One of the many reasons health care in America is so expensive is that it is so good and delivers so much. Consider premature babies:

Nearly 13% of all babies in the U.S. are preemies, a 20% increase since 1990. A 2006 report by the National Academy of Sciences found that the 550,000 preemies born each year in the U.S. run up about $26 billion in annual costs, mostly related to care in NICUs. That represents about half of all the money hospitals spend on newborns. But the number, large as it is, may understate the bill. . . .

For hospitals struggling with cost overruns in other areas, NICUs can be havens of healthy revenue growth and profits. Children’s National sets the goal of 4% profit margins overall, but NICU profits can be double that. Last November the hospital unveiled a $75 million tower that features various specialty units to treat heart and brain problems of preemies. Its expansion plans include a second NICU that will open in 2009. It will have 54 beds, boosting Children’s total preemie capacity by 25%. All of the rooms will be private and will be equipped with Internet systems that allow neurologists to monitor brain function from their homes.

Nowhere did I state that the increase in preemies is caused specifically by scheduled childbirth.

I mentioned it as an interesting factoid, a probable factor but not necessarily a big or significant factor, but then listed several other possible reasons, which jives with what Greta said about many factors contributing. I mentioned as she did the attempt to save babies at an earlier and earlier age, and I noted that was an ethical dilemma, because the earlier the term the more unhealthy the baby, in general.

It has nothing to do with C-section, although that has a few health risks too. (Where did that come from ?) C-section has nothing to do with causing a premature birth. It is sometimes the end result of a premature birth but it has zip to do with causing it.

Scheduled childbirth could be a contributing factor, and contrary to what Bill is saying, I have heard that doctors are being pressured to deliver earlier and earlier (anecdotal, no hard statistics yet).

The definition of premature is something only a lawyer like Bill could love. It was historically a small birth weight child, but is now considered prior to 37 weeks. 39 weeks is considered full term but a fully normally pregnancy could go out to 43 weeks. The estimated birth date has a margin of error of about 2 weeks, meaning for a hypothetical example you think you went to 37 but you really only went to 35, but you should have gone to 43 but it may or may not show up in the stats anyway as premature because low body weight is not the primary factor. 

It just means the NICU is humming. Since there is a lack of conclusive proof doctors probably are not liable to lawsuit but I agree a sane doctor should push back because of the risks.

The following snippet from myhealthsense.com is interesting:

“Between 1989 and 1999, the number of labor inductions - in which doctors hurry childbirth along with drugs to dilate the cervix and stimulate uterine contractions -  has soared to 775,245, according to the National Center for Health Statistics. That’s a whopping 19.6 percent of live births, up from 8.2 percent in 1989.

In many cases, the induction of labor is done for legitimate medical reasons such as toxemia (high blood pressure and other symptoms), gestational diabetes or a birth that’s a week or two overdue (which means the placenta, the organ that supplies the fetus with oxygen and nutrients, may start to break down).

But increasingly, induction of labor is done for “elective”  reasons, that is, pure convenience. And while some obstetricians hail this move –as elective inductions rise, weekend deliveries decrease – many obstetricians and nurse-midwives worry that the trend may lead to more Caesarean sections if induction fails, more respiratory problems in babies born with not-quite-mature lungs, and more chance of uterine ruptures triggered by drugs such as prostaglandins and Pitocin.

The national health statistics center does not keep track of how many labor inductions are done for medical reasons, how many for convenience and how many for a combination of the two, such as a woman with a track record of short labors who lives far from the hospital.“

Yes many births are done by “scheduled” C-sections these days, but doctors scheduled them at a point that is estimated to be full-term.  No reasonable, sane doctor would purposefully deliver a less than full-term baby.  It would create a huge malpractice liability and probably violate the Hippocratic oath. 

I also would like to know where the data comes from to support the assertion that the increase in preemie births is because of “yuppie” mommies choosing to get the kid out early.

After reading several articles on this subject it seems to me that the fact that
premature births are up by 20% in the last decade may be true but they don’t have a clue what has pushed the numbers.

The articles are filled with the usual “some” births “may” be caused by any number of factors. Not the least of which I suspect may be due to the fact that in the USA the attempt is being made to save ever younger and younger preemies.

Which doctors are reporting that women are electing to have C-sections to alleviate the late stage discomfort of pregnancy. I thought there was something about confidentiality. I hear of many instances of inductions, not even mentioned in most of the articles.

All the other factors mentioned are distinct possibilities I am sure. But laying this phenom at the door of C-sections primarily is just the latest scare de jour.

“Nearly 13% of all babies in the U.S. are preemies, a 20% increase since 1990.“

Why the 20% increase ?

One factoid a lot of people probably don’t know is that more mothers are electing to have premature births so that they end the agony of pregnancy quickly and can conveniently “schedule” the birth.

This is the ultimate in yuppy childbirth, a C-Section on demand, in between hair and nail appointments.

The problem is that even a slight decrease in the term produces a health risk. The furthur out you go the worse it gets.

The other issue is a big ethical delimma, that medical science is getting so good at pushing back the birth date you could easily end up with a child who survives birth but is so developmentally disabled and unhealthy as to have an entire lifetime of repetitive surgeries pain, disability, and heartache. 

There are no answers for these ethical questions that anyone would like. Easy answers exist but solve nothing. Science has gone Frankenstein; outstripped medical ethics.

One other cause of premature births is the drug culture.  Unhealthy kids born to unhealthy and underage mothers.

Fertility treatments are the latest culprit to be blamed. Mothers are giving birth later in life and turning to fertility treatments which increase the risk of premature birth.

Another yuppie phenomenon. If mothers would only consign their reproductive organs over to Mr. Smith NoVa would once again be the field of cows, so to speak, and there would be no transportation problems, just lots and lots of little bitty Smiths running naked in the grass.

Ah, never mind. Might all be developmentally impaired like their Dad. Whaddya think ?

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