Sunday, May 2, 2010
I used to hear the term 'late preterm' and wonder, what are they talking about? Now I know all too well. Now that I've had a week to ruminate about the speaker last Saturday at the birth conference (not Ina Mae, the neonatologist, or was she a perinatologist, I can't recall). Anyway, she gave the most compelling presentation on late pretermers, that is babies born between 34 and 37 weeks pregnancy. Almost all the students that come into my classroom thinks that 37 weeks is full term. Some think 36 weeks is. How can this be? Easy, when our casual practice of inducing every woman anytime after her 36th week of pregnancy for every reason imaginable has made preterm birth commonplace. Even the March of Dimes is finally going after physicians for it's massive social induction rates. It's absolutely startling that folks are beginning to forget that babies need 38-42 weeks to gestate. I quiz every class of students about how long a normal pregnancy should be- and I always hear 36 or 37 weeks. These babies are actually premature, and belong in a class known as 'late preterm.' The speaker spoke compellingly about how these babies may be endangered by the fact that they appear physically mature, and as a result monitoring things like respiratory status, thermoregulation, serum glucose and other measures of neonatal wellbeing may not be as diligent. There is no doubt as to the cause of the spike in preterm deliveries. The culprit is inductions. Women have become intolerant of their pregnancies. Physicians can't resist the ability to jumpstart labors for the least provocation, sometimes for no provocation at all! All this belies the fact that babies still need the same amout of gestation time that they always have. Having babies be born prematurely for any reason other than medical imperative should be considered unethical. Yet it is so common, the practice of induction has slowly but surely redefined the public perception of what constitutes, 'full term pregnancy.' Many women now consider the presence of a NICU an important consideration in selecting a birthing facility. Well if they submit to induction technologies used prior to the start of true labor, they are probably going to need one.