Our Blogs

Understanding the Causes and Risks of Preterm Birth

Written by Berkowitz

the words birth injuries being erased by a pencil

Nine months inside a mother’s womb is the best chance for a newborn. It is where they go through significant growth and development stages. While some might think most of the development is over near the end, babies still go through critical phases in the final months and weeks before birth.

Brain, lungs, and liver all need the entire pregnancy term to develop fully. Anytime a baby is born prematurely it can lead to chronic health problems, developmental delays, and severe complications. A baby that is born before the 32-week mark has a high rate of death and disability.

What is Preterm Birth?

A preterm infant is born before the 37-week mark of pregnancy. However, preterm births come in three subcategories which are based on the gestational age of the fetus and include:

  • Moderate to Late Preterm (32 to 37 weeks)
  • Very Preterm (28 to under 32 weeks)
  • Extreme Preterm (Less than 28 weeks)

Inductions and planned C-sections cannot be done before the 39th week to ensure the baby has enough time to develop and prevent any risk of preterm. The only time a physician should induce or perform a C-section before 39 weeks is for medical reasons.

The Statistics

According to the World Health Organization (WHO), 15 million babies are born prematurely each year. Sadly, 1 million children die every year because of the complications associated with preterm birth. Those that do survive have a lifetime of learning disabilities, visual and hearing issues, and physical disabilities. The United States has a high rate of premature births despite having access to modern medicine.

It is one of the ten countries with the highest rate of preterm births, with India and China being the highest.

In 2016, one out of every 10 infants born in the United States were preterm, says the Centers for Disease Control and Prevention (CDC). While the rates had decreased from 2007 to 2014, the CDC says that the preterm delivery rate has grown for the second year in a row with 2016 seeing a high number of premature births.

Risk Factors that Increase the Likelihood of a Preterm Birth

Certain medical conditions, lifestyle choices, and medical decisions can influence whether a mother experiences pre-term labor.

These risk factors include:

Social and Economic

A mother is at higher risk for preterm birth by age, specifically, if she is younger than the average or much older (over 40 years). Also, a woman with less access to quality medical care has a higher risk for premature deliveries.

Medical Conditions and Conditions Related to Pregnancy

Specific conditions that arise during the pregnancy can affect whether the mother carries her infant to full-term. It is a doctor’s job to identify these risks and do what they can to minimize them. Some common conditions that can do this include:

  • Infection
  • Previous premature births
  • Carrying twins, triplets, or multiple pregnancies
  • High blood pressure
  • Severe illness during pregnancy

Behavioral Factors

A mother’s tobacco and alcohol use before and during pregnancy can increase her risk of premature labor. Also, if she receives prenatal care later in the pregnancy, suffers from high-stress situations, or takes illegal substances she increases her chance substantially.

Warning Signs of Premature Birth

In some cases, premature labor happens suddenly and without warning.

Other times, the mother has early warning signs that her body is going into preterm labor. Her treating physician is supposed to monitor her progress, look for these warning signs, and act appropriately.

When caught early, the physician may be able to stop the labor. Other times, there is nothing that can be done to prevent it once it starts.

Some warning signs include:

  • Contractions that are not Braxton Hicks contractions
  • Cramps that are like a menstrual period
  • Low and dull aches in the back
  • Pelvic pressure – such as felling the baby press down
  • Changes in the mother’s blood pressure
  • Abdominal cramps that are not associated with gastrointestinal illness or distress

The Dangers of Having a Preterm Baby

A premature infant will spend a few days to months in the NICU of the local hospital – especially if the baby is in the extreme premature category. Premature babies are smaller than full-term babies; therefore, they need extra medical care and they may have complications during their stay as well as at home.

