Preterm Birth: A Public Health Crisis?

PHOTO: Alex Archer had her son three months early and her daughter six weeks early.
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Alex Archer was 20 weeks pregnant when a routine ultrasound turned her life upside-down, literally.

"My cervix was starting to open up," said Archer, 35, recalling the emergency procedure to stitch it shut. "I had to go on strict bed rest, with my head down and my feet in the air."

Archer, who lives in Westchester, N.Y., spent nine weeks in bed worried that the tiniest twitch could trigger a dangerously early delivery.

"It was horrible," she said. "I literally lied there thinking, 'anything could set this off.'"

At 29 weeks, at the advice of her doctors, Archer delivered a 3-pound, 5-ounce baby boy by C-section. He would spend six worrying weeks in neonatal intensive care at a cost of $300,000.

Roughly 12 percent of American babies are born before 37 weeks gestation, a new study found, landing the U.S. in sixth place behind India, Nigeria and Pakistan when it comes to preterm births.

"Urgent attention is needed to better understand and reduce these rates of preterm birth," the study authors wrote in their report, published Thursday in The Lancet.

More than half of babies born at 25 weeks or sooner survive in the U.S., thanks to cutting edge care. But it costs the country upward of $26.2 billion a year, or $51,600 per preterm infant, according to an editorial accompanying the study.

"The economic burden from preterm birth is, of course, of less importance than human suffering, but is far from insignificant," wrote Dr. Nils-Halvdan Morken of the University of Bergen and Haukeland University Hospital. "Preterm birth not only results in economic burdens due to initial neonatal treatment, but also in substantial costs to health services after discharge from the neonatal unit, culminating in an immense burden on health, education, and social services, and on affected families."

Babies born at 27 weeks or sooner are 10 times more likely to have intellectual disabilities and 80 times more likely to have cerebral palsy, according to Morken.

"Clearly, the implications go far beyond the immediate obstetric and neonatal outcomes and profoundly affect the everyday lives of affected infants, adolescents, men, and women," he wrote.

But some preterm births are spontaneous and impossible to avoid. Others are provider initiated, meaning a doctor decides it's best for both mom and baby.

"In some cases, the baby needs to come out. It would be worse for them to stay in," Dr. Marjorie Greenfield, division chief of general obstetrics and gynecology at University Hospitals Case Medical Center in Cleveland. "The medical team needs to weigh the risks and the benefits."

But for Archer, the advice from her medical team was hard to swallow.

"I felt so guilty," she said, recalling the feeling that her body had betrayed her. "I was like, 'What did I do wrong?"

Archer's son, now 4, is perfectly healthy. So is her daughter, 2, who was born six weeks early.

"When we found out I was pregnant again, I was so scared," she said, describing a repeat of the stitched cervix and strict bed rest – a break from her job as a physician's assistant that she used to study for her MBA. "But the kids, thank God, they're both doing pretty well."

Although Archer's insurance covered the cost of her kids' care, she said she would have taken out a loan.

"You do whatever you need to do for your baby and kind of push the thought of money aside," she said. "On other hand, being in health care, I understand the cost is astronomical, and it is a problem."

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