Myths about preterm birth

Giving birth to a premature baby is a nightmare that parents do not want to experience.

Why should a parent be worried about a premature birth? Is there medication to stop pre-term births?

Two obstetrician gynaecologist respond to common concerns expectant women have about pre-term births.

What is pre-term birth?

It is the delivery of a baby before 37 weeks of pregnancy. Babies are supposed to be born between 37–40 weeks.

What causes one to deliver a pre-term baby?

In most cases, the cause of pre-term birth is unknown. However, some factors could increase the chances of one getting a premature baby.

—Age of the mother: If a pregnant woman is less than 25 years and more than 35 years.

—Lack of some nutrients in food.

— Biological factors such as genetics, infections, non-communicable diseases, obesity, and substance abuse.

—Exposure to environmental toxins, household pollution, and smoke.

—Stress, psychological distress, depression, and anxiety.

In some cases, a doctor may opt for early delivery if a mother has high blood pressure or diabetes or other medical condition necessitating early delivery of baby, for example, twin pregnancy.

Can causes be identified early and managed?

Yes and No. Yes in the sense that prevention of pre-term birth is possible, to some extent. Good health before getting pregnant is encouraged. This is called preconception care.

—Eat a balanced diet and supplement with micro-nutrients.

—Go for screening for infections including sexually transmitted illnesses.

—Avoid harmful substances like cigarettes, shisha, bhang, and alcohol.

—Protect your mental well-being

—Ensure that you are not overweight

—Space your births at least more than 24 months.

—Have a doctor review any long term illnesses or medications before you get pregnant.

—Start prenatal care early and follow up on a referral to specialised doctors to reduce the chances of you getting a pre-term baby.

Is there an increase in the number of pre-term deliveries?

We are seeing an increase worldwide with certain countries being more affected than others.

In Kenya, the pre-term birth rate was estimated to be 12 per 100 live births in 2014, this could have increased up to rates of 14 per 100 live births, according to recent studies.

There are many determinants of pre-term birth including limited access to quality pregnancy care for mothers in low and middle-income countries, nutritional challenges before and during pregnancy, increased burden of infectious diseases, and a recent increase in diseases such as diabetes and hypertension. Additionally, adolescent pregnancies and short birth intervals (less than 24 months) could be contributing to the observed increase in rates of pre-term birth.

As a pre-term mother, what challenges I’m I likely to experience?

Every mother’s dream is to have a healthy baby, delivered normally. Hence when a baby is born pre-term, the mother gets psychologically affected and struggles to find the reason why it happened. This can lead to poor health for the mother with physical, emotional, and mental consequences. Babies born prematurely will require extra care both in hospital (intensive care, medicines, special feeds, repeat hospital visits) and at home (feeds, warmth, infection prevention, special care in case of disabilities) and this will cause economic and social exhaustion both for the mother and her family.

Will my pre-term baby survive?

Survival depends on how many months the baby is and whether a hospital is equipped enough to take care of the pre-term baby.

The odds of survival when a baby is born at less than 28 weeks of pregnancy (less than 1 kg baby) is low compared to a baby born between 32 and 37 weeks of gestation (1.8kg to 2.5kg baby). In developed countries, 80 to 90 percent of babies born pre-term are likely to survive as compared to only 10 to 20 percent in developing countries.

Lack of quality care during labour, delivery, and while in hospital contributes to low survival rates. Simple inexpensive interventions such as Kangaroo Mother Care can improve the survival of babies born pre-term.

What complications are pre-term babies born with?

Pre-term babies are at a higher risk of dying at birth and up to a few weeks thereafter. Pre-terms also will suffer a wide variety of short-term and long-term challenges. They experience difficulties in breathing and feeding, infections, seizures with long-term challenges including cerebral palsy, abnormal growth of lungs, visual, hearing, and learning problems.

Research has also demonstrated problems later on in childhood such as allergies, attention deficiency disorders. In adulthood, they tend to have asthma, heart disease, diabetes, and behavioural and socio-emotional difficulties.

If I have a pre-term delivery, will I have a repeat in my subsequent deliveries?

It is not given that you will get pre-term babies in subsequent deliveries but you have a slightly higher chance compared to a woman who has given birth to a term baby.

There is a 15 percent chance of giving birth to a pre-term baby in the next pregnancy but an 85 percent chance that you will deliver a term baby.

Is care for pre-term babies available locally?

Yes. For instance, Aga Khan University Hospital has the expertise and infrastructure to manage both very early pre-term births and late pre-term births. There is a specialised team of paediatric neonatologists, nurses, and auxiliary staff, working in a neo-natal care unit with cutting-edge technology.

Prof. Temmerman is the chair at the Department of Obstetrics and Gynaecology and director of the East Africa Centre of Excellence in Women and Child Health.

Dr Musana is a consultant obstetrician gynaecologist at Aga Khan University Hospital