How to reduce risks of premature birth

Tara Federly had done everything she was supposed to do during pregnancy. She kept up with prenatal doctor visits, took prenatal vitamins and followed a healthy diet. At just 24 weeks pregnancy, however, she began having extreme abdominal pain. A physician and a mother, she knew it was too early to have her baby.

"I called my husband and he rushed me to labor and delivery. Within 20 minutes, my daughter was born," said Federly, of Norwalk.

Weighing only 1 pound 6 ounces, baby Taylor remained in the Neonatal Intensive Care Unit at Blank Children's Hospital for 141 days. The Federlys' older son, Samuel, was only 15 months at the time, so they split time between the hospital and home.

Federly had suffered placental abruption, where the placenta detaches from the wall of the uterus. There's not a lot of warning and often times, delivery is the only way to save the baby, she said. The condition can be caused by trauma, such as a car accident. But that was not the case for Federly. Providers are unsure what caused the problem.

"I'd had an OB visit a couple days before and everything was going great. It was very abrupt," she said.

Federly's older child was born through cesarean because he was a big baby, but she had no other complications during her first pregnancy. In fact, her son was born a few days after term.

Premature birth – delivering before 37 weeks pregnancy – can happen to any mother, including those who have taken steps to provide a healthy start for their babies. Nearly 12 percent of babies are born premature and the March of Dimes notes that more than half of those occur spontaneously.

In Iowa, more than 4,600 babies are born premature, according to the state chapter of the March of Dimes. In its annual Premature Birth Report Card issued this month, the group issued Iowa a grade of "B" for its preterm birth rate of 11.1 percent. The goal nationally is to reach 9.6 percent or less by 2020.

Michelle Gogerty, state director of programs, advocacy and government affairs with the group's Iowa chapter, said state leaders are focusing on three areas:

• Reducing preterm births, including eliminating early elective deliveries prior to 39 weeks gestation.

• Reducing health care disparities, including health insurance coverage and meeting cultural diversity needs.

• Improving behaviors, including smoking cessation, avoiding alcohol during pregnancy, keeping prenatal visits and eating healthy.

Iowa's success was built from a 2012 statewide obstetrical task force formed in response to the need to eliminate early elective deliveries. The March of Dimes, the Iowa Department of Public Health and the Iowa Health Care Collaborative were key players and have continued meeting.

"One of the reasons Iowa is so progressive and we're doing so well is because we've pooled resources and shared recommendations and best practices," Gogerty said.

Dr. Paul Gisi, medical director for obstetrics and gynecology at UnityPoint Clinics, said women can follow a few tips to decrease the risk of going into preterm labor:

• Seeking early prenatal care.

• Gaining the appropriate amount of weight during pregnancy.

• Not smoking.

• Spacing pregnancies by 12 months.

Even healthy moms can have a preterm birth without an apparent cause or prior indication, Gisi said. He educates patients about preterm labor symptoms so mothers can notify providers early on if problems occur.

The March of Dimes notes that more research is needed to understand all factors contributing to premature birth. Four major research initiatives, using $250 million in funding, are underway to identify the unknown causes of prematurity and find effective ways to prevent or delay preterm births.

In the meantime, research and medical advancements have boosted survival rates of premature infants.

Like other micropreemies, Taylor directly benefitted from the March of Dimes, which funded research to develop surfactant therapy in the '90s. Surfactant, a protein in the lungs, helps keep the lungs or small airways open, preventing them from collapsing. Preemies don't make enough surfactant on their own, so the substance is given through a breathing tube to allow the lungs to work.

"Taylor really survived because of research that was done by the March of Dimes. That saved her life and we're grateful to all the research they're doing for prematurity," Federly said.

When Taylor was born, she could fit in the palm of her father's hand. She was unable to breathe on her own and was on a ventilator for two months. She also had brain bleeding, sepsis and pneumonia. When she was released, she had grown to nearly 9 pounds. She went home on oxygen and needed a gastrostomy tube because she was unable to use a bottle for all her feedings.

Parents of preemies are told to wait until their children are two years old and have met their developmental milestones to determine if there may be any long-term health concerns.

Now 14 months old, Taylor is a growing toddler. She's doing fine developmentally, but is slightly delayed in pulling herself up and crawling. She's also managing reflux, so still depends on a gastrostomy tube and sees a speech therapist to work on feeding issues.

"They're hopeful she doesn't have any major delays that she won't overcome. It will just take her a little longer to meet her milestones," Federly said.

If pregnancy does result in premature birth for a family, she advised the parents to remember to take care of themselves during those long weeks in the NICU.

"It's so hard. As a mother, you always want to take care of your children first. But having a premature baby, it's so stressful. They look to you for support and strength and you have to keep hope. There are so many organizations, including the March of Dimes, that are doing research to help prevent this. You have to keep the faith that things will work out," she said.

Watch a video of the Federly's prematurity story at DesMoinesRegister.com

Premature birth risk factors

• Previous preterm birth.

• On average, African American women are about 60 percent more likely to have a premature baby compared to white women. The cause for this is unknown and the focus of research.

• Carrying more than one baby (twins, triplets, or more).

• Problems with the uterus or cervix.

• Chronic health problems in the mother, such as high blood pressure, diabetes and clotting disorders.

• Certain infections during pregnancy.

• Cigarette smoking, alcohol use or illicit drug use during pregnancy.

Source: Centers for Disease Control and Prevention