Premature Births Among Infants 12
Premature Births among Infants:
The Immediate and Lasting Impacts
Wood, Allison
Concordia University, Nebraska
Each year, 500,000 babies are born prematurely, or prior to 37 weeks of pregnancy (nlm.nih.gov). The prevalence of this can be due in part to the mother’s actions being unable to carry the baby to gestation or other unknown factors that can contribute to an early birth and the potential for a number of effects toward the baby immediately following birth as well as later in life.
Systemic and intrauterine infections and inflammation (which are responsible for a majority of extremely preterm births), stress, uteroplacental thrombosis and intrauterine vascular lesions associated with fetal stress or decidual hemorrhage, uterine over distension, and cervical insufficiency are all biological reasons and molecular characteristics that may contribute to preterm birth. Additionally; traumatic events and stress to both mother and baby can also play roles (ncbi.gov, 2007).
My mother, although it was never fully determined what caused my birth prior to 26 weeks gestation, is believed to have had a placental abruption. The placenta is an organ that develops inside the uterus to provide food and oxygen for the growing baby. Placenta separates typically after the baby is born, and if the separation occurs prior to the birth of the baby, complications can occur for mother and the infant (health.utah.gov).
As a result of being born at such an early gestation, I had an extensive hospital stay in the Neonatal Intensive Care Unit, patent ("open") ductus arteriosus requiring surgery, hydrocephalus requiring a series of endoscopic third ventriculostomy surgeries and imaging tests until my teenage years (aboutkidshealth.ca, 2009), bronchopulmonary dysplasia requiring oxygen therapy, as most infants who encounter this particular problem are born more than 10 weeks before their due dates, weigh less than 2 pounds (about 1,000 grams) at birth, and have breathing problems (nhlbi.gov). I was born more than 10 weeks prior to my due date, weighed 2.9 pounds at birth (while dropping to 1 lb. 15oz. shortly after birth) and encountered a number of challenges, although my mother did not have any known contributing factors to delivering a preterm infant.
The statistical data was gathered surrounding premature births among infants primarily through vital records and data collection on the federal level; by the National Center for Health Statistics especially the Behavioral Risk Factor Surveillance Survey for mothers of preterm infants, Child Trends Analysis, Peristats etc. Looking at U.S. vital statistics data on nearly 20 million single, live births from 2005 to 2012; the early delivery rate fell more than 15 percent during that time (nlm.nih.gov, 2014). Biostatistical data is used to track information that is relevant to mothers who give birth to preterm babies; to follow and determine why this may occur, what is done and what outcomes may happen as time passes. Data such as this shows what happens to the babies born early as they age; what the morbidity or mortality rate might be for these infants, and what impact that may have within their lives.
On a broader, global scale, 40% of under-five deaths are in newborns. Over 60% of preterm births occur in Africa and South Asia and occurring in these same locations are over 80% of the world’s 1.1 million deaths due to preterm birth complications. Of the 11 countries with preterm birth rates of over 15%, all but two are in sub-Saharan Africa. In the poorest countries, on average, 12% of babies are born too soon compared with 9% in higher-income countries (who.int, 2012).
Due to premature birth there can be a number of short term effects among infants: breathing problems, heart problems, brain problems, body temperature control problems, gastrointestinal problems, blood problems, problems with metabolism and their immune system. The long term effects can include: Cerebral Palsy, impaired cognitive skills, hearing and vision problems, dental problems, behavioral and psychological problems and chronic, continual health concerns and issues. For the mother, giving birth prior to full gestation is cause for health risks and additional significance for her during the pregnancy and labor. This can include: polyhydramnios or preeclampsia (mayoclinic.org, 2011).
Biostatistical information allows public health staff to follow these high risk babies as they grow and potentially encounter challenges early or later in life; in the long term. Through this information, more ideas and insights can be formed about how and why babies are born preterm and what influence their early and often difficult start may signify as they age and progress.
Premature birth among infants is directly connected to social and behavioral factors involving the mother while she is pregnant. All that a mother does (or does not do) has the potential to harm the unborn baby or help it to thrive. The health belief model can be related to premature birth as it looks into a number of factors that will shed light on whether a mother will be likely to change her behavior for her own health benefit and/or that of her unborn child. The extent to which the individual feels vulnerable to the threat, the perceived severity of the threat, the perceived barriers to taking action to reduce the risk, and the perceived effectiveness of taking an action to prevent or minimize the problem (Schneider, 2014). Smoking and exposure to second-hand smoke, hypertension, diabetes, overweight and obesity, unintended pregnancies, stress, asthma, and perinatal depression are all maternal risk factors and lifestyle choices contributing to infant mortality or other poor birth outcomes such as prematurity among infants (scdhec.gov, 2013).
A mother’s actions and care greatly impact the result of her pregnancy and the impact on her unborn child. If a mother exhibits unhealthy behaviors; alcohol, smoking, poor nutrition and overall lifestyle habits her baby is more likely to be born preterm (nap.edu, 2007). There are other circumstances that are relatively beyond the mothers control in regards to state of her cervix, her age and her ability to carry a baby to full term- all potentially unbeknownst to her. Mothers are absolutely responsible for their decision to have a baby, but there is not a way to know risks that may be associated with a mother’s age, whether older or younger, as all situations can vary or have differing outcomes.
If a mother does not receive prenatal care and nutrition she can be at risk for any of these outcomes or effects. The mother may not realize she is vulnerable to putting her baby at risk, to what extent this may be, she may not feel adequately equipped to address these risks, or could potentially feel that the changes she may make might not have any influence on changing the health or birth outcome for her child. The mother may also participate in risky behavior such as drug, alcohol or tobacco use that can greatly impact the outcome of her baby’s birth.
