The preterm delivery rate in the United States has crept up over the past couple of decades to one in every eight deliveries. The consequences are significant: lung disease, prolonged hospitalization, brain injury, and more subtle long-term effects like learning challenges and even autism. The maddening aspect of preterm delivery is that -- at least the first time -- it's almost never anticipated. But with the recognition that progesterone supplementation can prevent preterm delivery in some women, and the conviction (albeit backed by scant data) that some prenatal interventions can stave off an early birth, the attentive woman may be able to improve the odds that their pregnancy will go to term. Here are eight specific steps women can take to prevent a preterm delivery:
1. Quit smoking: Along with cancer, heart disease, stroke and really nasty breath, smoking causes preterm delivery too. Go ahead and quit, and then reduce the risk that your child will die from sudden infant death syndrome by not lighting-up again after your delivery.
2. Check your cervical length: No, don't actually check it yourself, but when you have an ultrasound at 18-20 weeks gestational age to evaluate your fetus' anatomy, make sure that the ultrasound technician gets a good look at your cervix, and if she doesn't, ask her to do a vaginal ultrasound to measure the cervical length. Cervical length less than 2.5cm is a reason to visit a specialist. According to Dr. Michael House, a specialist in high-risk pregnancies at Tufts Medical Center in Boston, "A short cervix is at 18-20 weeks is a strong indication for progesterone supplementation. Randomized trials show progesterone prevents preterm birth in this setting."
3. Communicate with your midwife or doctor: Women who communicate well with their obstetric provider (or at least their provider's staff) are less likely to have a preterm delivery. My suspicion is because women who communicate well with their midwife or doctor are more likely to discuss signs of preterm labor or other problems sooner.
4. Go to every scheduled appointment. Regular prenatal care prevents preterm delivery.
5. Review your medical history with your doctor or midwife. Something in your past may increase your risk of delivering early. In particular, be sure to mention these issues to your obstetric provider:
a. Urinary tract infections -- these may be a sign that you harbor bacteria in your urine, and these bacteria can cause preterm delivery.
b. Any surgery on your cervix -- did you have a LEEP procedure after an abnormal pap smear? Any other cervical surgery?
c. Is your uterus shaped differently? Common abnormalities like a bicornuate uterus, uterine didelphys, or septate uterus are risk factors for an early delivery.
6. Review your obstetric history with your obstetric care provider. A prior history of preterm delivery is the MOST IMPORTANT risk factor of all. (In medicine, little puts you at higher risk for a problem than having had that problem previously.) If you have had any of these conditions, make ABSOLUTELY CERTAIN you discuss it with your doctor or midwife.
a. A preterm delivery
b. A family history of preterm delivery
c. A history of other obstetric problems
7. Take fish oil supplements (maybe). There are some studies that suggest that taking these may reduce the risk of preterm delivery. However, the published evidence is weak, so you can take this recommendation or leave it.
8. Take folate (otherwise known as folic acid). Yes, I know you already get folate in the bread you eat and in your prenatal vitamin, but make sure you are getting at least 400 micrograms of folate daily.
Of course, if there is going to be a list of things to do, there ought to be a list of things that make no difference at all, particularly things that women have been warned not to do in the past.
1. Exercise. There is no evidence that exercise leads to preterm delivery. Of course, be reasonable: no rock climbing, no TaeKwon-Do, don't start training for a marathon if you've never run before. But if exercise is a regular part of your life, keep doing it.
2. Sex doesn't cause preterm delivery. Typically, sex doesn't cause preterm delivery. That said, your doctor may suggest you avoid it if your cervix is short or you are on bed rest .
3. Coffee (in moderation) doesn't cause preterm delivery. One or two cups each day are fine, but stop there.