Multiple Pregnancies: Relations between pre term birth and defects
Pregnancies can be difficult and dangerous which is why mothers need to follow the instructions of doctors to avoid pre-term labor, especially when the birth of multiples is added to the equation. It is often thought that pre-term labor cannot be prevented and that most pregnancies that are associated with multiples is also associated with defects and deficiencies. Pregnant mothers often are faced with fears; the most common of which is having an unhealthy child. When carrying more than one child mothers are automatically placed into the high risk category (Griffith). "The general public and the press glamorize higher-order multiple births but they don't seem to realize that ANY multiple pregnancy, even twins, is a high-risk pregnancy and sometimes fraught with problems" (Griffith, par. 2). Information is key in reducing preterm birth. The more someone knows about the what their chance of risk is, the causes and effects of pre term labor, methods of prevention, and the more educated and well thought out their choices can be. Knowledge is the first step in prevention, follow through is second, and concern is third.
In order to understand why one would want to avoid pre-term labor one must know what the dangers to them are. Pre-term labor occurs in roughly 11 percent of all pregnancies. It is responsible for the majority of neonatal deaths and almost one half of all congenital neurological disabilities. Anything before 37 weeks of gestation is considered premature and anything before 32 weeks of gestation is what accounts for the majority of those neonatal deaths. The chances of preterm birth are substantially increased when having multiples because of the mothers body and its own limitations in carrying (Goldenberg and Rouse).
Twin pregnancies are now comprising and increasing proportion of total pregnancies in the United States; this could in part be from the expanded use of fertility treatments and older maternal ages at child birth (Twin pregnancy: Prenatal issues). Complications of pre-term birth can vary; specific complications associated are: Low heart rate, asthma, hernias, jaundice, necrotizing enterocolitis (intestinal problems), retinopathy of prematurity (visual problem), and various respiratory issues. Issues of pre-term multiples have been noted to last well into school age and are documented in experiencing issues that required some type of help such as, adaptive physical education, behavior modification, DD program, ESE placement, individual education programs, learning lab, physical therapy, separation in class, tutoring, and speech therapy (Griffith). Speech therapy happens to be the most common type of therapy for the school age children while respiratory issues are the most common in infancy.
Modern medicine is thought to be a fix for everything for some and despite the advances in technology, medicine, and treatments some people still choose to ignore the warnings and opportunities and go on believing they are invincible. There is a genetically linking tendency to hyper-ovulate; meaning it runs in the family. This being the case certain women have a higher chance of producing twins, these are the women who should be increasingly aware of what it is and what it means to carry twins."Most preterm births follow spontaneous, unexplained preterm labor, or spontaneous preterm prelabor rupture of the amniotic membranes. The most important predictors of spontaneous preterm delivery are a history of preterm birth and poor socioeconomic background of the mother" (Tucker, fig. 6). Spontaneous labor is associate with an increase in perinatal mortality and short term and long term morbidity. Even when most pre term births are associated with a spontaneous even there are still steps that should be taken at certain points in the pregnancy to alleviate the danger to the child and mother. Bed rest in hospital or at home is widely recommended for the prevention of preterm birth. This advice is based on the observation that hard work and hard physical activity during pregnancy could be associated with preterm birth and with the idea that bed rest could reduce uterine activity.(Sosa, Althabe, Belizan, and Bergel). Although mothers can limit their physical activity, that is not always the only cause linked to pre term labor. Mothers who smoke cigarettes are twice as likely as non-smoking mothers to deliver before 32 weeks of gestation (Tucker). When has a doctor every expressed, especially to a mother to be, that smoking is health? Taking care of oneself is essential when a carrying a baby; the mothers health affect the gestation of the children. Despite the known some women ignore the facts and advise and choose to follow their own directive.
A multiple pregnancy is automatically associated with higher rates of almost every potential complication of pregnancy, with the exceptions of post term pregnancy and macrosomia ("Prenatal issues," n.d., para. 2) Education on the facts, issues, and warning signs are key in the prevention of pre term labor. Knowing the warning signs as well as what can come of those signs are ignored could be the difference between a full term gestation and a pre term labor riddled with complications for the child and mother both immediately as well as through life. As well as bed rest, there are medications that can be used to help reduce contractions and limit how the body graduates through the labor process. Magnesium sulphate is used to inhibit uterine activity in women in preterm labor to prevent preterm birth (Crowther, Hiller, & Doyle, 2002). Magnesium sulphate is a medication that relaxes the muscles in the body, this is what allows the uterine activity to slow and allows medical professionals to slow or stop the process of labor. Doctors have also been known to use certain off label, or unapproved methods, such as terbutaline to stop contractions. Terbutaline is often used for patients with asthma, but has been known to help delay preterm labor (Terbutaline). " In February 2011, the Food and Drug Administration has ordered to put a boxed warning on the drug's label. Pregnant women should not be given injections of the drug terbutaline for the prevention of preterm labor or for long-term (beyond 48-72 hours) management of preterm labor, and should not be given oral terbutaline for any type of prevention or treatment of preterm labor "due to of the potential for serious internal heart problems and death." (Terbutaline, par. 1). This research is not something to ignore, argue against, or test; the warnings are put into place for a reason. Mothers to be must know every side of the coin and trust the medical opinion of the OBGYN that they have chosen. They must choose to follow every direction without fail in order to reduce their risk and give their child every chance to meet the full gestational period.
Early prenatal care is essential; this allows the medical professional of your choice to instruct you on how important it is to eat right, gain the proper amount of weight, and screen for infections that can harm the pregnancy. Prenatal vitamins, that contain folic acid, can be essential to the treatment as well. Studies have shown that a folic acid supplement can reduce the chances of a placental abruption. Ensure that the medical professional you have chosen is recommending certain testing. Some testing can detect a vaginal bacterial infection, for example, the body releases infection-fighting chemicals known as cytokines, which cause inflammation. This inflammation, in turn, launches the release of prostaglandins, which begin the chemical process that initiates contractions and the dilation of the cervix (Singer).
Preterm labor, whether with a singleton or multiple, has extensive risks both during gestation and after gestation for both mother and child. Knowledge of how at risk one is and being proactive about prevention is the key in prevention. The knowledge of how at risk one is and what puts them at risk can determine the appropriate treatment plan. Avoidance of complications such as defects or death, can be achieved through meticulous obedience of knowledge, prenatal care, a medical professionals directions, and sometimes medicinal intervention.
