U.S. Babies Die at Higher Rate

[essnce629]

http://abcnews.go.com/Health/GlobalHealth/story?id=1266515

***Latia
Conner, my homebirthed water baby, 8/19/03
http://www.babiesonline.com/babies/a/aug2003angel
http://www.gynosaur.com/assets/ribbons/ribbon_sapphire_24m.gif Self-weaned at 24 months! http://www.windsorpeak.com/dc/user_files/9870.gif

[lmariana]

Really interesting. Any thoughts on why the rates are higher here? I'm also curious as to why the US is getting more and more pre-term births. Anyone think that environmental factors have a role in this?

Oh, and is it just me, or is there a subtle assumption in this article that, in the US, all African Americans, Puerto Ricans and Native Americans live in poverty?

<<Within the United States, there are important differences in the infant mortality rates between racial groups and across geographic boundaries.

"Infant mortality rates tends to trend with socio-economic status," said Dr. Nancy Green, medical director for the March of Dimes. "African-Americans have much, much higher rates of infant mortality than other groups."

The rate among African-Americans is nearly double that of the general population: 13.9 versus 7.0. Rates among some other ethnic minorities also tend to be higher: the infant mortality rate among Puerto Ricans is 8.2, and for Native Americans, the rate is 9.1.

"Some of that is due to poverty but it doesn't track perfectly with poverty," said Green. The infant mortality rate among Central and South American immigrants, for example, is only 5.1.>>

Maybe I'm just a little sensitive to this, being Puerto Rican myself. Having seen first-hand the REAL poverty in Central and South America, I just don't think it's an accurate or legitimate comparison to how most impoverished people in this country live. If your children owns a pair of shoes and you get to use a toilet, you're already way ahead of the game compared to some of the places I've seen. I just don't think it's an accurate comparison.


Mariana
www.heinzandmariana.com

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BBB Knit Club
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[m448]

what a brief article and I'd love more info. However I can surmise why the infant mortality rate is higher in the US. A large part is higher rates of induction and c-section which would explain the large numbers of premature babies. Combine that with lower rates (compared to worldwide rates, and length of time) of breastfeeding and those are two factors which weigh heavily on the infant's health during the first year. I'd love to see the breakdown in numbers of infant mortality at birth vs. the rest of the first year but from what I've read even the at birth infant mortality rate in the US is extremely high compared to other countries.

Also, in most other countries I'm not sure if it's because of cost, necessity or because it's the standard of care but most births are treated as what birth is - a natural event not to be interrupted. People don't seem to want to hear it but low/moderate risk pregnancies fair better both for mom and child with a midwifery model of noninterventative care and little to no drugs used both during pregnancy and delivery.

I think I've only heard of a small segment such as the brazilian middle/upper class that has a high elective c-section rate due to convenience and importance of looks.

BTW, I'm hispanic (dominican). Now as far as the rest of the child's first year and rate of mortality then I'd guess that is probably when the socioeconomic factor weighs in. You'd be surprised how much whacked out information I've heard being distributed at WIC both about breastfeeding and infant nutrition in general.

[icunurse]

"However I can surmise why the infant mortality rate is higher in the US. A large part is higher rates of induction and c-section which would explain the large numbers of premature babies."

I am failing to see the connection between the two....premature babies are only born by c-section or induction when issues which may result in fetal demise occur (such as decreased fetal heart tones, in-utero infection, etc). In my previous work in a NICU, I saw far more premature birth deliver because the mother was in labor than compared to an induction/c-section for problems.

