>> mcfarland: welcome to healthy body, healthy mind. i'm dr. scott mcfarland. the goal of a healthy pregnancy is to deliver a baby at 40 weeks gestation. but every year in the united states, more than 500,000 women deliver their babies preterm. >> anything less than 37 weeks is considered a preterm birth. >> mcfarland: and delivering preterm can have potentially serious short-term and/or long-term consequences on the baby's health and development. >> the earlier the delivery, the more severe the complication. >> mcfarland: although in most cases the cause is unknown, as we'll see in today's program, there are some risk factors that may make it more likely

that a woman will deliver preterm. but scientists have developed different treatments that may help reduce the risk of preterm birth. [upbeat instrumental music] ♪ >> male announcer: major funding for healthy body, healthy mind is provided by: ther-rx corporation, a women's health-focused branded specialty pharmaceutical company that distinguishes itself through our commitment to the patients we serve. and by url pharma, using smarter science to deliver safer medicines. and by novartis vaccines, a leader in providing products to fight preventable viral and bacterial diseases. and by sanofi, a diversified global health care leader. discovers, develops, and distributes therapeutic

solutions focused on patients' needs. we work to prevent and treat the diseases that we know of today, as well as those we may face tomorrow. additional funding provided by: vertex pharmaceuticals. and by biogen idec. >> mcfarland: welcoming a new baby into the world can be a precious and beautiful time for many families. but if the delivery comes too early in the pregnancy, that special moment can begin a physically and emotionally challenging journey for both the parents and the child. >> go, baby. come on, push, sweetie. >> mcfarland: babies delivered after 37 weeks are considered full-term. a full-term pregnancy provides the best opportunity for a mother to deliver a healthy baby. >> well, it's important that a woman achieve term, or deliver

at least at 37 weeks of gestation to ensure that the fetus is mature. >> mcfarland: dr. ashley roman is a clinical assistant professor in the department of obstetrics and gynecology at nyu langone medical center and is a specialist at maternal fetal medicine associates in new york city. >> and we--when we talk about a mature fetus, we want to make sure that the lungs are mature and other organs are mature like the liver and the brain. >> mcfarland: pregnancies are measured in trimesters. each trimester contains different development milestones for the baby. and every week of pregnancy is important. >> the first trimester, which usually people say are the first 12 weeks of pregnancy, are when the organs are forming. it is a time of development of the different organs and a time when birth defects form if they are going to form. >> mcfarland: dr. alan peaceman is the chief of maternal fetal

medicine at northwestern memorial hospital in chicago and is professor of obstetrics and gynecology at northwestern university, feinberg school of medicine. >> the second trimester until 24 weeks' gestation is a time of rapid growth, where the organs grow and evolve into the developing functions that they are supposed to develop. at 24 weeks' gestation is when most people consider the third trimester beginning. and that's the time when maturation really takes place of all the organ systems to the point where a baby can function on the outside of the mother. so when a baby is born in the third trimester prematurely, you frequently will have situations of immature function of the organs.

>> mcfarland: new yorker rikisha hughes-burke knows firsthand about the uphill battle preterm babies face. her eldest son, a.j., was born just as she began her third trimester. >> i delivered by c-section. my son was 23 weeks and 5 days. and he weighed 1 pound, 5 ounces, 12 inches long. and it was a rough road for him. >> mcfarland: baby a.j. spent four months in the neonatal intensive care unit, also known as the nicu. >> he was born december 3rd. he was due march 31st. and he came home april 17th. >> mcfarland: and during his hospital stay, a.j. had to undergo various medical procedures to keep him alive. >> that included all kinds of needle sticks, blood transfusions, infections, surgery. mcfarland: for rikisha, the situation was especially harrowing. she had had several miscarriages before delivering a.j.,

and now she and the rest of her family were worried they were going to lose him too. >> a lot of people were scared. even my husband was very afraid. he'd been with me through all of these losses, and he had somehow maintained his composure when i was losing my mind after all of these miscarriages. >> the most challenging thing i think has been the loss of the babies. i just couldn't understand why this would happen. >> mcfarland: after four months in the nicu, a.j. was ready to go home. but his recovery was far from over. >> he developed slower than full-term children. he had extensive physical therapy, occupational therapy, speech therapy just to make sure that he had every opportunity to catch up. and now he's six, and it's-- i'm now seeing his personality.

