Helping mothers to help preemies

Preliminary birth data from the Pennsylvania Department of Health indicates there were slightly more than 138,000 babies born across the state in 2013 with a high of 22,018 in Philadelphia and a low of 37 in Forest County. Using the March of Dime figure and comparing to overall state birth data, approximately 11 percent of Pennsylvania babies are introduced to the world before they should be.

"If we can find a way to reduce the number of premature births, we would help many of these babies begin their lives healthier and also have brighter prospects for a healthier future," says Scott Shapiro, MD, president of the Pennsylvania Medical Society and a practicing cardiologist in Montgomery County.

A premature baby is born at least three weeks before its due date. This is known as preterm birth. Throughout pregnancy important growth and development occurs, particularly in the final months and weeks.

"It's really important to get the mother and baby to 40 weeks to give the baby its best chances for full development," says Kurt T. Barnhart, MD, FACOG, who is currently the chair of the Pennsylvania Section of the American Congress of Obstetricians and Gynecologists. "Pre-natal care is so important, and expectant mothers should work closely with their team of ob/gyn specialists throughout pregnancy."

Dr. Barnhart notes that even if the woman does everything correctly, there's no guarantee of carrying for 40 weeks, warning that extremely premature birth (less than 28 weeks) is responsible for a large percentage of infant deaths. In fact, more than 50 percent of all deaths in the first year of life are due to prematurity.

But most babies born early do survive and go home after sometimes prolonged hospital stays. However, as a result of their prematurity, they may develop medical problems that can have life-long consequences. According to the Pennsylvania Chapter of the American Academy of Pediatrics, these may include

• Visual problems

• Feeding and digestive problems

• Delays in development

• Cerebral palsy

• Hearing loss

• Breathing and respiratory problems

In most instances, it's not known why premature birth happens, and it may not be within the mother's control. But, there are certain situations which place a pregnant woman at a higher risk of a preterm delivery.

For example, health issues during pregnancy such as gestational diabetes, hypertension, heart or kidney problems, an infection, or bleeding due to abnormal positioning of the placenta can force an early delivery. Multiple gestations, a previous preterm delivery, or a shortened interval between pregnancies (<18 months between deliveries) also are risk factors. Finally, smoking, drug use, alcohol consumption, and poor nutrition may also contribute to preterm births.

Dr. Robert Cicco is a pediatrician specializing in the care of preterm newborns, and a past president of the Pennsylvania Chapter of the American Academy of Pediatrics as well as co-director of its PA Premie Network. He knows first-hand that, in addition to the medical problems encountered by the premature newborn, an early delivery places a significant amount of stress on families.

"Many of these infants are hospitalized for months in the newborn intensive care unit," he says. "In addition to the tremendous impact this has on health care costs, it also places an enormous emotional burden on families. Parents can experience guilt, a loss of control, uncertainty, anxiety, and depression both during and after the NICU."

According to Dr. Cicco, this stress may have a long lasting impact on the family. "As physicians, we must be sensitive to this but the best intervention is to minimize the risk of preterm birth in the first place."

So, while doing everything right is no guarantee of carrying to full term, what can a mother do to reduce her risk of preterm labor and birth? Physicians suggest the following

• Exercise, be active, and eat healthy foods.

• If you are planning a pregnancy, try to get to a healthy weight first. During pregnancy, talk to your health care team about safe weight gain.

• As soon as you think you're pregnant, make plans for your first prenatal care appointment and don't skip it. Also, throughout a pregnancy, go to all prenatal care appointments.

• Partner with your health care team if you have chronic health conditions such as diabetes or high blood pressure.

• Protect yourself from infections by washing your hands with soap and water often particularly after using the bathroom or blowing your nose. Some other tips that will help avoid an infection you don't want include having safe sex, not eating raw meat or fish, and not touching cat litter.

• Make necessary lifestyle changes. Don't smoke, drink alcohol, or take street drugs.

In addition to those tips, according to Deb Shoemaker, executive director at the Pennsylvania Psychiatric Society, pregnant women can work to reduce stress. Her organization suggests the following may help during pregnancy.

• Practice saying "no" and make slowing down a priority.

• Don't worry about chores. In fact, cut back on them in exchange for something you enjoy doing like reading a book.

• If you have a few sick days to spare, use them for a vacation.

• Try deep-breathing exercises, yoga, or stretching.

• Exercise regularly.

• Eat a healthy, well-balanced diet.

• Go to bed early. Get the sleep you need.

• Too much information can be a bad thing. Limit "information overload."

• Join a support group.