The report says during the first year, so I have to question what makes the U.S. significantly different than less industrialized coutries. How about our high rate of fertility drugs? Multiples icrease the likelihood of babies being born early, which in effect increases the likelihood of medical problems both immediately after birth and onward (premature babies have decreased immune systems). Could it be our advances in medical care? We have the technology today that we didn't have even 5 years ago. Babies who would have previously died are being given chances to survive, some may survive hours/days, some may make it longer, but, again, they will be at risk of illness. Could it be drug use? Increased usage in our society of both illegal drugs and cigarettes can affect a baby's health long-term, as well as play a role in premature birth. Maybe it is a mixture of our high stress lives/environmental factors? Both would have an effect on the health of the baby both before and after delivery. Finally, since the report does say during the first year, I also have to question if non-medical deaths apply - such as car accidents, shaken baby, house fires, etc.

In any case, it is sad that it happens at all, much less is a country of opportunity. There aren't one or two simple answers for this problem....there are so many reasons and so many factors, many of which we probably don't even know yet.

Traci
~Connor's Mom 02/2004~
Agency paperwork completed - waiting for #2!

[thomma]

"How about our high rate of fertility drugs? Multiples icrease the likelihood of babies being born early, which in effect increases the likelihood of medical problems both immediately after birth and onward (premature babies have decreased immune systems)."

That was my first thought.

disclaimer: I only skimmed the article...

Kim
t&e 5/03

[m448]

actually if you poll pregnant moms today you'll find that an elective induction (and many times elective C-section) at the 37 week mark is quite common. Considering that it's very likely dates are off to begin with the child could be anywhere from 35-39 weeks along which at 35 weeks gestation would require breathing help, etc.

Inductions on low risk women with no favorable cervix earlier in the pregnancy leads and begets further intervention. Induction for supposed large babies when u/s weights can be off by as much as 2 pounds (also at an earlier gestation) would account for preemies that didn't need to be as well.

[icunurse]

Respectfully disagree, in that less than 36 weeks is considered premature, making the slim part of medically induced babies "premature" (also have to add, but maybe it is just around where I live, but the women I know who are being induced for medical reason are still not having it done until just by their due date, as ordered by their doc). Even then, few singleton babies born after 34 weeks even require the need for oxygen. Just because a baby is premature by date (even those less than 34 weeks) does not necessitate the need for medical intervention. I feel that the same applies to the weight debate. Yes, US's are off by size of infant, but, again, that doesn't account for a significant number of the babies being born prematurely or necessitate the need for medical intervention.
Traci
~Connor's Mom 02/2004~
Agency paperwork completed - waiting for #2!

[m448]

I'll dig up mine but I'd love to see your stats on induction & gestational age as well as reasons for induction. Even the ACOG recognizes that large baby is not a medical reason to induce yet many women are still induced for this reason at an earlier gestational age (with the reason being so baby will not get larger closer to the due date).

[icunurse]

*sigh* I am not disagreeing that it happens or that dates are off or what the ACOG says. It is such a slim proportion of the induced/c-section baby population that is being discussed (actual prematurity of gestational age due to increased size, incorrectly measured size, whatever), that I just disagree that induction/c-sections are a major contributing factor to prematurity resulting in death within the first year. I'm out of the debate. Happy Thanksgiving.
Traci
~Connor's Mom 02/2004~
Agency paperwork completed - waiting for #2!

[Calmegja2]

ITA with Traci. I nominate her as my spokemodel on this topic. ;-)

[dogmom]

I thought about several factors, including many of what Tracy said about fertility drugs = more multiples= more premature boths. Clearly lack of good prenatal care is also an issue. I would also respectfully submit that maternal age also contributes to a higher premature birth rate. It also isn't like the rate doubled, it went from 6.8 to 7 per 1000 I believe.

Jeanne
Mom to Harvey
1/16/03

[chlobo]

I am in 3 playgroups with my daughter. Many of the mothers have had additional children since I've been in the groups. Of the ones who have been induced/had c-sections only *one* was induced before her actual due date. *ALL* other the other mothers that have been induced/had c-sections have had them on or after the due dates. I realize this is a very informal poll and one could easily argue that that is the standard of care in *my* particular part of the country and not in others but I would find it odd if the rest of the country were really that different.

