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Straight Talk About Premature Birth (VIDEO)

Posted: 07/12/10 09:00 AM ET

They say that a little knowledge is a dangerous thing. As a neonatologist, I was terrified when my son developed complications and had to be admitted to the NICU. When you're faced with this situation, the mind can play tricks on you and you tend to think about the worst case scenario. With all of my medical training and background, my mind still raced with questions and concerns. Why did this happen? What could I have done differently to have prevented this from happening?

The fact of the matter is, each year more than 500,000 babies in the U.S are born preterm. That's one in eight babies born too soon. According to the March of Dimes, the good news is that the U.S. preterm birth rate declined for the second straight year in 2008, to 12.3 percent of all live births, down 4 percent from the 2006 rate of 12.8 percent. This means that 21,000 fewer babies are born preterm and spared the serious health risks of an early birth.

As a doctor, I witness firsthand the many common misconceptions about prematurity. From my experience, most families immediately think that most babies die when born prematurely. In fact, the majority survive. However, even with the aforementioned decline in the preterm birth rate, more than a half million babies are still born too soon in the U.S. each year, and premature birth is the leading cause of newborn deaths (March of Dimes).

Leading to the question I often get from moms everywhere: how can I help prevent this from happening to me and my baby?

Risk factors are many and can include the following:

  • Maternal age (older and younger moms)
  • Pre-existing maternal diseases (hypertension, diabetes, lupus, to name a few)
  • development of preeclampsia during gestation
  • Infants with congenital anomalies


Sadly, we know that stressful lifestyles where women are involved in relationships where drug abuse and/or emotional or physical abuse are present are also a risk factor for preterm delivery.

Recommendations for a healthy pregnancy seem to change rapidly. Most importantly, women should seek prenatal care early and speak often to their OB-GYN or midwife about the most up-to-date recommendations. Additional known strategies that can lower the risk an early birth include:

  • Good nutrition and healthy lifestyle
  • Smoking cessation programs
  • Progesterone treatments for women with a history of preterm birth
  • Avoiding multiples from fertility treatments
  • Avoiding unnecessary C-sections and inductions before 39 weeks


If and when you find yourself in the situation of having a pre-term baby, the prognosis is variable, depending on how pre-term the infant was born in addition to what complications he/she had during the NICU course. It is so important to have your infant's medical progress tracked, and equally important to have the child's neuro-developmental progress is also followed. All states have a program called the Infant and Toddler program, which facilitates this follow-up and any necessary therapies, including physical, occupational and speech therapies.

Although some babies are born very ill, and may need intensive care, they generally recover pretty quickly. NICU teams are very cognizant that the whole family is affected. Caring for moms and dads is almost as important as the critical care the babies receive. There can also be long term impacts on the parents after a NICU stay. Many parents are anxious when it comes time for the baby to come home. It is the role of the NICU team to spend time with families at the time of discharge, helping them prepare and feel ready to care for their baby at home. Research has revealed a significant percentage of parents who have had infants in a NICU who in turn experience symptoms similar to those suffering from post-traumatic stress disorder (PTSD). It's very important for families to seek help if this happens to them.

My son has grown up knowing that his mom takes care of babies, some of whom are very sick. I used to tell him that I was working hard to get the babies better -- so that those babies could go home with their moms and dads. Somehow, that made sense to him and gave him a sense of satisfaction -- even if it took me away from him.

Having a baby in the NICU is an incredibly stressful time and everyone reacts and copes differently. So my personal advice to families experiencing this situation: visit as often as you can, ask a lot of questions, and remember to take care of yourself!



Dr. Dulkerian is featured in the new Discovery Health series, "NICU." Airing Thursdays at 10 PM (ET/PT) beginning July 15, NICU is an original 10-episode docu-drama series that goes behind the scenes of top national neonatal intensive care units, showing the day-to-day care required to sustain the smallest of lives.

 
 
 
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Birgitta Lauren
01:47 AM on 07/13/2010
Yes, straight talk was missing.... i wish moms had more info.
18 yrs as a prenatal fitness expert preeclampsia and premature delivery is preventable in most cases. the major causes of premature delivery is due to stress or a lack of nutrition and / or exercise. Nutrition and exercise can prevent the effects of gestational diabetes, hypertension, stress, and many other problems even including placenta previa.
i have seen it too many times. i have helped women reverse looming preeclampsias, diabetes, hypertension, ...lengthened pregnancies to 37-38 weeks of placenta previas etc... yes there are a few things such as sever stress of a death or divorce in family, lupus and such that cannot be helped, but in most cases, lifestyle choices are very important factors in how long a woman stays pregnant. And i won't dignify discussing smoking or drug use.
In addition to exercise, prenatal vitamins and excellent nutrition i must say, to any busy career woman: please slow down in the last 2 months or you will deliver early. No matter how healthy you try to live, executive moms that don't slow down work, always deliver 37-38 weeks. Moms that stay at home, around 39-41 weeks. "Health starts in the womb" - Birgitta Lauren Expecting Fitness com
05:47 PM on 07/12/2010
Her math doesn't add up: "the U.S. preterm birth rate declined for the second straight year in 2008, to 12.3 percent of all live births, down 4 percent from the 2006 rate of 12.8 percent." That's only 5/10 of a percent, not 4%.
12:05 AM on 07/13/2010
No. The preterm birth rate did decline 4%.12.3 is a 4% drop from 12.8. If she didn't use the word rate, then your 5/10 of 1% number would be correct.
10:44 PM on 07/15/2010
Thanks!
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03:54 PM on 07/12/2010
Oh, also, when I read the headline, I thought there was going to be some "straight talk" in the article. I once dated a neonatologist who was a little stressed out by what his profession had become, stressed mostly by parents who expect perfect outcomes for babies born VERY prematurely with many obstacles to overcome. He once told me, "What used to be a miscarriage-- now it's my patient!"
06:02 PM on 07/12/2010
Yeah, I had the same thought when I read the headline. It seems like sometimes we go to too much extreme to keep people alive, whether it's a premature baby or an adult on life support, or even an elderly person who is maybe just ready to die. But my profound belief in the eternal existence of the soul and that this life is "just a comma in a very long sentence" (from Conversations with Jesus, Linda Green) foster that opinion. However, I am also wise enough to know we can never judge another until we walk in their shoes. And God only knows the pain, fear, love and longing that these parents go through, that feed the desperate attempts.

