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Saint Thomas Health Medical Mondays: Premature Birth Awareness -- April 1, 2013 -- Dr. Connie Graves

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 Saint Thomas Health Medical Mondays

Monday, April 1, 2013
TOPIC: Premature Birth Awareness
Connie Graves, MD, OB/GYN & Maternal Fetal Medicine


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| Receiving a "C" on the 2012 March Of Dimes Premature Birth Report Card


Nov. 13, 2012 – Tennessee earned a better grade on the March of Dimes 2012
Premature Birth report card, giving more babies a healthy start in life and contributing to
the national five-year improving trend.

Tennessee earned a C on the report card for lowering its preterm birth rate to 12.8

"We're proud that our state's preterm birth rate is improving, thanks to the work of the
March of Dimes and our partners. Tennessee's progress means that more babies are
being born healthy, excess health care costs are being reduced, and families are being
spared the heartache of having a baby born too soon," said Leslie Ladd, March of
Dime's State Director "To continue this progress for mothers and babies, the Tennessee
Department of Health and the March of Dimes have set a goal to reduce premature birth
by at least 8 percent between 2009 and 2014."

Here, in Tennessee, the March of Dimes is supporting Group Prenatal Programs,
Hospital efforts to end Early Elective Deliveries and programs to address disparities in
preterm births that will help women have full-term pregnancies and healthy babies.

Tennessee is part of a national trend toward improved preterm birth rates, 40 states
saw improvement in their preterm birth rates between 2010 and 2011. On the 2012
Report Card, 16 states, including Tennessee got a better grade. Nationwide, the largest
declines in preterm birth occurred among babies born at 34 to 36 weeks of pregnancy,
but the improvement was across the board. Nationally, every racial and ethnic group
benefitted, and the preterm birth rates for babies born at all stages of pregnancy

Since 2006, Tennessee's preterm birth rate has dropped to 12.8 percent. In Tennessee,
the rate of late preterm births is 9.1% and the rate of uninsured women is 18.1%.
These factors contribute to improved infant health in Tennessee. It earned a star on the
report card for:

Reducing the percent of uninsured women of child-bearing age;

Lowering the late preterm birth rate.
These improvements mean not just healthier babies, but also a potential savings
in health care and economic costs to society.
The March of Dimes attributed the improved rates to an expansion of successful
programs and interventions, including actions by state health officials here and in
47 other states, the District of Columbia and Puerto Rico, who formally set goals
to lower their preterm birth rates 8 percent by 2014 from their 2009 rate.

"We will continue to work together to improve access to health care, help women
quit smoking and, through our Healthy Babies Are Worth the Wait consumer
education campaign, encourage women and health care providers to avoid
scheduling a delivery before 39 weeks of pregnancy unless medically necessary,
says Valencia Nelson, Tennessee Director of Program Services.
The United States again received a "C" on the March of Dimes Report Card.
Grades are based on comparing each state's and the nation's 2011 preliminary
preterm birth rates with the March of Dimes 2020 goal of 9.6 percent of all live
births. The U.S. preterm birth rate is 11.7 percent, a decline of more than 8
percent from the peak of 12.8 percent in 2006.

The Report Card information for the U.S. and states will be available online at:

Preterm birth, birth before 37 completed weeks of pregnancy, is a serious health
problem that costs the United States more than $26 billion annually, according
to the Institute of Medicine. It is the leading cause of newborn death, and babies
who survive an early birth often face the risk of lifetime health challenges, such
as breathing problems, cerebral palsy, intellectual disabilities and others. Even
babies born just a few weeks early have higher rates of hospitalization and
illness than full-term infants. At least 39 weeks of pregnancy are important to a
baby's health because many important organs, including the brain and lungs, are
not completely developed until then.
On November 17 , partners from around the world will mark the Second World
Prematurity Day in support of the Every Woman Every Child effort led by UN Secretary-
General Ban Ki-moon. An estimated 15 million babies are born preterm and of those
more than a million die as a result of their early birth. Prematurity Awareness events are
happening throughout November, including Blue Jeans for Babies events in Memphis,
Jackson & Chattanooga, Signature Chefs Auctions in Memphis, Knoxville and Johnson
City and Macy's Community Shopping Day in Nashville. Details can be found at . Other updates & activities include......