I think that a lot of the reasons Traci mentioned seem to make a lot of sense in terms of the big picture. However, I have no actual *stats* to back it up, although I did find one interesting article on the subject:

http://www.obgmanagement.com/content/obg_featurexml.asp?file=2000/09/obg_0900_00064.xml

[kijip]

>Oh, and is it just me, or is there a subtle assumption in this
>article that, in the US, all African Americans, Puerto Ricans
>and Native Americans live in poverty?

I noticed that too. However, a look at the economic and healthcare resources between ethnic groups paints a clear picture- some Americans get more and others less. Personal wealth on average for Blacks and Hispanics is subtaintially lower than the average personal wealth for Whites. That is a problem that causes other problems- like lower access the health services and higher rates of certain illnesses and infant mortality. It is terrible but unfortunately true. As I see it, only by acknowledging it and working to level the economic situation, can we help solve the disparate health situations.

>Maybe I'm just a little sensitive to this, being Puerto Rican
>myself. Having seen first-hand the REAL poverty in Central
>and South America, I just don't think it's an accurate or
>legitimate comparison to how most impoverished people in this
>country live.

Yes, relatively speaking, poor Americans are not poor compared to some other parts of the world. But relatively speaking poor Americans are poor compared to other Americans. And in parts of our country I think many Americans would be surprized to see just how disadvantaged some Americans are- not eating daily, no money for needed medicine, sick all winter due to no heat etc. And those differences add up to serious health risks- less money for medicine, medical care, good nutrition etc.

[tarahsolazy]

In some of my patient groups, ie 22-24 weeker premies, the death rate in the US is between 30% and 80%. In many other countries, these babies are not resuscitated, and are not counted in infant mortality rates. Some countries go as high as 28 weeks in their definitions of live birth. In the US, 99% of 28 weekers survive. So the calculations are somewhat complex, not exactly apples to apples. I'm not debating how these babies should be counted in any country, just that the fact that not everyone counts the same makes things hard to compare.

Assisted reproduction greatly increases the risk of prematurity, both due to multiples and just at risk pregnancies, and some component of advanced maternal age. Women >40 are at greater risk of prematurity overall. Prematurity is the highest leading cause of perinatal death, which includes neonatal death, in the US after congenital anomalies. Babies with congenital anomalies are also aggressively resuscitated here, and pregancies are closely monitored, with babies with problems delivered as they get into trouble in the womb, which will decrease the numbers of these babies being stillborn, but also increases our neonatal deaths.

There are also definate racial, ethnic, and class disparities as well, and those are real, and to be carefully considered. Those we should be ashamed of, and work to bring everyone's level of access to care to a point of equality.


(the following doesn't directly address infant mortality)
Although I don't want to get into any debates, and I agree that there are tons of unneccessary inductions done, these likely do not contribute significantly to infant mortality. Morbidity, ie, NICU admissions, ventilator days, disruption in breastfeeding, etc. Those are the tragedies that arise from convenience inductions prior to 39 or 40 weeks. Seeing what I have, over the last decade, I'd not agree personally to an elective induction, especially before 40 weeks, or a scheduled CS at less than 40 weeks.

[tarahsolazy]

Technically, its less than 37 weeks. The highest population group nationwide for NICU admissions is 34-37 week babies.

This has NOTHING to do with infant mortality, however.

[kijip]

Dar Williams songs stuck in my head. Really, truly stuck! What sucks even more is that I have like 6 songs going at once!

I have never had a way with women but the hills of Iowa make me wish that I could...

And they swiveled around slowly like they saw something bad with the eyes in the back of their heads like he always knew they had and they said what a coincidence and hey you're just the man...

Well, that does it! I will just have to listen to her CDs...off to find them!

