As Babies Are Born Earlier, They Risk Problems Later

Becky Veduccio of Bloomfield, N.J., said daughter Sophie spent several days in intensive care after being delivered 31/2 weeks early. (By Russ Veduccio)

Medical advances are making it easier to spot babies who are in distress or developing poorly, prompting doctors to deliver them early -- either by Caesarean section or by inducing labor with drugs -- to prevent stillbirths. Techniques for caring for premature babies have also improved, giving physicians more confidence that a baby will survive if delivered early. That makes them more likely to suggest an early delivery at any hint of a problem that might endanger the mother or baby -- or risk a lawsuit.

"In the past they wouldn't have dared -- they would have tried to wait it out," McCormick said. "Now they know what the neonatal intensive-care unit can do. That's been a very powerful, powerful change."

So powerful, obstetricians say, that the rate of stillbirths has dropped and the chances that a premature baby will survive have risen sharply.

"We shouldn't be worried," said Charles J. Lockwood of the Yale University School of Medicine. "We're doing a good job of avoiding stillbirths and subsequent infant mortality. When you have a fetus with no growth or insufficient food, the better place for that fetus is outside the womb."

But some specialists question whether the increase in Caesareans and inductions is the reason for the drop in stillbirths. And they worry that too much of the increase may be due to women hastening delivery for nonmedical reasons -- they want to make sure their mother will be in town, their husband has a business trip pending, or they are just fed up with being pregnant.

"It's a common request," said Mark Lollar, an obstetrician in San Ramon, Calif., who routinely honors such requests for the wives of professional athletes so their husbands can be present. "I have no problem arranging that for them."

Lollar and other obstetricians insist that they make sure that the fetus is at least 38 weeks old. "We never compromise the mother or the baby's safety," Lollar said.

Other experts, however, say it can be difficult to calculate the precise gestational age of a fetus.

"If a woman comes in late in the pregnancy and only has one ultrasound, you can have an error of up to two weeks, which can be significant," Tonse said.

After losing her first baby three days before her due date, Becky Veduccio and her doctor decided to induce labor in March just before her 37th week. Her daughter, Sophie, spent several days in intensive care getting breathing help, antibiotics and intravenous fluids. Less than a week later she was readmitted to the hospital for jaundice, and she has had digestive problems ever since.

"I thought 36 1/2 weeks would be okay," said Veduccio of Bloomfield, N.J. "But it's been just torturous. Every time we thought we could relax, something else would happen."

The lungs, brains and other organs of babies born even a week or two early are often underdeveloped, making the infants much more likely to have problems breathing, maintaining their body temperature and feeding. They are also vulnerable to infections and jaundice, which can be life-threatening or cause brain damage.