News Moms Need

A study published today in Obstetrics & Gynecology shows that hospital-based quality improvement programs across many states can be remarkably effective at reducing early elective deliveries of babies.

The rate of elective early term deliveries (i.e., inductions of labor and Cesarean sections without a medical reason) in a group of 25 participating hospitals fell significantly from 27.8 percent to 4.8 percent during the one-year project period, an 83 percent decline.

The March of Dimes, which partly funded the study, calls the findings good news, because babies delivered before full-term are at increased risk of serious health problems and death in their first year of life.

“This quality improvement program demonstrates that we can create a change in medical culture to prevent unneeded early deliveries and give many more babies a healthy start in life,” says Bryan T. Oshiro, MD, of Loma Linda University School of Medicine and lead author of the study.

“Reducing unnecessary early deliveries to less than five percent in these hospitals means that more babies stayed in the womb longer, which is so important for their growth and development,” says Edward R.B. McCabe, MD, medical director of the March of Dimes. “This project saw a decrease in the proportion of babies born at 37 and 38 weeks and a corresponding increase in the 39-41 week range during the one-year period studied. Additional studies, perhaps over a longer period of time, could clarify whether such quality improvement programs can also bring down a hospital’s overall preterm birth rate.”

This was the first project of a collaborative with perinatal quality improvement advocates from state health departments, academic health centers, public and private hospitals, and March of Dimes chapters from the five most populous states in the country: California, Florida, Illinois, New York, and Texas. These five states account for an estimated 38 percent of all births in the United States.

The March of Dimes urges hospitals, health care providers, and patients to follow the American College of Obstetricians and Gynecologists guidelines that if a pregnancy is healthy, to wait for labor to begin on its own. The final weeks of pregnancy are crucial to a baby’s health because many vital organs, including the brain and lungs, are still developing.

“A Multistate Quality Improvement Program to Decrease Elective Deliveries Before 39 Weeks,” by Dr. Oshiro and others, appears in the April 8 online edition of Obstetrics & Gynecology, Vol. 121, No. 5, May 2013.

A maternal-fetal medicine specialist is an obstetrician who concentrates on the care of pregnant women and babies in high-risk situations. Another name for this doctor is a perinatologist.

A maternal-fetal medicine specialist treats women with a number of conditions. Complications with mom’s health, include:
• A history of multiple miscarriages or premature birth
• Diabetes (gestational or preexisting)
• Hypertension (high blood pressure)
• Preeclampsia
• Infectious disease (toxoplasmosis, parvovirus, HIV/AIDS, etc.) or chronic illness
• Rh disease
• A family history of heart, kidney, or other disease

A maternal-fetal medicine specialist often treat pregnant women who are carrying multiples (twins, triplets or more) as the risk for preterm birth is significantly increased.

This doctor also specializes in the care of women whose baby is known to have:
• Abnormal fetal growth
• A known birth defect or suspected genetic disorder, such as Down syndrome, Trisomy 13 or Trisomy 18
• A baby with macrosomia (too large)
• A baby with fetal growth restriction (too small)

If you find yourself in a position where the risk of complications is higher than the average pregnancy, ask your current health care provider for a referral to a maternal-fetal medicine specialist. You may or may not need the extra care, but it will be good to get a second opinion.

Your risk may be a little higher, but just because you’ve already had a premature baby, it doesn’t mean your next baby will be born early.

Your health care provider may not have been able to tell you why your baby was born early. Sometimes labor just starts early without any warning. Other times doctors have to deliver a baby early if a mother’s health or the baby’s health is in danger.

There may be things you and your doctor or midwife can do to help you stay pregnant longer. It’s best to have an open conversation about these things before you get pregnant again. When you decide you’re ready to get pregnant again, talk to your provider about seeing a specialist who is trained to care for women who are likely to have pregnancy complications, including premature birth. These doctors are sometimes called maternal-fetal medicine specialists, or perinatologists. Your doctor or midwife can help you find a specialist.

There are some risk factors that make a woman more likely to have her baby too early. Some risk factors are things you can’t change, such as already having had a baby born too early. But other risk factors are things you can do something about, such as quitting smoking.  Click on this link to read about different risk factors and what you can do about them. 

What can you do about preterm labor? Learn the signs of preterm labor (labor that begins before 37 completed weeks of pregnancy) and what to do if they happen to you.

If you’d like to talk to other women like you who are thinking about pregnancy after having a premature baby, visit the discussion group “Pregnant? On Bedrest? Trying Again?” in the March of Dimes online community Share Your Story.  You’ll be able to connect with lots of women who are or have been in your shoes.

There are lots of myths about sex and pregnancy, such as:
   - Sex can be harmful or painful during pregnancy.
   - Intercourse could hurt the baby.
   - The baby somehow “knows” that sex is taking place.
 
The truth is that unless your doc or midwife advises you otherwise, sex during pregnancy is safe for the vast majority of us. And as for the baby, he or she has no idea what Mom and Dad are doing. The baby is well protected by a cushion of fluid in the womb and by the mom’s abdomen.