i'm now seeing him. he likes to sing. he likes to dance. you know, he likes to play instruments. and it's amazing because his vocabulary took a long time. >> mcfarland: a.j.'s a happy, healthy six-year-old today. but the odds were against him when he was born. >> there are some babies that survive at 23 weeks, but these are pretty uncommon. it's usually about 24 weeks where we're talking about a realistic chance. but even at that point, when the baby's 3 1/2 months premature, there are a lot of risks. the survival is certainly not guaranteed. and there are many complications that the babies can have, both short-term and long-term. by 28 weeks, that risk does drop significantly, but it's still a serious concern. the babies have to stay in the hospital a long time.

and there are still babies that do not survive or have major complications which impair long-term function. >> mm-hmm. >> now, mom? >> yeah, go ahead. >> mcfarland: chicago resident jori krischke is a mother of two healthy children with another one on the way. but jori's first child, her daughter avery, was born very early. the family's ordeal began with what jori thought was just a backache. >> i had a very normal pregnancy up until about 26 weeks. at 26 weeks-- it was a friday. i was at work. my back started to hurt. the back pain started to hurt more and more. then on the way home, it moved to the front, so it was kind of in my lower abdomen. we decided that we would go to the e.r. because it didn't seem like a normal backache at that point.

>> mcfarland: doctors told jori she was fine and sent her home. but the pains continued throughout the weekend, and on monday, she went back to her doctor. >> i just still felt like something wasn't right. the pain was getting a lot worse. and so i told him anywhere between, like, 10 to 30 minutes, i would have these pains that would last anywhere from, like, 20 to 40 seconds. he said the baby was fine and that i could go home. >> mcfarland: when the pains continued the next day, the krischkes decided to go back to the e.r. and there it soon became clear that jori was going to deliver her baby right away. >> my water broke with some force. and i don't really remember if she came out then or, like, shortly after that, but nothing was ready. they just--pretty much, i pushed maybe twice. >> mcfarland: avery was born at 27 weeks' gestation, 2 pounds, 10 ounces, and was in the nicu for 3 1/2 months. she had many obstacles to overcome as the result

of the preterm birth. >> we started off having-- we thought it was gonna be pretty good. she had--where the valve in the heart doesn't close all the way, which is pretty common for that. so it's routine for, you know, people call it routine to us. we're like, "oh, my gosh, she has to have surgery." when she went to go in for that surgery, they found that her bowel was perforated, and that kind of changed the momentum. but we were lucky because they only took a small portion out. it just was tough 'cause she had, you know, it's just tough-- i mean, they're only 2 pounds. she, you know, was having a tough time breathing, and then you throw in a perforated bowel. and you start thinking, like, "how much is this kid gonna take, you know, before they give up?" and never did, never did. >> mcfarland: most preterm deliveries come as a complete surprise. in fact, approximately half of the women who delivered preterm had no risk factors. doctors say that's the challenge: identifying women who appear to be at low risk of an early

delivery who end up delivering preterm. >> and how far premature was she? we usually divide preterm births in--in two types. one is spontaneous preterm births, and one is indicated preterm births. spontaneous preterm birth is when something happens such that the mother goes into premature labor or otherwise develops a condition which results in preterm birth, which the physicians are not able to stop. the other situation is indicated preterm birth, and that's where there is nothing happening with regard to preterm labor, but either the mother or the fetus is developing a condition and deteriorating where a decision is made by the health care provider that the baby's gonna be better off on the outside. and so delivery is initiated by the caregiver. >> hi, rikisha, how are you? >> i'm well. how are you? >> all right, so let's take a look with your blood pressure

and go from there. >> mcfarland: rikisha had an indicated preterm birth. she developed a dangerous blood infection, and because of that, doctors delivered the baby early. >> so once you have sign of infection, the baby has to come out right away. i didn't realize how serious it was, but later on, the doctors told me i pretty much almost died. >> mcfarland: while, as in rikisha's case, an indicated preterm birth is often a medical emergency, the other type, a spontaneous preterm birth, can happen without any warning, but there are a number of risk factors. >> probably the most common one that people know about is multiple gestation, where the woman is carrying twins or triplets. the risks of delivering premature are ex--significantly elevated. we also recognize that another premature risk factor is prior preterm birth. so any woman who has had a spontaneous premature birth

previously has a significant risk of that happening again. >> there are a number of other risk factors. race is one of them. black women have a higher risk of having a preterm baby. >> mcfarland: dr. debra jones is the president of perinatal and gynecologic specialists of the palm beaches. >> tobacco use, substance abuse, having chronic--any chronic medical problem predisposes you to preterm birth. >> preterm babies are at risk for a number of different problems. one is their immune system is not as mature, so they're more likely to be susceptible to infections. their lungs may not be mature, so they may need assistance from a breathing machine. they're more likely to have bleeding in their brain because their brain can be very, very sensitive to changes in blood pressure and other stimuli. their intestinal system may not be mature, so they may not be able to--to eat normally.

