Why is the rate of premature babies higher in the U.S. than any other industrialized nation?

John Fisher
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Stopping Medical Injustice
The U.S. preterm birth rate of 12.3% is the highest in industrialized countries and slightly higher than Africa's 11.9%, according to a new study in the Bulletin of the World Health Organizations.  Is this a problem that should concern you? YES!

First the basics: Forty weeks is full gestation for a newborn and babies are considered premature when born before 37 weeks' gestation.  About 70% of premature babies are born from 34 to 36 weeks' gestation, which is considered late preterm. Prematurity is the leading cause of death of newborns and premature babies face higher risks of intellectual disabilities, vision and hearing loss and other health problems.

The problem for premature babies is that their organs, such as their liver and kidney, are not fully developed and as such, their organs do not function at their normal capacity. With underdeveloped organs, "premies" are susceptible to health problems that a full term newborn would not have.

For example, newborns may have abnormal levels of a toxin known as bilirubin, which can cause brain damage, also known as kernicterus, if the toxin is not eliminated by the liver.  Full term newborns can process relatively high levels of bilirubin without any damage to the brain because their livers are fully developed and function at normal capacity.  However, a premature newborn has an under-developed liver and their liver does not process and eliminate bilirubin as it would in a full-term newborn. With a premature newborn, excessive levels of bilirubin are eliminated by the liver and they not can cause a form of cerebral palsy known as athetoid cerebral palsy.  It is for this reason, among others, that physicians want to prolong the pregnancy until the baby is close to full term.

The U.S.'s rate of 12.3% is almost double that of Europe's rate of 6.2% and every year more than half a million babies are born prematurely in the US costing the country roughly $26 billion in medical. (March of Dimes Perinatal Data Center)

In view of this serious problem, the question must be asked: Why does the United States have the highest rate of babies born prematurely than any other industrialized country?  Jennifer Howse, president of the March of Dimes, attributes the high rate of premature babies in the U.S. to high rates of cesarean section, smoking among pregnant women and a large number of labor inductions before 39 weeks. Is the fear of litigation causing obstetricians to deliver babies before 39 weeks' gestation?  Are obstetricians needlessly performing C-sections resulting in a disproporationately high number of premature babies?  This is a major heath problem in this country and the questions must be addressed.

You might ask: Why would an obstetrician induce labor for the mother of a preterm baby?  Why would an obstetrician perform a C-section for the mother of a premature baby?  The answer is simple: the obstetrician believes that there is an abnormality with the baby, such as ominous fetal heart tracings, that justifies the delivery of the baby, even with the risks attendant with a premature newborn. In many cases, if the baby is not delivered immediately with a cesarean section or labor is not induced, the baby will be stillborn or risks serious brain damage that can be caused by lack of oxygen to the baby.  The obstetrician believes that the C-section or induction of labor is the best way save the preterm baby's life or minimize the risk of brain damage and neurological handicaps.

It is an worthwhile goal to reduce the number of preterm babies, but more importantly, obstetricians should refuse to let the statistics about preterm babies get in the way of their focus of ensuring a healthy baby, whether preterm or not. Before you blame the "malpractice crisis" and malpractice lawyers for the US's high rate of preterm newborns, get all of the facts. 


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