10 Reasons for Preterm Births You (likely) Don't Know About!

As a mom of two premature babies, I have been asked numerous times our kids ages, to which I typically explain (mostly with Lakai) that they were born prematurely thus explaining their corrected/actual ages. Every once and awhile, I get that look when they take in the words “born extremely prematurely”, the look that tells me that they are judging me. No, it’s not paranoia, nor is it my guilt over my kid's early births playing with my mind and emotions. It is the simple fact over time I have come to learn that look means judgement, because of the questions that are asked after the look is given or in the tone in which they are asked.

Before having Lakai I knew very little about premature births, in fact I had a very hard time looking at photographs of premature babies. They simply, scared me. They looked so sick, so frail, and I had very little knowledge of how a premature birth happens except for the causes that are surrounded by negative stigmas. Smoking, drugs, drinking, poor prenatal care and poverty. There is very little public awareness regarding preterm births, the media rarely covers premature births beyond celebrating when extremely small babies come home from the NICU or when something goes terribly wrong such as families battling hospitals about keeping their child on life support or not.

In the end it’s hardly fair to blame people who give that look, for what they might be thinking about us when they learn our kids were premature. But that does not mean the judgement is not painful, especially because we are our harshest critics, we judge every possible thing we could have done wrong to cause our kids to come early (even though most of the time we have done nothing).

Here are some common causes for preterm birth:

1. Exposure to the medication DES - Among DES-exposed daughters, about 64% have delivered a full-term baby in their first pregnancy, compared with 85% in women who were not exposed to DES.

2. High blood pressure and preeclampsia - Also referred to as toxemia, preeclampsia is a condition that pregnant women can get. It is marked by high blood pressure accompanied with a high level of protein in the urine. Women with preeclampsia will often also have swelling in the feet, legs, and hands. Preeclampsia, when present, usually appears during the second half of pregnancy, generally in the latter part of the second or in the third trimesters, although it can occur earlier.

Eclampsia is the final and most severe phase of preeclampsia and occurs when preeclampsia is left untreated. In addition to the previously mentioned signs of preeclampsia, women with eclampsia often have seizures. Eclampsia can cause coma and even death of the mother and baby and can occur before, during, or after childbirth.


3. Diabetes - If you had type 1 or type 2 diabetes before pregnancy, you are more likely to deliver your baby early. Good blood sugar control can be hard to maintain during pregnancy, even in women who have been well-controlled for many years. Keeping blood sugars within a healthy range can reduce the risk of premature birth and other risks of diabetes during pregnancy.

4. Clotting disorders (thrombophilia) – The thrombophilias are a group of disorders that promote blood clotting. Individuals with a thrombophilia tend to form blood clots too easily, because their bodies make:

Too much of certain proteins, called blood clotting factors or
Too little of anti-clotting proteins that limit clot formation
A thrombophilia can be inherited or acquired later in life. About 15 percent of people in the United States have an inherited thrombophilia (1, 2). Acquired thrombophilias are less common. Thrombophilias may pose special risks in pregnancy.

5. Short time period between pregnancies [One study found that an interval of less than 18 months between birth and the beginning of the next pregnancy increased the risk of preterm labor, though the greatest risk was with intervals shorter than 6 months (9). A woman should discuss with her provider the best pregnancy spacing for her.]

6. Incompetent cervix - Ultrasonography of the cervix, obstetric ultrasound has become useful in the assessment of the cervix in women at risk for premature delivery. A short cervix preterm is undesirable: At 24 weeks gestation a cervix length of less than 25 mm defines a risk group for preterm birth. Further, the shorter the cervix the greater the risk.[48] It also has been helpful to use ultrasonography in women with preterm contractions, as those whose cervix length exceeds 30 mm are unlikely to deliver within the next week

7. HELLP  -  HELLP syndrome is a life-threatening obstetric complication usually considered to be a variant or complication of pre-eclampsia.[1] Both conditions usually occur during the later stages of pregnancy, or sometimes after childbirth. "HELLP" is an abbreviation of the three main features of the syndrome:

Hemolysis
Elevated Liver enzymes
Low Platelet count

8. Bleeding - This does include placental abruption, where the placenta tears away from the uterine wall too early. It also includes bleeding disorders that may be genetic or acquired. Bleeding of any sort should be reported to your doctor or midwife.