[Saccade]

Yes, I saw this new study also, and discussed it at length with my OB colleagues here as I approahed my 42nd week of pregnancy. The OB faculty practice here (very anti-C/S as a rule) is gathering data that suggest that 41 weeks is a good cutoff for when to think hard about induction, but meanwhile it seems that the 42 week cutoff does have substantial support in the published literature, with a J-shaped mortality curve past 42 weeks (i.e. significantly more problems for the baby as you get past that mark).

-- Saccade

DS #1, 7/13/05
http://tickers.baby-gaga.com/t/eleeleabk20050713_-8_My+child+is.png[/img][/url]

[icunurse]

Thanks for pointing that out....I meant 36 weeks or less....mind and typing hands didn't meet :)
Traci
~Connor's Mom 02/2004~
Agency paperwork completed - waiting for #2!

[psophia17]

In response to your comment at the bottom...

How sad is it that my C/S, because DS was breech, ended up scheduled for 39 weeks because if we waited until either his due date or I went into labor, the out-of-pocket expense was so high that we chose to go early rather than wait it out and be out a significant bunch of money.

And I had what counts as decent medical coverage at the time. I can't imagine going through that if I had no coverage, like many of the groups mentionned in the article do.

[m448]

see on my corresponding birth board alone (december '05) there are at least dozens of moms who have scheduled inductions or c-sections for 37-39 weeks gestation. Statistically speaking a 37 week mom has 50/50 chance of having a baby that was actually younger than 37 weeks thus requiring the NICU. In fact all around me I hear women being induced around 37-39 weeks purely because it's a subsequent child, or an elective C after a previous c-section. So it may be my corner of the world but also my online corner of the world (but go figure, my cohorts on MDC actually at this point we have a 0% induction rate.)

Also, Traci while I understand your statement that you've only seen required inductions of preterm babies from the point of view of many midwives, doulas and even laid back OBs much of what is "required" or necessary these days in obstetric care is usually a side effect from some interventative practice that IS the standard of care for all pregnancies (prenatal testing that is highly unreliable, etc.)

As far as the post dates theory there's some great info here:

http://www.gentlebirth.org/Midwife/datesppr.html

[Saccade]

Disclaimer (apres Dr. Solazy :) ) -- this is off the topic of infant mortality also:

Gentlebirth is a great resource, but note re this internet literature review:
"The author of this paper is anonymous, and the original date of publication is lost - probably sometime around 1998." The literature on management of post-dates pregnancy since then is active and continues to evolve. I'm not an OB, so obviously I don't attend national OB meetings, but I understand that this is an active topic of debate and that elective early induction is increasingly regarded as poor form, at least in academic/evidence-based practices.

Based on personal experience, I do indeed have the sense that the most current practice WRT postdates induction varies widely by region or even by institution. In my city alone, a woman might indeed choose early induction at one private facility, at least as of 3-4 years ago (though this is even changing there). At the academic hopsital where I work and teach (and where I delivered), induction (assuming a healthy pregnancy) prior to 42 weeks (or 41, for the most interventionist OB on staff -- though she is easily talked out of it) is way outside of the standard of care, to the point where I don't think it would be offered.

So there's hope that even the small number of babies who are might, in theory, be hurt by the practice of early elective induction will drop. This is good news for all of us taking part in this discussion!

E for clarity

-- Saccade

DS #1, 7/13/05
http://tickers.baby-gaga.com/t/eleeleabk20050713_-8_My+child+is.png[/img][/url]

[Saccade]

>In some of my patient groups, ie 22-24 weeker premies, the
>death rate in the US is between 30% and 80%. In many other
>countries, these babies are not resuscitated, and are not
>counted in infant mortality rates. Some countries go as high
>as 28 weeks in their definitions of live birth. In the US, 99%
>of 28 weekers survive. So the calculations are somewhat
>complex, not exactly apples to apples. I'm not debating how
>these babies should be counted in any country, just that the
>fact that not everyone counts the same makes things hard to
>compare.