There are some circumstances, however, that can make sex during pregnancy unsafe. Women who have the following health complications should talk to their health provider before engaging in sex:
   - A history or risk of miscarriage 
   - A previous preterm birth or other risk factors for preterm birth 
   - Unexplained vaginal bleeding, discharge or cramping
   - Leaking amniotic fluid
   - Placenta previa (when the placenta is low and covers the cervix) 
   - Incompetent cervix (when the cervix is weakened and opens too soon)

If your pregnancy is considered to be high risk, you may need to be more cautious than other women. Your health care provider may advise you to avoid intercourse for all or part of your pregnancy. This is an important conversation to have, so don’t be shy.

But again, for most of us, sex is safe, nothing to fear and may even become a more intimate experience. Many women find that pregnancy makes them want sex more than they did before they became pregnant. This sex drive is caused by hormonal changes. For some women, newfound voluptuousness can play a role in making them feel sexier than ever.

Other women may find that their sex drive comes in waves while pregnant. Here is a link to some common changes you may find throughout your stages of pregnancy.

Overweight and obesity during pregnancy can cause health problems for your baby. You know that it’s not great for your health, but it can affect your baby’s well being, too. While most babies of overweight and obese women are born healthy, problems can include:
• birth defects, including neural tube defects (NTDs) which are defects of the brain and spine
• preterm birth 
• injury, like shoulder dystocia, during birth because the baby is large 
• Death after birth
• Being obese during childhood

Dr. Patrick M. Catalano, a highly renowned obstetrician, professor and researcher has focused on nutrition and metabolic conditions before and during pregnancy and how those conditions affect a fetus’ growth and how much body fat it gains. His research has shown that infants born to obese mothers and mothers who have diabetes are heavier at birth and have a higher risk of developing metabolic disorders, including insulin resistance, a precursor to diabetes.

Dr. Kathleen Maher Rasmussen and her students broke new ground in understanding the threat being overweight at conception has on successful breastfeeding.  We know that breast milk is the best food for babies during the first year of life. It helps them grow healthy and strong. Dr. Rasmussen’s work on over-nutrition found that there is delayed onset of milk secretion and shorter breastfeeding in women who were significantly overweight.

If a woman starts pregnancy at a healthy weight, it can not only lower the risk of preterm birth and birth defects, but can give her baby a healthier start that can have life-long benefits.

So why do women still smoke? Smoking at some point during pregnancy varies widely, from 10% in Canada to 23% in the U.S. and 30% in Spain, according to the March of Dimes 2012 Premature Birth Report Card. Those are huge numbers, which may reflect how hard it is to quit. And since smoking nearly doubles a woman’s risk of having a premature baby, we need everyone’s efforts to help women quit.

Not only is smoking harmful to Mom, it’s also harmful to your baby during pregnancy. When you smoke during pregnancy, your baby is exposed to dangerous chemicals like nicotine, carbon monoxide and tar. These chemicals can lessen the amount of oxygen that your baby gets and oxygen is very important for helping your baby grow healthy. Smoking can also damage your baby’s lungs.

Babies born to women who smoke during pregnancy are more likely to be born prematurely, with birth defects such as cleft lip or palate, and at low birthweight. Babies born prematurely and at low birthweight are at risk of other serious health problems, including lifelong disabilities (such as cerebral palsy, intellectual disabilities and learning problems), and in some cases, death.

Secondhand and thirdhand smoke are proven to be bad for babies’ health. All the more reason for both Moms and Dads to quit. With counseling and social support, smoking cessation programs have yielded a significant reduction in preterm birth.

Want help quitting? Try http://smokefree.gov/.

Join us on Twitter for a chat with U.S. Surgeon General, Dr. Regina Benjamin, on TUES 11/20 at 1pm ET. We’ll be talking about how completing a family health history can help give babies a healthy start in life.  National Family History Day is part of the Surgeon General’s Family Health History Initiative. 

Understanding your family health history is important for everyone, but it’s especially important for pregnant women, new moms or couples thinking about starting a family.  Knowing both parents’ family health histories can help identify risk for genetic conditions, birth defects, or preterm birth.

Follow the chat using #familyhealthhistory and join the conversation by following on Twitter, @marchofdimes or @SGRegina.

Join us on Twitter on Friday November 16th at 3 PM ET to participate in a global relay on premature birth.

Hear from our global network partners: European Foundation for the Care of Newborn Infants (Europe), @EFCNIwecare; Bliss Baby Charity (United Kingdom), @blisscharity; National Premmie Foundation (Australia), @premmfoundation; Little Big Souls International Foundation (Africa), @littlebigsoulsi; and others.

Parents from around the world are encouraged to take part and share their stories. Be sure to use #worldprematurityday to actively participate.

Although the relay chat is on Friday, Saturday November 17th is the actual World Prematurity Day. We will be tweeting and would love to see pictures of preemies from around the world. Please join us then and share your photos on #worldprematurityday.

We’re so close! Three weeks ago with your signatures you helped us launch the White House petition as a symbol of hope for families whose children are born too soon. Just as the March of Dimes and President Roosevelt galvanized America to defeat polio, today millions of March of Dimes volunteers are working to support research and programs to identify the causes of premature birth.

We now are asking you, our volunteers and supporters, to share the opportunity to sign the petition with 10 of your friends and family. If each one of us adds 10 people to the petition, it will succeed. Help to honor babies born prematurely by lighting in purple the birthplace of the March of Dimes: the White House.

The petition can be found at http://1.usa.gov/T0l7ze. Thank you so much!