Late pre-term babies not out of woods

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When Tom Cavaliero arrived at the neonatal intensive care unit with his newborn a few weeks ago, he felt like he'd brought in Andre the Giant.

The other babies in the NICU ... were a fraction of the size of Gunner, who weighed 7 pounds, 8 ounces.

Still, Gunner's entry into the world was not easy. For a week, a maze of feeding tubes and oxygen lines weaved around him as he struggled to breathe.

... Gunner is an example of a bigger wave of babies born too soon.

In the United States, the rate of premature births rose by more than 20 percent from 1990 to 2006, with the largest increase in babies born when the mother was 34 to 36 weeks pregnant ...

These babies, some 70 percent of the premature population, fare better than the 1- and 2-pound infants born earlier. But they often have more problems breathing, feeding and maintaining their body temperature than full-term babies.

They also have a greater risk of dying.

... over the past decade, doctors have increasingly induced labor early or conducted a cesarean before full term.

The percentage of induced late preterm births more than doubled between 1990 and 2006, from 7.5 to 17.3 percent ... The percentage of late preterm births delivered by cesarean rose by 46 percent, from 23.5 to 34.3 percent.

There are many medical reasons for a baby to be delivered early: the mother's blood pressure is too high, or the baby has stopped growing, or the sac of protective fluid around the baby has ruptured.

But health officials say there are plenty of non-legitimate reasons, too: a family wants a baby born before a father deploys, or when a relative is available to help out, or before the doctor goes on vacation.

Health care providers have even heard of families who want a baby born before the end of the year for a tax deduction. Sometimes the expectant mother is just tired of being pregnant.

A committee called OB Right ... has been working ... to bring down the rate of unnecessary early inductions.

In 2005, Sentara Norfolk General Hospital and Sentara Leigh Hospital began to require medical documentation from doctors who schedule an induction or cesarean before 39 weeks of pregnancy. Tests must show that the baby's lungs are mature enough or that there is a medical reason for early induction ...

"We have better outcomes, less respiratory and transitioning issues," said Diana Behling, who manages OB Right. "The longer we can keep the baby inside the mother, the less risk for the baby."

... Over time ... families and health care providers have become more aware that the policy is about protecting a baby's health.

Virginia Health Information ... released a database ... that ... shows the cesarean rates of hospitals and doctors. Those statistics show that cesarean births statewide went from 22 percent of all births in 1996 to 35 percent in 2007 ...

If that trend continues, by 2016 half the births in Virginia will be by cesarean. Federal health goals call for a rate of 15 percent.

The American College of Obstetricians and Gynecologists made guidelines more stringent ... to clarify when babies should be delivered before 39 weeks ...

Melissa Maimann, Essential Birth Consulting 0400 418 448