let's get something straight

in most cases, it is not anything the parents (read: mother) did to cause a pre-term delivery. with all the ruckus about the duggars lately, as well as some other worrisome posts by some moms on some message boards i frequent, i think it's time we talk about what really causes preemieness. i mean really.

so, let's talk about what DOESN'T cause it, and lets dump some of that guilt right now ladies:

not going to church. sorry folks. i have to start with that one.. because, well, it's just so absurd. my husband and i being christians, and attending worship pretty regularly.. i'm pretty sure our story would prove that conclusion false. from my research i can't seem to find any correlation between religious practices and preemie babies. (for a more applicable argument to people feel they are christians and believe this, i'd like to draw your attention to job. an example of bad things happening to a good man. also, i'd like to draw your attention to ecclesiastes 9.11 "again, i saw that under the sun the race is not to the swift, nor the battle to the strong, nor the bread to the wise, nor the riches to the intelligent, nor the favor to those with knowledge, but time and chance happen to all." i'm not claiming that God never delivered a punishment to people for disobedience.. but the scripture shows us plenty of examples of "time and chance".) not to mention, "going to church" is not even indicative of a relationship or obedient attitude toward God.. it is something many, many, people do once a week to check a box. ugh. there are just so many things wrong with that statement i don't know where to begin. having a preemie isn't God's punishment to sinners, and it isn't some karmic retribution. it often happens to good people, it happens to bible believing christians.. it just happens sometimes.

eating/sleeping/exercising wrong. i'm not saying don't do those things... but i'm saying if you singlehandedly downed that bag of cheetos a week before
your 25 weeker came. it wasn't the yellow #6 causing those contractions.

having more than one kid. a duggar sized family. a two kiddo household. it doesn't really matter. if you haven't had a preemie before, your chances of having a preemie are the same as anyone else baking a single bun in their oven.

stress. ok.. not normal amounts of stress. not, i was stuck in traffic for an hour on the beltway stress... you should worry more with "i just found out my husband is leaving me and i'm 6 months pregnant" stress... that is the stress that can be problematic for pregnancies. (and if you have that kind of stress, you've got some other problems as well..eek.)

sex. nope. doesn't cause miscarriages, labor or anything of the like. and no, guys, the baby can't feel anything. the rhythm is really soothing to the baby, and a woman's body is made for all that...  sex is a great way to still feel like a wife when you're swollen and huge and gross feeling, feeling wanted by your husband is so important, and meeting his needs is equally important, so research this topic until you feel comfortable enough. (or vice versa- if you're the one who's instigating, and he's the one who's scared, have him read up on it, and assure him of it's safety.) of course, if you've been put on pelvic rest, someone is out of luck.

eating too much spicy food. i'm trying to be polite here... but i don't even know what to say. no, spicy food doesn't cause pre-term birth.

we all have dealt with the "what did i do?" feeling as we walked into the nicu for the first time.. and many times after that... but it wasn't us! here are some of the real causes... the best that the medical community can provide us with anyway:

infection of the cervix or uterus. apparently this is a big deal, and i'd never even realized it. this can be prevented with antibiotics in most cases. [more below]

already having a preemie. yes. if you've had one, your chances of having another are pretty significant. (if you had a preemie, then had a termie, then your chances on baby #3 are less.) if you've already had one little early bird, your chances are about 15%  of having another. if you've had two, your chances are 40%. ok, for those of us that are just going for broke- if you've had THREE, your chances are 70% that kiddo number 4 is going to be greeting you early.

gestational diabetes. just read here. this also causes problems for your baby during and after birth. GA babies tend to be bigger and can have jaundice, breathing problems, and low blood sugar. it's a good idea to try and prevent this by lowering weight gain- before and after pregnancy. that doesn't mean you won't get it. but, if you do, be sure it's treated to avoid severe problems.

pre-eclampsia. hello- welcome to my world. urg. i hate that. nice to meet you mr. pre-e, and i see you've brought your friend hellp to join you. thank you for raising my blood pressure to dangerous levels, dropping my platelets, and shutting down my kidneys and liver. i don't get the chance to do that on my own when you're not here. this crapfest deserves a post of it's own. so, without going into too much detail... about 5% of women get pre-e (but close to half had high bps before pregnancy). if it runs in your family, or your spouses, you're more likely to get it. if you're having multiples, or are over 40... if you're diabetic.. if you already have a high bp. if you have a clotting disorder like mine, APS, or MTHFR, or FVL.. you're pretty much out of luck- though taking blood thinners can stave it off for a time.

placental abruption. this is where the placenta separates from the uterine wall too early... like, while you're pregnant, and not after delivery. this is only a problem in about 1% of pregnancies. you'll know if this is happening by bleeding (light or heavy), cramping, aches, a sore uterus, or pain in the back or stomach. this is usually a problem in women carrying more than one baby, have had an abruption before, use cocaine, or have gestational diabetes. (do you like how using cocaine is slipped in there all non-chalant?) so, stay away from cocaine... noted.

placenta previa. one out of every 200 pregnancies will have placenta previa. it's mainly in women over 30 or under 20. it's usually in women who have had one other pregnancy, and/or some sort of uterine surgery... like a c-section. (as i'm writing all this i'm thinking, "great, one more thing that could possibly happen to me next time."sheesh.) if you smoke [read the entry about smoking below] or are having multiples your risk increases. if you have it, you'll most likely have bright red bleeding around 34+ weeks or so. usually they find this during ultrasounds though.. not through any symptoms. you'll need a c-section if you have p.p... so even if you aren't having a preemie.. be ready for the big cut.

abnormalities of the uterus or cervix. in this category we can go ahead and add incompetent cervix. (which is one of the more common abnormalities.) they'll usually find this in ultrasounds, and it can be helped with bedrest and a cerclage.. though your chances of delivering early are very high.

