Wednesday, November 17, 2010

Dr. Hill's Editorial on Preterm Birth

The following column can be found in today's Sarasota Herald-Tribune here. Born in Sarasota will post follow-up commentary shortly.

The burdens of pre-term births are significant -- in terms of the individual's lifetime health, the medical care required and the economic costs expended. Simply put, reducing the rate of pre-term births is in everyone's interest and must become a priority.

The most recent national statistics show a 3 percent drop in the pre-term birth rate, to 12.3 percent in 2008 from 12.7 percent in 2007. Prior to this decline, the rate of pre-term birth had steadily increased for more than 20 years.

The modest decrease was encouraging, but pre-term birth remains a serious health problem -- an epidemic -- with more than 540,000 pre-term births annually.

In Florida, the pre-term birth rate in 2008 was 13.8 percent and has not declined in recent years; in other words, one of every seven babies is born too soon.

Nearly 240,000 babies are born annually in Florida -- more than 32,000 of them prematurely.

Even worse, each year 1,700 babies in Florida do not live to their first birthday.

Prematurity is the leading cause of newborn death and has increased more than 30 percent since the 1980s -- in both Florida and Sarasota County. Many of the county's newborns suffer serious health problems or die because of their early births. Preventing pre-term birth (birth before 37 weeks of pregnancy) is critical to give more babies a healthy start.

These statistics are startling. Yet even more surprising is a growing trend of women electing to deliver their babies early.

Just because grandma is in town or daddy is off work is no reason to have a baby early.

A healthy full-term pregnancy is 39 to 40 weeks, yet we are seeing a rise in scheduled deliveries at 37 and 38 weeks -- a practice once thought to be safe.

But research is revealing the serious consequences of scheduling births even a few weeks too early. While not officially labeled "premature," babies born between 37 and 39 weeks are at significantly greater risk of complications compared with full-term babies.

More bothersome is a 2009 study that found many women do not clearly understand the definition of a full-term pregnancy.

Nearly a quarter of moms surveyed considered a baby of 34- to 37-weeks' gestation to be full term. Half defined full term as 37 to 38 weeks and 92 percent of women reported that giving birth before 39 weeks was safe. Some women mistakenly said that, since pregnancy is nine months, 36 weeks is safe as well. Clearly, this information shows we have a lot of work to do to educate mothers, their families and the community about the definition of a full-term pregnancy, which is 40 weeks.

Scheduled cesarean sections and elective inductions have become frequent and are viewed as an accepted way to avoid potential complications and problems during labor and delivery.

Unfortunately, those good intentions often result in health problems for newborns who may have to spend time in a hospital's neonatal intensive care unit, need a ventilator to help them breathe or have trouble feeding because of their early birth and may miss an opportunity for the benefits of breastfeeding.

The March of Dimes has invested millions of dollars in the fight to prevent pre-term births. Today the March of Dimes marks the eighth annual Prematurity Awareness Day by issuing its 2010 prematurity birth report card. Sadly, Florida will receive an "F" for the third consecutive year.

Florida can do better to help its pregnant women and their families lower the pre-term birth rate to a national goal -- 7.6 percent.

Hospitals and health care professionals can help by following guidelines to decrease elective deliveries before 39 weeks and recognize the warning signs of pre-term labor.

The March of Dimes has joined with other health organizations in an effort to eliminate early, elective scheduled inductions and cesarean sections -- those done without medical cause. The partners are launching an aggressive educational campaign for women and physicians.

With aid from the March of Dimes, a new tool has been developed in the fight to ensure all babies get to a full 40 weeks. In Florida, several hospitals -- including Sarasota Memorial Hospital and Manatee Memorial Hospital -- are taking a leadership role to address elective deliveries before 39 weeks and to teach the early recognition of symptoms and signs of pre-term labor.

These hospitals are using a new tool kit, which supports health-care providers, patients and hospital staff in changing delivery practices and making decisions to eliminate elective deliveries. Health care providers in Sarasota have always been concerned about reducing the risk and the number of pre-term births. We now expand our concern to ensuring babies have a full 40 weeks of pregnancy.

We want people in our community to know how they can lower the risk of an early birth by encouraging smoking cessation, preconception care and early prenatal care; promoting awareness of treatments for women with a history of pre-term births; avoiding multiple gestation from fertility treatments and unnecessary cesarean sections and inductions before 39 weeks of pregnancy.

Together pregnant women, their families and friends, policy leaders, the general public, health care professionals and hospitals can make a difference in the health of babies born in Florida and all across our county.

Washington Clark Hill, M.D., is a Maternal and Fetal Medicine Specialist at Sarasota Memorial Hospital and a member of the Board of Healthy Start Coalition of Sarasota County Inc.

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