<SNIP>

>There are also definate racial, ethnic, and class disparities as well, and those are real, and to be carefully considered. Those we should be
>ashamed of, and work to bring everyone's level of access to care to a point of equality.


These points are very well taken and I wanted to agree heartily that, together, they may well explain a large part of the variance in infant mortailty rates.

For point one, it's like looking at medical center mortality rates -- the places that get the toughest cases referred to them will have a higher rate of complications and death. If we try to keep micropreemies alive rather than allowing them to pass away (not saying which is right), we will fail at a high rate and make out denominator artificially high, thus lowering our percentage of survivors.

Re. point two, IM(NS)HO, bringing all women up to the same standard of care would have such a large impact on perinatal mortality that it would dwarf the effect of limiting elective induction at 37 weeks, statistically speaking. Not that we shouldn't try for that goal, also, in my admittedly biased judgment...


ET fix quoting

-- Saccade

DS #1, 7/13/05
http://tickers.baby-gaga.com/t/eleeleabk20050713_-8_My+child+is.png[/img][/url]

[tarahsolazy]

She's got a new one, The Best of Me. Its got a great anti-W song called Empire, you'll love it, check iTunes. I saw Dar live this month, and she sang "Iowa" IN IOWA. Fabulous.

[C99]

>Statistically speaking a 37 week mom has 50/50 chance of
>having a baby that was actually younger than 37 weeks thus
>requiring the NICU.

I am not a doctor, but I think this statement is just wrong. I baby born before 37 weeks gestation (whether the dates are off or not) does not necessarily require a NICU stay or even intervention.

[m448]

I'll clarify - that's in reference to induced babies at 37 weeks. Inductions usually with pitocin, some type of prostaglandin.

[kijip]

Dar Williams was such a high school kick for me- thanks for the trip down memory lane. I saw her live from a few feet away in 1998 while in college. I have all of the cds through about 1998 and then nothing till now. Toby spent a few weeks grooving to the first song I quoted (he loved the refain "We are the part-y generation...") and that has been the only Dar Williams in my life until tonight. I will have to check out her new stuff. I have a friend that is totally into all the music I was into in high school (Ani DiFranco, Dar Williams, Indigo Girls) so I think I know what she is getting for Christmas! Really, truly, thanks. Our CD collection is so freaking big (in binders) it can be years before I find something all over again!

[MarisaSF]

>She's got a new one, The Best of Me. .

Ooooh- thank you! I think I know what I'm getting for the holidays too!
Sorry to butt in... :)

[cmdunn1972]

Good point. My husband has been traveling to India a lot lately on business. That country doesn't have a welfare system. It's not as obvious in larger cities such as Mumbai, Delhi, or even Calcutta. However, when you get to the more out-of-the-way smaller cities, such as Jamshedpur, it's a real problem. We're talking people who live in the crowded train station, who are literally shrinking from lack of food, and raw sewage running openly down city streets. While it's horrible to be poor no matter where you are in the world, there's poor, then there's poor-with-no-way-out poor.

[cmdunn1972]

I would think that a lot of reasons why an industrial nation such as the US would have greater infant mortality rates than other industrial nations is due to a combination of multiple factors:

1) The U.S. has one of the largest rates of development of new drugs and medical research than other coutries of similar standards-of-living.

2) The U.S. is a capitalist-focused country where the almighty dollar rules.

3) The cost of doing medical research is high, and the cost is passed off on mostly the consumer.

4) It's easier to recoup profits from domestic consumers than international ones.

5) The U.S. has a high rate of uninsured citizens, including children, and the U.S. does not have a 100% insured rate for children (so kids fall through the cracks with regards to medical coverage).

6) Those who lack insurance usually can't pay the full cost of well visits to the doctor, and infants who don't get well-visits are probably more likely to have health problems in infancy since they don't get regular medical care.