By the way, regarding home births, my sister had her second child at home with only the assistance of her husband - planned that way (he's a brave man).
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thinkingwomanmillstone
I'm nervous. My life is under a Micro-bioscope.
07:21 PM on 07/12/2010
It was a bunch of banal generalizations acting as an ad for her new tv show. Her new tv show will probably keep the expectation going that premature birth has no real consequences developmentally especially in the case of multiples born extremely prematurely.
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03:51 PM on 07/12/2010
That looks like a pretty good home birth to me. Everyone was prepared, stayed calm, and had a good outcome. Was it supposed to be scary or warn people away from home birth?

I had 3 babies at home. My midwife missed the second birth because of a snowstorm but her assistant, who lived closer, arrived just in the nick of time.

Anyone notice how peaceful and private a home birth is? Yeah. I was very happy to have avoided hospitals and get the not-rushed, personal, informative care that a midwife gives.

Sorry to be up on my soapbox but I am very pro-home birth.
05:01 PM on 07/12/2010
if it can be done, so am I. In fact, we had our last baby at home much as they did in this video..with my husband catching. Just happened to quickly for any other help to arrive. Best birth ever. Of course, in a hospital, I also had a birth where I delivered myself. Baby was coming quickly and the nurse ran out of the room. So, if I'm going to end up doing it myself, might as well do it at home.
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05:18 PM on 07/12/2010
Wow! Funny!
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crom14
02:07 PM on 07/12/2010
I was born premature a very long time ago. My weight was 3lbs 4oz. I had so many difficulties to overcome,ranging from extreme shyness, learning disabilities, crossed eyes,my childhood was difficult. As a adult I came to terms with some of my problems and worked hard to overcome many issues. ( The lack of coordination is the worst)
I rarely see anything on the long term problems that occur with premature birth.I wonder how many suffer in silence.
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JFaye
My micro-bio is not empty. Thank you.
04:00 PM on 07/12/2010
A whole lot ... I spent 8.5 months in the NICU with my 1.7 pounder (783 kilos)... This is a hard life not only for the fetus', infant, baby and later older child or teenager .... but believe me for the parents as well. Far too much silent suffering and yet what else can you do. God bless you.
01:16 PM on 07/12/2010
26 years ago, I had my twins six weeks prematurely. We were able to keep them in there to 34 weeks through bedrest for nearly two months...a month of which I was hospitalized. I didn't realize how stressful this was until two years later when I was carrying our next baby. Around 32 weeks I had a day in which I had quite a few regular contractions. Luckily, it turned out to be nothing, but that in itself was traumatizing...kept thinking "I can go through this again!".
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AntoniaBologna
10:51 AM on 07/12/2010
I had my 1st child, prematurely, and it WAS a stressful time. We had the best team to help us at UCSD, and for that I will always be grateful. It was never determined why he was born at 28 wks. and only 2 lbs. 13 oz. I was not a smoker, I drank a total of 4 oz. of wine during my whole pregnancy, I ate well, I exercised within limits. I was 35 when I became pregnant, but went on afterward to carry another baby full term at a later age. What continues to be stressful is the fact that almost every child who is born prematurely will carry some residual effect from it. For some, it is an inability to sleep well. For mine, it is sensory issues. I am so happy that my child is healthy and has so few problems but I continue to this day to deal with his prematurity, 11 yrs. later.
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JFaye
My micro-bio is not empty. Thank you.
04:04 PM on 07/12/2010
19 years and counting with a life of complex "residuals" from our NICU experience... Sensory, cognitive, respiratory, traumatic brain injury, countless orthopedic problems and surgeries ... Yet, he has a sense of humor that befuddles the mind of anyone in his presence....
09:13 PM on 07/12/2010
My daughter was 2 lbs., 12 oz. I had pre-eclampsia and nearly died myself. At one point, my BP got so high that my vision blurred. I spent six days in the hospital after an emergency c-section. That time was HE**. I had not decided to breastfeed, but after they said it would be so beneficial to her, I pumped and brought her milk to the NICU. When I brought her home, nearly two months after she was born, I was scared to death. I spent the first week sitting up holding her, sleeping in a chair, because I was afraid to put her down, even though she was attached to an apnea monitor. I was not a smoker either, but was an older mom. I really can't tell she has any residual effects, YET, or none that I have noticed, and am very thankful - since there were so many children in the NICU born prematurely with brain bleeds, etc. No one who hasn't been in that situation can ever understand. I am glad your child is healthy with very few problems.