PPROM. that's right- with 2 p's. it's preterm premature rupture of membranes. normally, when there's a premature rupture of membranes (PROM) it's the beginning of labor and occurs after 37 weeks gestation.
you're at risk for this if you smoke [see the smoking post below], have had PPROM before, or have had vaginal bleeding at some point during your pregnancy. you'll know you have this when you see a leak or gush of fluid from down below. (i read that you can do the "sniff test" if it's smelling like ammonia- you've just sniffed your pee. if it smells sweet- head to the hospital, that's amniotic fluid.)

gum infections. ok. so, i just read that on a ton of resources.. and i still don't really believe it. but, if that's what everyone else is saying.. i guess i should add it. some say it's for the same reason that i listed above about infection.. that the infection causes the release of hormones causing delivery. others say that it's the inflammation that cause the immune system to produce inflammation in the cervix and uterus, causing the early labor. prego women are more likely to get gum infections.. so i guess it's something we should all look out for while pregnant. (because we needed one more thing- right?)

multiples. if you're carrying more than one- your chances are 54%, compared to 9% of us single baby mamas. but, you get double to pay off for your pregnancy troubles, think of it that way.

abnormal amounts of amniotic fluid. yeah...that's all i could really find on it.. right there. women with abnormal amounts of amniotic fluid, too much (polyhydramnios) or too little (oligohydramnios). ok, i'm just being lazy because it's 3am.

and the unknown. many preterm deliveries occur for no understandable reason. in this catagory we'll go ahead and include the fetal distress that is sometimes not understood that leads to early delivery. sometimes the doctors just don't know what causes it.

what can we do? well... here are a few things.. but the information is constantly changing with new studies. you have to seek out the best options for the reason behind your pre-term birth. that said, here are a few generalizations:

wait to have another. so, it looks like the risk of having another preemie goes down if you wait at least 18 months. the closer together the pregnancies... the more likely a repeat.

stop smoking. if you're that stupid. you shouldn't read my blog. i mean, really... who's smoking with possibly a preemie already at home and a bun in the oven? ok. if you're still reading, you should know that there are 3 types of smoke exposure. firsthand, which means you would be the stupid person i was just talking about. secondhand, which means you're married to, or related to, someone who is either very weak, or unwilling to smoke away from you and/or your children. and thirdhand. thirdhand is the stinkiness that you smell on clothes and jackets and hands and hair of smokers. thirdhand is the toxins in the cigarette that have deposited on everything around the smoker- even carpeting and surfaces.. there are cancer causers in there too, lingering long after the actual secondhand smoke has cleared. (i just read a new study on this recently that i plan to do a post on soon. so check back.. or, just google it like a regular person. :)

treat infection early. they don't know exactly why.. but infection is a big deal in causing babies to be born early... they think that the inflammation causes a release of prostaglandins- which also release to start labor when you're full term. so, if you feel like there's a little something not right- be it a UTI or a yeast infection or bacterial vaginosis- get it checked out asap. that doesn't mean you definitely need antibiotics all the time.. but that you should just be very involved with your doc about things like that.

take your treatments. if you have a condition that needs to be managed, (like a clotting disorder that requires you to take aspirin + lovenox shots daily) manage them. this is where screening becomes so important. knowing if you have something wrong to begin with can help you plan for progesterone (17p) shots or get a cerclage. so go early, talk to your mfm, get your exams and ultrasounds and drink that nasty sugar drink... it's all to help out your sweet baby.

don't be too skinny. yeah.. i know... we ALL have that problem, right? but there is a link between losing lots of weight and having a preemie- even if you lost dramatically BEFORE getting pregnant. i jest not. so, keep some of that baby pudge. (i suppose i should say, that it appears that the magical BMI number for this is 19... umm.. so.. if i lose more than 10 points i'll have something to worry about.) seriously though ladies, no crazy dieting.

don't be overweight. i said it. and it's coming from a girl classified "obese" in week 26 before i had my preemie! but, the overweight thing can lend itself to gestational diabetes, hypertension, heart disease, etc. etc. etc. it just makes it harder on your body. carrying a few extra pounds doesn't actually cause any direct problems (that i've found) with pregnancy.. but it can cause a ton of issues that can cause problems with pregnancy. so, eat smart, exercise, and find a happy and healthy weight to hang out at.