I would surmise that the majority to infant deaths are due to parents who can't afford health insurance and can't afford paying full price for regular doctor's visits. So, the parent(s) decide that that they can't go. Also, only the lowest incomes even qualify for Medicaid, so many uninsured children simply fall through the cracks. (My guess is that many uninsured parents are "working poor" who work to pay the rent but don't get coverage from their employer.)

[trumansmom]

And it's really, really good! :)


Jeanne
Mom to Truman 11/01 and Eleanor 4/04
Independent Consultant, Do-Re-Me & You!

[Calmegja2]

>
>>Statistically speaking a 37 week mom has 50/50 chance of
>>having a baby that was actually younger than 37 weeks thus
>>requiring the NICU.
>
>I am not a doctor, but I think this statement is just wrong. I
>baby born before 37 weeks gestation (whether the dates are off
>or not) does not necessarily require a NICU stay or even
>intervention.
*****

Exactly right.

And my OB's offices, in the three states where I purposely delivered 36/37 weekers for IUGR issues ( I make very bad placentas), to deliver at that point, I was monitored closely, and had amnios to check for lung viability.

My boys had NICU stays, completely unrelated to the age of gestation at birth. One was for a compressed nuchal cord issue, and one for TTN.

And the other early delivery had no issues at all. And we went home 24 hours later, because she passed every requirement to do so.

It';s anecdotal, I know, but in three offices, we weren't seeing willy nilly early deliveries at preterm ages without cause.

[m448]

Again your anectdotal incident is about as valid as mine or anyone else's.

I'm in awe at the huff created by my one statement. I'm not saying that non-medically required inductions and c-sections are the SOLE reason for our high infant mortality rate but personally I do see it as a major factor because it's the first step in a series of events (such as failure to initiate breastfeeding or maintain breastfeeding) that DO have a large impact on a child's health the first year and beyond. Other factors that would affect initiation and duration of breastfeeding would be our lack of maternity leave as well.

Also, a non medically indicated induction would expose a child to drugs that have been proven to produce heart decels and reduced oxygen available to the child during delivery. Under extreme circumstances where the child is better off delivered than in utero these risks are acceptable but a large baby (again delivered BEFORE term as custom) is NOT considered a valid medical reason for induction. So this perfectly healthy baby (other than possibly being large +-2lbs on the u/s weight estimate) would be exposed to the risks of reduced oxygen and fetal distress caused by the induction. This child could end up in the NICU for just a few days and be fine but just as easily the reduced oxygen could cause something more serious. People are just too reticent to admit that something may have gone wrong due to the standard of care when they're on a baby high post delivery.

If you examine statistics from many other countries besides the US cosleeping and extended breastfeeding tend to be more common. Apparently their rates of infant mortality are also lower (at least the SIDS rates for cosleeping majority countries). So despite the fact that the US is outwardly so advanced when it comes to medical care I think it does more damage than good in the bulk of healthy, low risk pregnancies to have overly managed obstetric care.

Again, so no one gets their panties in a wad, I'm not referring to people who need MEDICALLY indicated inductions or c-sections but those instances are rare. Why is it that the ACOG can agree a reasonable c-section rate would be 10% and that's high yet our current c-section rate hovers around 25%?

I do agree with other points brought up as possible reasons for infant mortality as well but to me it doesn't rule out the above. It doesn't have to be mutually exclusive.

[Calmegja2]

>Again your anectdotal incident is about as valid as mine or
>anyone else's.
>

****

Yep. Which is why I have trouble with your statements.

And you're drawing in other issues which aren't really part of the original assessment. You're making it sound like early inductions for weight issues and convenience inductions are what's driving the higher mortality rate.

I disagree, and I don't think it's something that you can support by anecdotes from either side.

[m448]

that's because I truly believe that there are more convenience inductions going on than people care to admit. It's like many other parenting issues, people don't want to offend by admitting that someone's induction was a convenience induction (either for the doctor or the expecting woman).

As far as not liking my statement - that's your right.