Established a partnership with the Tennessee Department of Health, TN Initiative
on Perinatal Quality Care, and TN Hospital Association to implement a Healthy
Babies Are Worth The WaitTM education campaign to improve preventable late
preterm rates, please visit for more

Continue to fund evidenced based Centering Pregnancy programs designed to
improve access to and utilization of prenatal health services;

Support Stork's Nest programs to enhance prenatal care through partnerships
with local Zeta Phi Beta Sororities to help address disparities in infant mortality
and prematurity among African American communities;

Support innovative approaches to educate more women about the importance of
being healthy before a pregnancy ever begins;

Provide informational support and risk reduction education to families affected by
preterm birth through our NICU Family Support program;

Received more than $1 million dollars in research grants to find the answers to
various contributors to poor birth outcomes.

What is premature birth?

Pregnancy normally lasts about 40 weeks. A baby born 3 or more weeks early is premature.
Many premature babies-those born closer to 37 weeks-do not have problems.

Babies who are born closer to 32 weeks (just over 7 months) may not be able to eat, breathe, or
stay warm on their own. But after these babies have had time to grow, most of them can leave
the hospital.

Babies born earlier than 26 weeks (just under 6 months) are the most likely to have serious
problems. If your baby was born very small or sick, you may face a hard life-or-death decision
about treatment. Doctors and nurses often call premature babies "preemies."

Why is premature birth a problem?

Babies who are premature may not be able to feed by mouth, breathe without stopping, or stay
warm. Their bodies simply need more time to fully develop and grow. After they outgrow the
problems caused by being born too soon, most babies can safely go home from the hospital.

When a baby is born too early, his or her major organs are not fully formed. This can cause
health problems. Any premature baby can have medical problems. But those who are born before
32 weeks are more likely to have more serious problems.

Having a premature baby is stressful and scary. To get through it, you and your partner must take
good care of yourselves and each other. It may help to talk to a spiritual advisor, counselor, or
social worker. You may be able to find a support group of other parents who are going through
the same thing.

What causes premature birth?

Premature birth can be caused by a problem with the fetus, the mother, or both. Often the cause
is never known. The most common causes include:

Problems with the placenta.
Pregnancy with twins or more.
Infection in the mother.
Problems with the uterus or cervix.
Drug or alcohol use during pregnancy.

What kind of treatments might a premature infant need?

Premature babies who are moved to the neonatal intensive care unit (NICU) are watched closely
for infections and changes in breathing and heart rate. Until they can maintain their body heat,
they are kept warm in special beds called isolettes.

They are usually tube-fed or fed through a vein (intravenously), depending on their condition.
Tube-feeding lasts until a baby is mature enough to breathe, suck, and swallow and can take all
feedings by breast or bottle.

Sick and very premature infants need special treatment, depending on what medical problems
they have. Those who need help breathing are aided by an oxygen tube or a machine, called
a ventilator, that moves air in and out of the lungs. Some babies need medicine. A few need

Breast milk can give a baby extra protection from infection. So your hospital may urge you to
pump your breast milk and bring it in for at least the first few weeks after the birth.

NICU doctors and nurses are specialists in premature infant care. If your premature baby is in
NICU, you can learn a lot from the medical staff about how to take care of your baby.

Does premature birth cause long-term problems?

Before the birth, it is hard to predict how healthy a premature baby will be. But your doctors
can prepare you for what may lie ahead. They can base this on your condition and how many
weeks pregnant you will be when you give birth. Most premature babies do not develop serious
disabilities. But the earlier a baby is born, the higher the chances of problems.

Most premature babies who are born between 32 and 37 weeks do well after birth. If your
baby does well after birth, his or her risk of disability is low.
Babies most likely to have long-term disability are those who are born before 26 weeks or
who are very small, 1.7lb or less. Long-term problems may include mental retardation or
cerebral palsy.

What can you expect when you take your baby home?

When you're at home, don't be surprised if your baby sleeps for shorter periods of time than you
expect. Premature babies are not often awake for more than brief periods, but they wake up more
often than other babies. Because your baby is awake for only short periods, it may seem like a
long time before he or she responds to you.

Premature babies get sick more easily than full-term infants. So it's important to keep your baby
away from sick family members and friends. Make sure your baby gets regular checkups and
shots to protect against serious illness. Sudden infant death syndrome (SIDS) is more
common among premature babies. So make sure your baby goes to sleep on his or her back.
This lowers the chances of SIDS.

