The March of Dimes released this year’s Prematurity Report Card with a state by state breakdown this week. More than half a million babies in in the United States are born too soon. The United Sates as a whole rates as a C and only one, ONE state received an A rating.

How is this even possible in this day & age?

Why is this happening?

Consider the following:

• Too many mothers are uninsured or underinsured and as a result don’t receive adequate prenatal care.
• Fully one third of births in the United States are surgical births. The rate of cesarean births continues to rise every year.
• The rate of early inductions is also rising.
• Overuse of testing, especially late in pregnancy, resulting in more medically managed, earlier births.
• There is not enough access to VBACs (Vaginal Birth After Cesarean).
• There are not enough midwives to manage healthy women during their pregnancy & birth.
• Anecdotal rather than evidence based information is being disseminated. One look at My OB Said What? gives you only a taste of what’s being said out there.
• Many due dates are off and babies are being born at 36-37 weeks when the care provider thought the baby was 38-40 weeks.
• The are more families having problems conceiving and thus are having to use a fertility specialist. These pregnancies often result in multiple births and many birth early & need time in the NICU.

The two most common reasons I hear for birthing a baby early are gestational age and size of the baby.

Despite the fact that a “term” pregnancy is considered 37-42 weeks, even waiting until 38 or especially 39 weeks to induce reduces the incidence of prematurity and allows the baby’s systems to fully mature. A week or two makes a huge difference even that late in pregnancy. Just because a woman reaches 40 weeks doesn’t mean that her time is up either & she must be induced or have a cesarean unless there is some legitimate medical reason.

A “big baby” is not a reason to birth a baby early. Ultrasound images can be up to 2 pounds off on either side of the reading. I hear so many women say their doctor said they couldn’t birth this baby because it is too big only to find the baby was a mere 6 or 7 pounds, not the 9 or 10 that it was thought to be. So the baby was born too early & can have complications solely based on a weight guess. Later many of these same women birth larger babies. And tiny women can birth 9, 10 even 11 pound babies. And no, they don’t all have traumatic births. When did our bodies change so much that we are no longer able to birth our children?

Prematurity brings with it a whole host of problems from immature lungs to problematic breastfeeding. When a baby is in the NICU can create a disconnect between the baby and it’s parents creating further issues once the baby is allowed to come home. It also causes emotional and financial hardship on the family.

So what can we do to help prevent the rate of premature births from continuing to rise?

• Educate yourself – Know what a normal pregnancy, labor and birth look like.
• Have faith in your body – Many women are told their bodies are not capable of birth. Big Red BS flag flying there.
• Get a second opinion or change to a new, supportive provider even if you are in your 39th weeks of pregnancy. Yes you can.
• Have a supportive birth team. Hire a knowledgeable doula.
• Know your options. If a provider is suggesting you need to be induced or need a cesarean ask “Why?” And then ask, “How?”, know your options and don’t settle just for what your provider says, there may be more available that would be better for you. And then ask, “When does this decision need to be made?” Use BRAIN analysis – Benefits, Risks, Alternatives, Intuition (what does it tell you), (what if I) do Nothing
• Same questions for testing. “Is is necessary?” “What will the results tell us?” “How will this affect my birth?” Again, use BRAIN.

Of course there is a time and a place for intervention and high risk care, but there is also a time and a place to just let a woman be to birth her baby.