[kath68]

[Again, so no one gets their panties in a wad, I'm not referring to people who need MEDICALLY indicated inductions or c-sections but those instances are rare. Why is it that the ACOG can agree a reasonable c-section rate would be 10% and that's high yet our current c-section rate hovers around 25%?]

I think the people you perceive as having their "panties wadded" are just finding your basic premise untenable. Namely, that the small percentage of births that are voluntary c-sections, and of those the ones that are "early", and of those the ones that are gestationally miscalculated, and of those the ones that have significant complications, and of those, the ones that actually die, is predominantly responsible for the overall increased U.S. infant mortality rate. I have no stats on it (nor do you, I suspect), but it seems that the number of infant deaths under those rare circumstances is not the driving force behind the mortality rate.

I don't think anyone disputes that early "convenience" c-sections when not medically necessary seem inappropriate. It just seems more credible that other more complex factors are at play re: infant mortality -- like poverty, the way the U.S. counts infant mortality, etc. All the things other posters have mentioned. What is troubling to me about your thesis is that it smacks of blaming mothers for the U.S. infant mortality rate, when there could be plenty of other places to put blame (and fix problems -- like better health care).

For the record, disagreement does not equal wadded panties. Using that kind of language brings the discussion down a notch, and I am sure that is not what you intended.

[m448]

You're reading way too much into my comments. I never stated that the expectant mom was to blame and it's exactly why I made my panties in a wad comment because it seems that people are taking general comments in a personal manner on this thread because they feel insecure in their own choices. That's usually when people find offense when there is none. I fully intended to use those words and don't think it brings down the discussion at all. That's your perception.

I've had trouble finding stats for precisely the thesis I was proposing but I think it's less because the inductions are happening and more because it won't pay to do that type of research. Again, I'm not stating that other theories on this thread aren't valid possible reasons for the infant mortality thread but merely proposing some to be added to the list. It does seem however that only a select few are allowed to theorize on this board while others have to take the flack. I'm up for it. Plenty of time on my hands this weekend LOL.

I would love to see this "low" statistic of inductions and c-sections many of you are mentioning. I also challenge the meaning of "necessary" as defined by the obstetric machine. Your post is full of seemingly strong argumentative words yet with no substance but your own opinion which is exactly what I've been doing (providing my own opinion) and am somehow being called out on it.

ETA: the article clearly states that the preterm population has increased significantly so it's not such a large leap to my own hypothesis that reducing unnecessary inductions is a way to keep that number down and thus reducing the infant mortality rate. There are many hands in that pot though and people are slow to change.

AGAIN, I'm not stating this is the only reason and never have said that. I am stating that it's just as valid presumption as many of you have made on this thread.

[kath68]

I am glad you enjoy debate for debating's sake. I hope you find people who want to take you up on it. Not me. Esp. when you accuse people you don't know of disagreeing with you only because they are "insecure with their own choices." For the record, I have never had a c-section, and would never consider a convenience c-section. I have no personal gripe against you or your theory -- it just doesn't make intuitive sense to me.

My hope was just to clarify for you why people seemed to disagree with you. I think, BTW, people have been pretty polite, so I don't understand why you think you are taking "flack."

[Saccade]

>ETA: the article clearly states that the preterm population
>has increased significantly

But isn't this because we are pushing the micropreemie threshhold significantly? When I first started medical school, fetuses who were below a certain age and who were delivered (for mom's health, or because preterm labor couldn't be stopped) were allowed to pass away (and were not counted in infant mortality stats). By the time I did NICU call for several months during intership, that age had dropped, and now that I am working at a major academic medical center, I read EEGs on frighteningly small ones that NEVER would or could have been kept alive just 10 years ago (and many times the EEGs don't look so hot :( ) . Many of these awesomely tiny babies don't make it for very long, and each one is counted in the infant mortality rate.