9. Too little or too much amniotic fluid. - Oligohydramnios means that there is not enough amniotic fluid inside the
uterus surrounding the fetus. Not having enough amniotic fluid can lead
to several complications.

Amniotic fluid is usually derived from baby's urine and it is inside the protective sac that your baby lives in inside your uterus.  Naturally, because of its importance, several issues may arise if the amount of amniotic fluid is not correct.

Amniotic fluid serves many purposes, all for the betterment and protection of your unborn child.  Not only does it help to provide a cushion to protect the child from trauma (should you fall), but it also keeps the umbilical cord from becoming compressed and reducing the oxygen supply to your baby, keeps the child moving so that bones develop correctly, prevents infection, and helps to keep a regulated temperature in the womb.  Naturally, because of its importance, several issues may arise if the amount of amniotic fluid is not correct.

The amount of amniotic fluid is measured either by checking the largest pocket of fluid by ultrasound or by measuring the largest amniotic fluid pocket in each of four quadrants and then adding those up. This is called the AFI or Amniotic Fluid Index.

Finding an amniotic fluid pocket that's at least 2 cm in vertical diameter is usually considered adequate

Alternatively, any AFI more than 25 cm gives you too much amniotic fluid, and any AFI less than 5 cm during the third trimester is too low.

Because the AFI has too many "false positive" results (too many people diagnosed with too low fluid when in fact the outcome was OK),  the single pocket amniotic fluid evaluation has recently been found more reliable than the AFI. Any single pocket that's over 2 cm is considered adequate.

Too much amniotic fluid- Polyhydramnios
If you have too much amniotic fluid, your uterus is likely growing faster than it should.  This generally occurs within roughly one percent of all pregnancies.  There are several potential causes for hydramnios or polyhydramnios, the formal name for the condition of having too much amniotic fluid.
These causes could be:

Maternal Diabetes:  In ten percent of diabetic mothers, this condition presents itself because of difficulty managing the diabetes.
Carrying Multiples: One child can take too much blood from the other which increases the risk for this condition.
Fetal Abnormalities: In rare cases, the baby stops swallowing the fluid and no longer passes it through his or her kidneys.
Fetal Anemia: Even rarer, the baby could have an infection or Rh compatibility issue that can be treated with blood transfusions.
Too little amniotic fluid - Oligohydramnios
If you have too little amniotic fluid, a condition known as oligohydramnios, there could be several different causes as well.  Your healthcare professional will likely suspect this if you are leaking fluids from an early stage (or too soon) in your pregnancy, or if you have had a previous pregnancy where you experienced preeclampsia, restricted growth of the child, or diabetes.   An estimate 8% of pregnancies have this condition at some point during the third trimester of pregnancy, and 12% of women who go to two week past their due date have this condition.
Causes for this condition could be:

Ruptured/Leaky Membranes: May heal itself, but increases risk of infection to the unborn.
Placental issues: Causes reduction in nourishment to the child and therefore stops the recycling process the child creates when he or she drinks and processes the fluid through the kidneys.
Certain medical conditions: diabetes, preeclampsia, high blood pressure, etc.
Carrying multiples:  As above.
Fetal abnormalities: The baby’s kidneys may not be functioning, or there could be a congenital heart defect.

10. PPROM - is a condition that occurs in pregnancy when there is rupture of the membranes (rupture of the amniotic sac and chorion) more than an hour before the onset of labor. PROM is prolonged when it occurs more than 18 hours before labor. PROM is preterm (PPROM) when it occurs before 37 weeks gestation. Risk factors for PROM can be a bacterial infection, smoking, or anatomic defect in the structure of the amniotic sac, uterus, or cervix. In some cases, the rupture can spontaneously heal, but in most cases of PROM, labor begins within 48 hours. When this occurs, it is necessary that the mother receives treatment to avoid possible infection in the newborn.



So next time you are told that someone’s baby has been or was born prematurely please be gentle with your snap judgements, or better still do not judge at all. Because not all preterm births are caused by something the mother has done. More often than not, it was a cause completely out of their control. And being judged is the last thing a preemie mom needs, they already harshly judge and punish themselves, even though they know 100% that the preterm birth was not their fault.