an apple a day. or something like it. studies have shown that not only low dose aspirin, but fish oil, vitamins C and E as well as calcium and antioxidants were able to reduce pre-e in recent studies. also, i've recently read that eating a lower cholesterol diet can help too.

take it easy. that means your body, and your mind. there are links between stress and early labor, as well as extreme physical stresses and early labor. unfortunately, i don't think that means we can opt out of the dishes while pregnant, but it does mean you don't have to dig a ditch in your back yard. (unless, of course, you're one of us lucky enough to get on bedrest- in that case, bring your knitting, cause you're going to be wishing for some dishes to do!)

writing this really helped me to put my little 27 weeker experience in perspective. i'd love to hear feedback from you about dealing with the causes behind your early delivery and what specifically caused it.

what did i leave off?
what crazy reasons have people suggested for your little one coming early?
what fabulous advice to preventing a repeat?


Trish said...

Well said!
I can't say I've had too many weird things said to me about why it happened. A lot of people ask if I had high BP before (no) or they'll just ask what causes pre-e (a good question) but that's about it.

I do know some people who have been asked plainly "Why.. what did you do?" both to a miscarriage and to learning someone had a preemie.

People are assholes.

Jessica B said...

There is actually a lot of evidence about a correlation between oral hygiene and length of pregnancy. Ironically, when I worked in a lab at UT, I worked with a bacteria that causes periodontal disease. Then I worked in a lab in Honolulu that did cellular studies on the amnion and chorion with the mission of learning more about PPROM. Tricare Dental (United Concordia) provides an extra teeth cleaning during pregnancy. I learned this after my pregnancy.

Victoria said...

Great Post - I went into labor (no known reason) at 27 weeks. My daughter was born at 32. I also suffered a miscarriage. People STILL ask me...what's wrong with you? Can you just not have babies!?!? I wish everyone would read this - well said!

sweet tea in a pink glass said...

I came across your blog though Kelly's korner, I laughed and cried as I read though your story, in part to the fact that it is so similar to ours, the other because now I have someone to talk too!! I love your blog, I wish I was able to get my thoughts together enough to blog about it. My "early bird" Abby (which I thought was so funny because I decorated her room in birds and we called her early bird but now have moved on to love bird) was born at 27 weeks, weighing 1 lb 13 oz 13 inches long, on October 15, 2009. Though our time in the NICU 10 weeks, I thought we were going though it all but have learned that we are so blessed and it could have been so much worse. She was on the vent for 3 weeks then to nasal canula on and off for the remainder of our stay. She came home on o2 for about 3 weeks then I just had her on it at night (for my own personal sercurity). I rememmber thinking how much I couldn't wait to get her off all these wires and to carry her though the house without a trail of wires, how quickly I've forgotton where we came from. She's now 4 months actual, 1 month corrected.
Do you mind if I ask your opionion on a few things...
1) We live in south florida, she gets the rsv shot once a month and now they are telling me, it's okay to go out and about, just be careful. Do you go out in public? I have so much guilt every time I do.
2) What are some exercises you did with her at 4 months? The PT just called me on friday to set up our appt., for evaluation, I can't wait. But was wondering what I can do. The pedi told me not to do too much, because she doesn't want her burning too many calories...
3) I promise not too many more,
Is your early bird on Neosure? If so, do you get coupons for it, I can't seem to find any anywhere, any ideas?

Thank you so much for your time and blog...

Whitney said...

I found your link on Kelly's Korner. I also have a 27 weeker who was born on October 21, 2009 at 1 lb 10 oz. I had pre-eclampsia/HELLP and the baby had reverse end-diastolic flow through the placenta. I enjoyed reading your story.

Anonymous said...

I had my baby at 28 wks due to a severe UTI that landed me back in the ER exactly a week later. 4 days before giving birth I had went to the dr with a severe migraine, vomiting, fever, etc. I sat for 4 hours but no one came to see me even though I did give a urine sample. The dr had been riding me about gaining 27 lbs, although I was big before getting pregnant, had a pre ttc checkup, had dieted, excercised, got my blood sugar, pcos and hypotyhroid under control. He also stayed on me about failing my sugar test by 1 point after taking me off my blood sugar meds, and not flossing. Even at the pp checkup he tried to blame me, I didn't floss, I didn't starve myself, I had high sugar. Its so hard. Im glad to see you mentioned UTI, it should really be mentioned more than the gums because UTIs are SO ramapant in women, esp pregnant women, and even more so for women with a history of UTIs (like me) and its almost impossible to tell you have one. I ALWAYS know when i have one, I get about 4 a year. I had no idea, I couldn't tell at all. Thats supposed to be one reason they always take a urine sample, but apparently not all dr's care as much as they should!

I did get so sick of hearing oh, he'll be fine or they'll let him come home when he's 5 lbs, or the best was when people didn't understand why we were so desperate to get him home (he was in a NICU an hour away) becuase then you'll have to get up in the night and feed him and stuff. I guess some people really think it's like a nice vacation where you drop off your baby at the NICU to be babysat. Its just one of those things you'll never understand unless you've been through it. That is what I wish most of my family would have understood.