She may not have an awareness of the need for proper nutrition, supplements- vitamins and minerals, physical activity or low stress to promote healthy growth in her baby, and allow her to carry to full term (ncbi.gov, 2014). She may not anticipate the risks that are posed to her child by taking part in these behaviors, she may not identify the level of risk to which she is subjecting her child, she may feel or be unable to stop these behaviors or may not see the immediate benefits from changing her behaviors or potentially feel that her child is already at risk, so there is not a need to discontinue such behaviors.
Social support and Socioeconomic status can all be a part to the mother’s overall health and wellbeing; and in turn, that of the infant. Lack of social support or low socioeconomic status can compound any of the factors mentioned prior and contribute further to premature birth among infants (oxfordjournals.org, 2003). Social supports and socioeconomic status can be tied to interpersonal and intrapersonal factors as well as community factors as highlighted within the ecological model of health behavior (Schneider, 2014).
Risk factors for premature births among infants include first and foremost; prenatal care and subsequent maternal behaviors as well as awareness among the population. Much of the focus within the United States is on tertiary prevention, “aimed at improving the outcomes for infants born prematurely and requiring expensive use of neonatal intensive care (Schneider, 2014).” African American babies and those babies with mothers within a low socio-economic status have a higher prevalence of being born early (marchofdimes.org, 2014).
There are additional elements that may add to the potential for pre-term, or premature, births. These can include, but are not limited to: previous premature deliveries, multiple births, obesity, diabetes and bacterial infections. There is also the possibly 50% of premature infants born to mothers who are not otherwise at high risk levels (Pfizer, 2006). There are also those mothers who have complications with their cervix that prevents a full-term pregnancy; this can include a shortened cervix or what is otherwise known as an “incompetent” cervix (nih.gov, 2007).
I myself was a born prematurely as one among that percentage; that potential 50%. There was no indication my mother was at a level of high risk. She received prenatal care, had no risk factors present as mentioned above, and it is still unclear as to why I was born prior to 26 weeks, at a low birth weight, with a host of complications that all required an initial stay of almost 8 months in a neonatal intensive care unit as well as a return stay in the hospital a few short weeks later upon my return home for additional months. At the time of my birth there were two other infants born pre-term in the same gestation and weight-range as myself; both from the same (population approximately 1,100) rural, Maine town in which my family resided. All three of us were born to mothers with no clear indicators that they were at risk of delivery prematurely.
I can also identify the challenge of proximity to services that was difficult for my family upon my birth and throughout my hospital stay; and continued need for specialist appointments. When I was in the hospital throughout the first year, my family had to travel over an hour to check on me, feed me and visit. I was fortunate that my family was supported by family and friends within the community to do so and had adequate insurance with which the majority of my care was covered. There are 37 hospitals in Maine; with 15 hospitals identified by the Flex Monitoring Team as Critical Access Hospitals. There are 39 Rural Health Clinics in Maine, and 18 Federally Qualified Health Centers provide services at 108 sites in the state (raconline.org, 2013).
Many of these hospitals were not or are not equipped to deliver critical care babies, which can also play a role in the survival and thriving of an infant born prematurely. If a mother or baby is not able to receive the care needed because of distance to the hospital, this can pose an additional challenge to a baby born too soon, fighting for life. The visitation of family and the ability for the mother to breast feed her infant can be a positive experience and boost the baby’s immunity by providing additional antibody proteins, fats and minerals which can help their bodies fight further infection and gain strength (nhs.uk, 2013).
There is the question as to whether infant mortality falls into the realm of a health problem or a social problem; according to Introduction to Public Health (Schneider, 2014). Environmental, nutritional, behavioral, medical and social elements are all said to play a role in early infant births. At-risk mothers are more likely to live in impoverished circumstances and not receive the same care as mothers of higher socio-economic status. There may be a gap in knowledge, accessibility, availability, and financial stability for mothers more likely to deliver pre-term babies. An increase in the use of drugs, alcohol or smoking is generally more common to mothers who reside in poor neighborhoods, although these activities and subsequent risks can also occur among affluent women (Schneider, 2014).
Premature birth among infants is a great public health problem for its proximal impact on the lives of the children and their families but also for the resources necessary to get and keep the babies healthy and well throughout their lives. The high prevalence and costs of prematurity have captured the attention of policy-makers in many high-income countries, such as the United States (who.int, 2012). In 2007, the Institute of Medicine reported that the costs associated with premature birth in the United States at $26.2 billion each year. This includes: $16.9 billion inmedical and health care costsfor the baby, $1.9 billion in labor and delivery costs for mother, $5.7 billion in lost work and pay for people born prematurely, and $611 million for early intervention services: programs for children from birth to age 3 with disabilities and developmental delays that can occur among children born before full term. These programs help children learn physical, thinking, communicating, social and self-help skills that normally develop before age 3.$1.1 billion was also used for special education services. These services are specially designed for children with disabilities ages 3 through 21; to help children with development and learning (marchofdimes.org, 2014).
Preterm labor occurs for 1 in every 9 births and peaked in 2006 at a rate of 13% of births (nih.gov). Many states in particular, have been increasingly successful in accomplishing a decrease in the number of premature births; gaining further knowledge through research and spreading information and awareness (marchofdimes.org, 2014). A number of steps and developments have been taken to improve the number of preterm births; both in care during pregnancy and post-birth as well as support services on national and international levels. These include, but are not limited to: NIH National Institute of Child Health and Human Development – NICHD, March of Dimes Birth Defects Foundation, PreemieCare (healthfinder.gov) in the United States specifically.