and they may have problems with their intestines. so premature infants do face a number of different problems. >> mcfarland: they knew the risks, but rikisha and jori both wanted to have more children. so they decided they would try again to have a healthy full-term baby. >> i decided, "okay, i think i could do this again," because despite what he-- what i went through with him, i kind of had been doing my research from right after his birth to kind of know that if i wanted to have more children, i needed to have my ducks in a row and know what i wanted--what i needed to do next. >> mcfarland: so before both women became pregnant again, they had a preconception consultation with their doctors. >> i'm glad you that you came in to see us after your last pregnancy. >> mcfarland: experts recommend all women at risk for preterm birth speak with a medical professional as early as possible to discuss their options. the best time for this consultation is either before conception or in the first

prenatal visit. doctors will often do routine testing to see if there are ways to lower the risk of delivering preterm. one test involves an ultrasound that looks closely at the woman's cervix. >> women who have very early deliveries--18, 19, 20, 21, 22, all the way up to 26 weeks-- most of the time, we think that this is from weakened cervix, called an incompetent cervix, and most practitioners offer them something called a cervical cerclage, which is a stitch that your physician would put around your cervix. >> mcfarland: the cervix is the lower portion of the uterus and is the doorway between the uterus and the vagina. during pregnancy, the cervix closes to help keep the fetus in the uterus. when labor occurs, the cervix dilates, or opens, to allow the baby through. in general, the cervix is normally around 4 centimeters long. this is the distance between

the outside world and the fetus. the shorter the cervix, the thinner the wall between the fetus and the outside world. although rikisha's initial preterm birth was due to an infection, during her checkup for baby number two, doctors found that her cervix was shorter than normal, which helps explain why she had had six miscarriages before she was able to deliver her son, a.j. dr. andrei rebarber is the president of carnegie hill imaging and maternal fetal medicine associates, as well as clinical associate professor at mount sinai school of medicine in new york. >> her cervix--which is sort of doorway or the opening to the uterus--was just incompetent and unable to maintain a pregnancy and would just painlessly, without contractions, just start to open up and dilate. bacteria would make their way up, and she would deliver. so she actually had surgery to close the cervix, not from below, from the vaginal route, but from above to get up higher

and close it. and the next pregnancy went to full-term. and that was very rewarding after she had about six different other prior pregnancy losses. and now she's pregnant again with her third. >> yeah, baby two was different. it was leisurely. it was amazing to me, really, because they took him out. they showed him to me. they cleaned him up. and then they gave him to my husband, but i could hear him crying the whole time, which to me was a sign that he was fine. he was healthy. you know, he was full-term. and then after that, they brought him to me. and they kept him on my chest while they were, you know, fixing me up. >> mcfarland: in rikisha's case, it was a simple surgical procedure that allowed her to deliver a healthy baby. but there are other treatments, including medications, that can help women bring their pregnancies to full-term. coming up, we'll take a look at the medication that has been most effective in reducing the risk of another preterm

birth. did you know that the national prematurity rate is about 12% in the united states? among african-american women, it's as high as 18%. if you'd like to see this program again or watch any of our other healthy body, healthy mind programs, please visit our website at: >> we would recommend in the form of... unfortunately, there isn't a magic pill or a magic drug out there that treats or prevents preterm labor and delivery completely. so most of the current emphasis is on the prevention side. and the prevention side is the use of a drug that's been around for a long time. it's progesterone. >> progesterone is a hormone that's naturally made by

the body. it's been identified since around the 1950s, and it was named progestin because it supports pregnancy. it supports gestation. and normally it's made early in pregnancy by the ovaries. and then starting in about the late first trimester, it's made by the placenta. and it's been shown to maintain and sustain pregnancy and help it to achieve term. >> we don't exactly know what the mechanism of action is and how it works, so there's several theories. it has to potentially do with direct effect on the uterus to relax it. it might actually have anti-inflammatory properties that may help keep the uterus quiescent from inflammation, which is one of the pathways to preterm birth. >> mcfarland: "quiescent" is defined as an inactive or tranquil state. >> there are a couple different forms of progesterone out there that have been shown to be beneficial. it's progesterone either supplied as a vaginal suppository or progesterone-- a special form of progesterone supplied as a shot. both forms have been shown to reduce the risk of preterm