Here are what parents can expect with a premature infant:

  • Premature 23 to 24 Weeks: Only half of the infants at this age will survive and ever leave a NICU. The youngest premature baby to ever survive was 21 weeks and six days, but the 23 to 24 mark is typically the cutoff timeline where hospitals will intervene and try to save the baby – known as the age of viability. A micro-preemie is barely over a pound, and their body systems are underdeveloped; therefore, they will rely on machines for feeding, breathing, and regulating temperatures.
  • Premature 25 to 26 Weeks: At this stage, the infant will still have health issues, and the lungs have already formed the alveoli, which allows for gas exchange. Despite the development, they may even require help breathing.
  • Premature 27 to 28 Weeks: Babies in this group do have a 95 percent chance of surviving and leaving the NICU, but they will not be without their problems. These babies are still developing retinas, and are at high risk for retinopathy.
  • Premature 29 to 30 Weeks: A baby born in this range still requires an extended NICU stay, but has a much higher rate of survival. The brain is still rapidly developing at this stage and by the end of 30 weeks will create the folds that help the body control its body temperature.  Babies at this age cannot feed themselves; therefore, they require IVs to keep them hydrated and fed.
  • Premature 31 to 32 Weeks: These infants have a higher chance of catching up to full-term babies regarding development, and they often do not require an incubator to regular their temperatures. However, they need special care, and their immune system is immature, which makes them at high risk for infection.
  • Premature 33 to 34 Weeks: At this stage, an infant will have fully developed bones, they can suck and swallow which allows them to self-feed, but they also cannot handle overstimulation. Therefore, these infants will have difficulty sleeping and become overstimulated easily. They may still require help breathing the first few days.
  • Premature 35 to 39 Weeks: Babies at this stage are closest to full-term, but the lungs are still not fully developed, which means they need to stay in the NICU until they can breathe on their own. Furthermore, babies born before the 39th week are unlikely to have developed the necessary fat on their bodies to regulate temperatures, making it hard for them to stay warm or have the strength to eat.

The Complications of Prematurity

Not all premature babies have complications, but a vast majority have some form of complication – with others suffering a multitude of them at once. The infant’s weight at birth determines a lot whether they will experience more life-threatening complications.

Also, some of the complications of prematurity might not be apparent at birth – and could develop much later.

  • Breathing Complications: A premature baby does not have a matured respiratory system; therefore, they cannot breathe without assistance. If the baby’s lungs do not have surfactant, he or she might develop respiratory distress syndrome – which prevents lungs from contracting and expanding as they should. Also, a premature infant could establish bronchopulmonary dysplasia and apnea.
  • Heart Problems: The most common heart issues in a premature infant include low blood pressure and ductus arteriosus. These defects sometimes close off themselves, while other times they must be surgically corrected.
  • Brain Complications: Premature infants have not had the time they need to develop their brains fully. Therefore, they are at high risk for bleeding, known as intraventricular hemorrhage. Most can resolve themselves, but other times these bleeds require surgical intervention. Too much bleeding can lead to permanent brain damage, and some infants develop hydrocephalus.
  • Body Temperature Issues: An infant with temperature issues cannot regulate their body temperature. This is because their brain is underdeveloped, and they lack the body fat needed to regulate. Hypothermia, a common complication, leads to breathing problems, low blood sugar, and the baby may use his energy just to stay warm – leaving them unable to eat.
  • Gastrointestinal Distress: Premature babies are likely to have digestive complications, including necrotizing enterocolitis (NEC), which is a potentially fatal condition if not treated immediately.
  • Metabolic Disorders: Because premature babies cannot eat or regulate body temperatures, they suffer from low blood sugar, too much glycogen, and their immature livers can shut down.
  • Blood Disorders: Premature infants are at high risk for infant jaundice, anemia, and sepsis.

When is Preterm Birth an Issue of Malpractice?

Not all premature births are malpractice. However, when a physician fails to monitor his patient or knows that a patient is at high risk for premature birth and does not act accordingly, they could be held liable for malpractice.

Careful doctors may need to use medications to stop premature labor, speed up an infant’s lung development so that they can breathe, and do what they can to prevent infection. Even if they cannot stop the labor, they have a duty to the mother and infant to avoid further complications that come from premature births.

Contact a Connecticut Medical Malpractice Attorney Today

If your baby was born premature, contact a medical malpractice attorney for a free consultation. An attorney that has experience in this type of case can help determine if you qualify for compensation and gather the evidence necessary to show that the physician breached their expected duty of care.

Contact Berkowitz and Hanna, LLC today to schedule a no-obligation case evaluation.