Coping with the risks of premature delivery

In this story: Risks of second births Facing the possibility again New advances, but still far to go A happy ending RELATEDS

(WebMD) -- Nan Highstreet's pregnancy seemed to be going smoothly. But a routine exam at six months revealed that her cervix was starting to dilate. One week later, Nan woke up in a puddle. Her water had broken, threatening her baby's life.

Two days later, her son Matthew came into the world, weighing a mere 1 pound, 12 ounces, after just 24 weeks of development. He was too small to go home and remained in the neonatal intensive care unit (NICU), where Nan tended to him 12 hours a day for the next three months. Each day brought a roller-coaster ride of emotions for Nan and her husband, Allen; the baby would do well, then take a turn for the worse, then recover again -- all in a matter of hours.

After finally bringing Matt home, the Highstreets, much like other parents of premature infants, struggled with the decision to have another baby. They knew that a premature birth -- and the emotional trauma that goes along with it -- could happen again.

They had legitimate reason for concern. About 10 percent of births are premature among white women in the United States; the figure is 20 percent among black women. A woman's chances of having a subsequent preterm birth increase by two to four times, according to a study released by the Centers for Disease Control and Prevention (CDC) in March 2000. And if a preterm birth occurs at 31 weeks or less, or when a woman is under the age of 18, the chance that it'll happen again is even higher.

The good news is that, even though a woman's risk increases, she's in fact more likely to have a normal birth than a preterm birth the second time around, says Melissa Adams, Ph.D., the researcher who led the CDC study. "The study showed that the odds favor a full-term birth even in women at highest risk for a preterm delivery," she says.

Still, a second preterm birth can happen. And when it does, parents face a slew of medical problems. Nearly all the organs needed for survival -- including the lungs, heart, brain, liver, kidneys, digestive system and skin -- are dangerously undeveloped, says Dr. Maha Amr-El Meligy, a neonatologist at Valley Presbyterian Hospital in Van Nuys, California.

"These babies are completely unprepared to live in the outside world," she says. There's simply no substitute for a mother's womb.

Outside the womb, preemies like Matt must struggle to survive. With firsthand experience of this, the Highstreets did plenty of soul-searching and praying in making their decision to have another child. In the end they chose to go ahead, supported by reassurances from their doctor that he would closely monitor the pregnancy. Their daughter Jane was born a healthy full-term infant, weighing in at over six pounds. Mother and baby were able to leave the hospital together just 48 hours after the delivery.

The experience boosted the couple's confidence, and they looked forward to having a third child, problem-free. But it wasn't to be. At 22 weeks, Nan again woke up in a puddle of water. "It was the worst deja vu you could ever imagine," she says. "We were devastated, because this time we knew what was ahead."

Her doctor did what he could to delay the delivery as long as possible. Yet two weeks later, when tiny Christine was born into the world with a single push, she weighed a scant 1 pound, 2 ounces. Six years after bringing Matt home, Nan and Allen were again back in the NICU.

Unfortunately, little can be done to prevent preterm births like Christine's, because doctors haven't yet pinpointed the cause, says Dr. Michael Plevyak, a fetal-maternal specialist. Instead, scientists have directed their energies toward saving the babies when such births do occur.

The field of neonatology has seen significant advances since Matthew's birth, especially in dealing with one of the most urgent problems preemies face -- underdeveloped lungs. Doctors have introduced steroid treatments to help accelerate lung growth and a compound known as surfactant to replace what isn't produced in sufficient quantities by premature babies' lungs.

These and other advances have been very successful in keeping more preemies alive. However, many of these infants continue to face the possibility of other serious long-term health problems like brain damage, mental retardation, cerebral palsy and blindness, says Amr-El Meligy.

"We can save smaller and smaller babies, which seems heroic," she says, "but we as medical professionals know that their futures may be difficult. As hard as we try, we can't always prevent these problems."

Fortunately, both Matt and Christine escaped such health problems, despite the enormous odds against them. Matt, now 13, is a straight "A" student and actively involved in sports. Christine, now 8, has just finished the second grade and loves ballet, playing dress-up, and tea parties. Nan says she feels blessed. "When they were born, I knew the risks. I was fully prepared for a motherhood of wheelchairs, 'special ed,' and extra care," she says. "It is unbelievable for me to see them so healthy today. I feel it's truly a miracle."

Even though the Highstreets would have liked to have more children, they decided against it. Now, with Allen's urging, Nan volunteers her time to Special Care Parents, a group that supports couples while their infants are in intensive care. She uses her own experiences to reassure anxious parents and helps them realize, as she has, that "there will be life after the NICU."

© 2000 Healtheon/WebMD. All rights reserved.

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Risk of a second premature birth is low for most women
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Pregnancy and preterm labor

Coalition for Positive Outcomes in Pregnancy
Centers for Disease Control and Prevention's Reproductive Health Information Source

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