily than medical concerns? When a woman has chosen to have a baby, is it ethical for her, and her obstetrician, to make this kind of decision? Are physicians on the hook for malpractice if they agree to such a request and get it wrong? I have a hard time understanding how convenience wins out against possibly developmental and physical delays, but I've never been a parent. I'm sure it's a touchy issue, and I'd be very interested in what Linda of the Women's Bioethics Blog and some of my midwife readers have to say about it. I tend to be in agreement with the husband, who reacted to the story by saying, "Babies have been telling women they want to come out for a very long time. They may not be able to do much else, but they know when it's time to get out of that uterus." Okay, so some babies don't always get it right, but I think you get the point. What say you?

Resources:
  • Premature Babies - MedlinePlus
  • March of Dimes: Prematurity
  • Premature Infants - JAMA Patient Page
  • A Primer on Preemies - Nemours Foundation
  • Premature Birth Complications - American Pregnancy Association

    Technorati Tags: ; ;
    MeSH Tags: Infant, Premature; Obstetric Labor, Premature; Premature Birth
  • 1 Comments:

    Blogger Hilary said...

    I think this is another example of a health question being turned into a lifestyle choice.

    When people weigh health decisions that only effect themselves, they usually do not factor in comfort and convenience and scheduling anywhere near as often as they seem to be willing to when their babies are concerned.

    12:34 PM  

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