Premature Infant - Delivery of Your Premature Infant

Preparing for the premature birth

A premature delivery may happen suddenly or after days or weeks of waiting and worrying. If you
know you may deliver early, you, your partner, and your doctor can prepare for a premature birth.

Use a hospital with a neonatal intensive care unit (NICU). If you deliver in a hospital without
an NICU, your infant may need to be moved to the closest hospital that has one.
Get to know the NICU. If you can't visit the unit, someone from the NICU can visit or call you
to discuss your questions.
Mature your fetus's lungs over a 24-hour period by taking a course of corticosteroids.
A tocolytic drug also may be used, to delay labor while the corticosteroids work.
Corticosteroid treatment is considered the single most effective measure for preventing infant
complications of prematurity.1 For more information, see the topic Preterm Labor.

If you deliver after 36 weeks of pregnancy, your infant's risks of problems are very low. Although
a special medical team is usually nearby for such a delivery, most 36- and 37-week newborns
aren't treated any differently than full-term newborns.

The premature delivery

Unlike many full-term or near full-term childbirths, you and your premature infant (preemie) are
considered high-risk during preterm labor. As a result, you will have less freedom, both to make
birth-related decisions and to move about freely. You can expect the following:

Your birth plan and birthing choices will be less useful during this birth. You can refuse
medicines such as painkillers during preterm labor. But other treatments such as antibiotics
or corticosteroids can be important to ensure your infant's chances of good health after birth.
Be sure to ask as many questions as you can think of about your medical care. The more you
understand about your doctor's decisions, the less anxious you will feel.
You will be on intravenous (IV) medicines and fluids.
You will be on constant electronic fetal heart monitoring. You also will be checked
regularly for changes in heart rate, body temperature, and uterine contractions.
You will probably deliver vaginally, rather than by cesarean section (C-section), as long
as you and your fetus show no signs of distress.

A childbirth (obstetric) team and a new baby (neonatal) team will be present for your delivery. The
neonatal team will bring special equipment with them, including a bed with an overhead heater
and resuscitation equipment for your infant. You may deliver in a surgical room that is ready for
cesarean delivery, or you may deliver in your hospital room.

After the premature birth: The infant

As soon as the umbilical cord is cut, the neonatal staff will watch over and stabilize your
infant. If your infant is less than 36 weeks' gestation at birth, he or she will then be moved
to the NICU for observation and specialized care. If you deliver in a hospital without an NICU,
your infant may need to be taken to another hospital. This typically requires a specially equipped

At birth, little can be predicted about how well or how poorly your premature infant will do. If there
are no signs of problems, you can feel cautiously hopeful. But during the first hours and days,
your infant will adjust to living outside of the maternal "life-support system." This is a time when
birth defects and complications of prematurity often become apparent.

After the premature birth: The mom

While the neonatal staff attends to your infant, the obstetric staff will care for you. Depending on
your condition, your postpartum care and recovery time will take at least a few hours. Meanwhile,
your birth partner may want to accompany your infant to the NICU.

Before your breast milk comes in (3 or 4 days after childbirth, or postpartum), you will be asked
to decide whether you plan to breast-feed your premature infant. If you decide to breast-
feed, expect initially to pump milk for feedings until your infant is mature enough to feed orally.
Providing breast milk for and later breast-feeding a premature infant can be an emotional and
logistical, yet rewarding, challenge. You may have mixed feelings about it and worry that it may
be too difficult. Before making your final decision, consider the following.

Breast milk contains antibodies that help protect your vulnerable infant against early, serious
infections, including sepsis and necrotizing enterocolitis, as well as ear and upper
respiratory infections during early childhood.

The benefits of breast milk over formula include better nutrient absorption, digestive functioning,
and nervous system development.
Both specialized formula and breast milk can offer your infant excellent nutrition.
Pumping and breast-feeding can be one of the most beneficial and rewarding things you do
for your premature infant, but it may also be exhausting and difficult. If you cannot breast-feed,
decide not to breast-feed, or find that you have to discontinue doing so, formula feeding will meet
your infant's nutritional needs.

Because formula does not give your infant added protection from early infection, your hospital
may strongly encourage you to pump milk for your infant during the first weeks of life, at a
minimum. Your hospital's lactation consultant can be very helpful with pumping and breast-
feeding questions and problems, both before and after the birth.


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