A: We have written extensively about medical interventions that have been shown to prevent premature birth. In this piece, we will discuss steps that mothers can take to help prevent preterm delivery. Of course, all issues pertaining to prenatal care should be fully discussed with the mother’s obstetrician. It is important to remember, as well, that the prevention of premature birth is the responsibility of the medical professional that is providing care to the mother and child.
Steps Mothers Can Take to Help Prevent Premature Birth
Progesterone and cervical cerclage are the only medical treatments that have proven effective in significantly reducing the incidence of preterm birth. Nonetheless, many experts recommend the following interventions to help prevent preterm labor.
- Have a nutritious diet: There is evidence that inadequate nutrition during pregnancy results in premature birth. Mothers with adequate nutrition and a normal body mass index (weight and height ratio) have better pregnancy outcomes than other mothers. Low intake of n-3 fatty acids (such as fish oil) has been associated with a higher rate of premature birth. In one study, mothers whose diets were supplemented with fish oil had a lower risk of giving birth before 34 weeks than mothers who did not receive the fish oil (received placebo). In another study, diets supplemented with a certain type of fatty acid (docosahexaenoic acid) in fortified eggs had babies who were approximately 6 days older than those who did not receive the fortified eggs. A diet low in saturated fat and cholesterol and enriched with polyunsaturated fatty acids (fish, low-fat meats and dairy products, oils, whole grains, fruits, vegetables, legumes) significantly reduced the rate of preterm birth in low-risk pregnancies compared with mothers who consumed their normal diet. It is the responsibility of the mother’s medical professional to inform her of what constitutes a nutritious diet.
- Avoid a short time period in between pregnancies: Mothers who become pregnant within 6 months of a previous birth are at a high risk of having a premature baby. Doctors should discuss family planning strategies with mothers.
- Reduce work fatigue: Research shows that work fatigue is a risk factor for preterm birth. Pregnant women are at a higher risk of having a preterm birth if they work longer than 42 hours per week, stand more than 6 hours a day, or have low job satisfaction.
- Avoid cigarettes and cocaine: Smoking is associated with preterm birth, placental abruption, premature rupture of the membranes (PROM), placenta previa and intrauterine growth restriction (IUGR). Researchers also think that smoking has a direct effect on spontaneous preterm labor and delivery. Approximately 60% of pregnant women who test positively for cocaine experience preterm delivery. Physicians must take an in-depth history of their patients. It is the responsibility of the medical professional to inform the mother of the health risks related to smoking and cocaine use and to provide information about options for cessation, counseling or referrals to treatment programs.
- Discuss medical interventions with the physician that can prevent preterm delivery: All expecting mothers should know the risk factors for having a high risk pregnancy and giving birth preterm. There are certain medical interventions that have been shown as being very effective in preventing premature delivery in women at risk.
What Medical Interventions Can Medical Professionals Do That Mothers Can Ask About?
There are many things that medical professionals can to to help avoid preterm birth. It is the physician’s responsibility to administer proper treatment, but it is important that mothers be aware of these options. It is the duty of the physician to discuss these options with their patients.
- Tocolytics for stopping sudden onset preterm labor: If a mother goes into preterm labor, the physician can give her medication called a tocolytic to temporarily stop the contractions. This does not remove the condition that is causing the preterm labor, but will delay delivery for about 48 hours so that steroids can be given to the mother to help the baby’s lungs (and other types of tissue) mature. Indomethacine is the most common tocolytic used.
- If using assisted reproductive techniques (ART), physicians can decrease the risk of having multiple babies (twins or more): Multiple births are six times more likely to be preterm than are single births. One strategy to prevent multiple conceptions resulting from ART includes limiting the number of pre-embryos that are transferred in each ART cycle.
- Proper treatment of UTIs and other infections: Physicians should prescribe a 3 – 10 day course of antibiotics that are safe for both the mother and baby when treating UTIs and other infections. The choice of antibiotic should address the most common infecting organism. Ampicillin used to be the drug of choice, but in recent years, E. coli has become increasingly resistant to ampicillin and other antibiotics. Medical professionals must conduct antibiotic susceptibility tests to determine which antibiotics will work to treat the woman’s infection. A repeat urine culture should occur once treatment is over to verify the infection is cured. UTI’s recur often in pregnant women so close monitoring with frequent urine cultures after initial diagnosis and treatment is essential. It is imperative to change to a more sensitive antibiotic if a mother’s infection is not cured by initial treatment. Some common antibiotics (such as fluoroquinolones and tetracyclines) should not be prescribed during pregnancy due to possible toxic effects on the baby, though fluoroquinolone use is appropriate for resistant microorganisms. Even asymptomatic mothers must be treated due to potential complications for the baby. Research shows that treatment of pregnant women who have bacteria in their urine decreases the incidence of preterm birth and low birth weight infants. By screening for and aggressively treating pregnant women, it is possible to also significantly decrease the annual incidence of kidney infection during pregnancy.
