On January 6, 2011, happily pregnant, I went to get an ultrasound. I left the office in tears, having been told that my cervix was shorter and more open than it should be and that I was in danger of delivering early, which at 20 weeks and 2 days, meant certain death for my baby.
Of all the normally formed infants who die, most of them, sixty to eighty, percent die simply because they were born too early. A normal pregnancy lasts 40 weeks and prematurity is defined as birth at less than 37 weeks. For those pregnancies that make it to 23 weeks, only about one third will survive; of those babies delivered at 25 weeks, half of them will survive; and, of those babies delivered at 29 weeks about 90% will live.
Unfortunately, depending on how early they are born, premature babies can have :
*poorly formed lungs (bronchopulmonary dysplasia),
*lungs that don’t inflate (respiratory distress syndrome),
*damaged bowels (necrotizing enterocolitis),
*bleeding in the brain (intraventricular hemorrhage),
*and underdeveloped eyes (retinopathy of prematurity).
Given the seriousness of prematurity, researchers have tried to identify those women who are most at risk. Women who have had a previous preterm delivery are more than twice as like to delivery the next baby early. Infection in the amniotic sack (the sack where the babies grow and develop) has been shown to be a major reason why women deliver early, especial those who deliver at less than 25 weeks. Black women are twice as likely than white to experience a preterm birth. And, since one third of births occur after the spontaneous rupture of the amniotic sack, it is important to mention that smoking is a big culprit because nicotine weakens the amniotic membranes. Also, women who get infections in other parts of the body like appendicitis, pneumonia, cholecystitis (infection of the gallbladder), or pyelonephritis (infection in the kidneys) also have an increase risk of delivering early. Certainly, women who are carrying twins or triplets are more likely to deliver early.
Because many pregnant women have pelvic pain, cramping and occasional contractions, it is difficult to determine who is really at risk for preterm delivery. (I had contractions but assumed that I just needed more hydration and rest.) Physicians can check for fetal fibronectin, the absence of this biochemical marker can predict 90% of the time that delivery will not occur for at least seven days. The length of the cervix as measured by an ultrasound also helps us to determine who is at risk—the shorter the cervix, the higher the chances of preterm delivery.
With this forecast, doctors can take steps to prolong pregnancy and reduce the severity of lung disease in premature babies. For women who have had a preterm birth or those whose cervix has measured short, a cerclage—a stitch around the cervix—can be placed. In recent years, a hormone called progesterone has shown to help prevent preterm labor. Once contractions start and if the patient is at least 24 weeks, an IV medication called Magnesium Sulfate is used to prevent delivery for at least 48hrs, long enough to allow for the administration of steroids. Steroids will help babies’ lungs mature faster. Before 24 weeks, many doctors will use a medication called Indomethacin to stop cramping.
So, I was put on bed rest, given antibiotics, Indomethacin and started on weekly progesterone injections. My doctors decided not to place a cerclage. Every three weeks I had the length of my cervix measured by ultrasound. I was relieved each time I was told the cervix was not getting worse but fell apart when my fetal fibronectin was positive (a positive result only predicts delivery 23% of the time). I received steroids in preparation for a premature birth. At the end of the most intense emotional roller coaster ride of my life, I delivered the most beautiful baby I had ever seen, my son Cole, at 38 weeks.
To my doctors, a heart felt thank you; to friends/family who shoveled snow, sat with me, brought me food and movies, who drove hours to go with me to the doctor, who called daily, I will never forget your kindness and I appreciate you more than words can express. To my son, I thank you for renewing my faith in God.
There you have it. Now spread the word.