birth. >> mcfarland: recommendations regarding the type of progesterone that a mother receives may be dependent on the risk factors of the individual patient. your physician will decide what treatment is appropriate for you. given jori's history of a prior spontaneous preterm birth of a single baby, she was a candidate for weekly progesterone injections. >> i gave birth 37 weeks. it was wonderful. ko was born 6 pounds, 13 ounces. and--i think, yeah, 6 pounds, 13 ounces, healthy, very different. good job, that's good. >> mcfarland: and jori is back on this therapy for baby number three. >> it pretty much comes down to the injection for my situation. and so i get the injection weekly. we start it at 16 weeks. and i'll get it all the way up until, i believe, 36 weeks. >> the treatment for preterm birth using progesterone starts at 16 to 20 weeks

and continues on till 36 weeks. >> mcfarland: but as with any medication, there may be some side effects. the use of progesterone to prolong pregnancy and prevent a preterm birth is only intended for women who have had a previous preterm pregnancy. >> so patients with a prior history of preterm birth, the most important thing is to define whether it was spontaneous preterm birth or medically indicated. was it because the baby wasn't growing fine, and you're delivering early because you had to get the baby out? or was it because you just starting contracting, broke your water, and then delivered the baby? so that's important. and then if it was a spontaneous preterm birth, those are patients that we start at around 16 to 20 weeks to put them on the progesterone shots. >> it is a daunting proposition for many families after they've been through the ordeal of having a preterm birth. sometimes the baby doesn't survive, or it has a long hospital stay, or many complications. and women understand that the risk of this happening again is increased. they're very hesitant or

fearful of trying again. the good news is that most of these women can do well in a subsequent pregnancy and end up with a normal, healthy baby. >> mcfarland: speaking to a health care provider early in the pregnancy process may help identify any risk factors and may help reduce the risk of another preterm birth. >> there is some good news. the good news is that your doctor is better equipped to prevent preterm labor. we understand the risk factors a little better. and we have drugs that are preventative drugs. we're more aware of the importance of the healthy mother having a healthy baby. >> good-bye, grandma! >> mcfarland: rikisha hughes-burke and jori krischke had successful full-term second pregnancies, and now both are looking forward to baby number three. >> i would probably tell people who are thinking about getting

pregnant and/or who have had a premature baby, i would tell them to try and find out exactly what it was that may have caused why they had the preemie, 'cause then at that point, you'll be able to find out possibly what you may be able to do or not be able to do to prevent it next time. >> so it's very, very, very important to find a supportive doctor and make sure he has a supportive team, so if you're having any fears for any reason, if you're having any pains-- whether imaginary or real-- you're comfortable calling the doctor's office and comfortable feeling like someone will respond to your concerns. really, i think that's-- that's paramount. >> bye! >> bye. >> bye. >> mcfarland: although it's not known exactly why some women go into labor early and deliver their babies preterm, there are ways to decrease the risk, even if a woman has delivered a preterm baby in the past.

physicians suggest early counseling and monitoring in order to set in motion a plan to prevent a preterm birth and to look for signs that something may be going wrong. it is important to be proactive in discussing your health and your baby's health with your doctor, especially if you have previously experienced a preterm birth. that's it for this edition of healthy body, healthy mind. i'm dr. scott mcfarland. see you next time. if you'd like to see this program again or watch any of our other healthy body, healthy mind programs, please visit our website at: to answer any specific questions you may have, be sure to contact your health care provider. to comment on today's program, please call: or email: or visit our website at:

>> announcer: major funding for healthy body, healthy mind is provided by: ther-rx corporation, a women's health-focused branded specialty pharmaceutical company that distinguishes itself through our commitment to the patients we serve. and by url pharma, using smarter science to deliver safer medicines. and by novartis vaccines, a leader in providing products to fight preventable viral and bacterial diseases. and by sanofi, a diversified global health care leader. discovers, develops, and distributes therapeutic solutions focused on patients' needs. we work to prevent and treat the diseases that we know of today, as well as those we may face tomorrow. additional funding provided by: vertex pharmaceuticals. and by biogen idec.