We can debate using our limited healthcare resources to support these tiniest babies (who face considerable risk of ongoing health problems) vs. using them to support basic healthcare and nutrition for other babies -- now that's a very hard debate. But many countries favor funding primary healthcare rather than pushing the preemie frontier, and their infant mortality numbers look better (fewer dying micropreemies on one hand, better routine care on the other -- they have better numbers through both of these means).

Note also: I am as crunchy as anyone you're likely to meet, and do agree that early induction for nonmedical reasons wouldn't be a choice I'd make, and would also like to ensure that women who make that choice know the risks to their babies. In the end, though, this is their choice.

Rest assured that there are plenty of public health students who ARE looking at the questions you pose, trying to help you with your hypothesis (there were two in my advanced biostats class last semester -- I have one master's from a large school of public health and am doing public health/biostats work beyond that in my copious free time :) ). And, at least where I live, they are educating women about the risks.

You're right, though, the risks/benefits of induction story isn't playing in the media across the country -- as usual, women's health stories aren't seen as profitatble. Now this is something that all of us can work together to change!

ET add EEG comment/qualification...

-- Saccade

DS #1, 7/13/05
http://tickers.baby-gaga.com/t/eleeleabk20050713_-8_My+child+is.png[/img][/url]

[m448]

Please reread and you'll notice that I'm not debating for debates sake (otherwise every other thread on this board would be considered the same). I have a theory, you have a theory. You (and others) have chosen to attempt to disprove my theory.

Regarding being insecure in choices I mentioned that because early on in the thread Petra thought I would somehow consider her choice to induce at 39 weeks as something sad according to my comments. Do I think it's sad - yes I think it's sad that the state of healthcare is such that people consider such choices. I too had elective surgery (gallbladder removal) about 2 weeks before the end of the year to max out my out of pocket. However, elective induction of a pregnancy is something that my own PERSONAL set of beliefs doesn't allow for. Do I have a general belief against elective induction? Yes. Do I judge Petra for making that choice as an individual? No. It's her choice. But you have to admit that in everything you hold an opinion one way or the other. It's human nature.

Saccade, that's very heartening to hear. I think another poster also mentioned the fact that we've pushed the threshold of preemies who are saved a bit further back than other countries and I definitely see that (and am seriously in awe at that as well). I'm glad that the teeniest of the preemies has a better chance today because of it but I'm also glad that as you've stated others within the field are looking to educate women on their choices.

Ultimately that can never be a bad thing.

[Calmegja2]

>I am glad you enjoy debate for debating's sake. I hope you
>find people who want to take you up on it. Not me. Esp. when
>you accuse people you don't know of disagreeing with you only
>because they are "insecure with their own choices." For the
>record, I have never had a c-section, and would never consider
>a convenience c-section. I have no personal gripe against you
>or your theory -- it just doesn't make intuitive sense to me.
>
>
>My hope was just to clarify for you why people seemed to
>disagree with you. I think, BTW, people have been pretty
>polite, so I don't understand why you think you are taking
>"flack."
>
>
*******
Yes, this is exactly what I was thinking.

I also have no personal gripe against you or your theory, but it doesn't resonate with me, or with my experiences. And since you were talking about your experiences, and not hard data, I thought it was fair game, and equally weighted, though not as proof, just fodder.

And FTR, I did have three inductions, medically necessary to save my babies' lives, and at the earliest point of lung maturity as could be determined, with the possibility of taking them earlier, if the issue was warranted.

I didn't raise my points with you out of insecurity in my own choices, because I'd lay my odds on the table any time, knowing to my toes that I made the right choices for them. I think you personalized the discussion in a way that wasn't warranted, with your last comment about personal insecurity.

And beautifully said, Saccade. Beautifully said. I agree, as the parent of one of the babies that would not have been attempted to prolong life 9 years ago when he was born, I now hear of babies smaller than he was being resuscitated, and usually with very, very poor outcomes.