- Proper treatment of kidney infections and sepsis that can occur from infection: A kidney infection is a serious illness that can progress to maternal sepsis (bloodstream infection), preterm labor and premature delivery. Early, aggressive treatment is important in preventing complications. Hospitalization is indicated for mothers who are exhibiting signs of sepsis, who are vomiting and unable to stay hydrated, and who are having contractions. Treatment with oral cephalexin or IV cephalothin has a high success rate, and both are equally successful in preventing low birth weight and preterm deliveries. Antibiotic therapy should be started before obtaining the results of the urine culture and sensitivity tests. Several antibiotic treatments may be used, including IV cefazolin, IV gentamycin plus ampicillin, or intramuscular ceftriaxone. Treatment of a kidney infection should continue until the mother has no fever. Most mothers respond to hydration and prompt antibiotic treatment within 24 – 48 hours. The most common reason for initial treatment failure is resistance of the infecting organism to the antibiotic.
- Mothers with a short or incompetent cervix can be treated with a cerclage: A cerclage is a stitch or stitches used to reinforce the cervical muscle and prevent premature birth. The mother can receive a cerclage (or cerclages) between 14 and 24 weeks of pregnancy, and sometimes sooner. The stitches are removed between weeks 36 and 38 to avoid problems during labor and delivery.
- Hormone therapy for women with a prior preterm birth or short cervix: Mothers who have previously given birth prematurely or who have a short cervix can benefit from progesterone (a hormone produced in the body that helps women become and remain pregnant). Progesterone keeps the uterus from contracting. Mothers can choose an all-natural progesterone or a synthetic form. Treatment is either injected into the muscle or given vaginally on a daily basis. Type of progesterone treatment is dependent upon the reason the mother is at risk of having a preterm delivery.
What Health Risks is Premature Birth Related To?
Premature babies are those born before 39 weeks. Due to underdeveloped organs and body systems, premature babies often have breathing problems, feeding difficulties and other issues and are susceptible to birth injuries such as the following:
- Intraventricular hemorrhages (IVH – brain bleeds)
- Hypoxic ischemic encephalopathy (HIE)
- Periventricular leukomalacia (PVL)
- Cerebral palsy
- Intellectual disabilities
- Developmental delays
- Motor disorders
These birth injuries can cause lifelong problems for the child, which is why it is critical for physicians to take all measures necessary to prevent premature birth. Physicians should take thorough histories of expecting mothers and they should be aware of any problems that cause premature birth as well as any risk factors mothers may have for preterm delivery.
What Are the Risk Factors for Premature Birth?
Identifying risk factors for premature birth early in pregnancy provides an opportunity for intervention to prevent an early delivery, although many women with no risk factors give birth to premature babies. Risk factors for premature birth include the following:
- History of preterm birth, either with twins or a single baby. History is the strongest risk factor for premature birth of a single baby or twins.
- History of abortion. This includes abortion induced by medical intervention as well as spontaneous abortion.
- A short interpregnancy interval. The sooner a mother becomes pregnant after a previous pregnancy, the higher the risk of preterm delivery.
- Assisted reproduction. Pregnancies conceived with assisted reproductive technology, such as in-vitro fertilization, are at a higher risk of preterm delivery.
- Being pregnant with twins, triplets or more.
- Vaginal bleeding caused by partial shedding of the uterine lining in early pregnancy (decidual hemorrhage).
- Infection. This includes chorioamnionitis, which is inflammation of the placenta and fetal membranes caused by infections in the mother, such as Group B strep (GBS), urinary tract infection (UTI), bacterial vaginosis (BV), and E coli. Even if maternal infections don’t cause chorioamnionitis, they are still risk factors for preterm delivery. Having a short cervix is an independent risk factor for both infection and premature birth.
- Periodontal disease. These are oral infections, such as gum and tooth infections.
- African American race.
- Low or high maternal age.
- High blood pressure during pregnancy / preeclampsia.
- Tobacco and alcohol use and substance abuse.
What Are the Signs of Preterm Labor?
Preterm labor usually begins unexpectedly. Like regular labor, signs of early labor are:
- Contractions (the abdomen tightens like a fist) every 10 minutes or more
- Change in vaginal discharge (leaking fluid or bleeding from the vagina)
- Pelvic pressure (the feeling that the baby is pushing down)
- A low, dull backache
- Cramps that feel like a menstrual period
- Abdominal cramps with or without diarrhea
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Premature birth puts a baby at risk of having numerous birth injuries. Physicians must recognize risk factors for premature birth and follow standards of care to prevent the baby from being born preterm. If your baby was born prematurely and has a condition such as hypoxic ischemic encephalopathy (HIE), cerebral palsy, a seizure disorder or developmental disabilities, contact the trusted birth injury lawyers at Reiter & Walsh ABC Law Centers. We have helped children throughout the country obtain compensation for lifelong treatment, therapy and a secure future, and we give personal attention to each child and family we represent.
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