Preterm Babies, Fetal Patients, and Childbearing Choices

by John D. Lantos, Diane S. Lauderdale

Overview

Why preterm birth rates in the United States remain high even as access to prenatal care has improved and infant mortality has steadily dropped.

The United States has one of the highest rates of premature birth of any industrialized nation: 11.5%, nearly twice the rate of many European countries. In this book, John Lantos and Diane Lauderdale examine why the rate of preterm birth in the United States remains high—even though more women have access to prenatal care now than three decades ago. They also analyze a puzzling paradox: why, even as the rate of preterm birth rose through the 1990s and early 2000s, the rate of infant mortality steadily decreased.

Lantos and Lauderdale explore both the medical practices that might give rise to these trends as well as some of the demographic changes that have occurred over these years. American women now delay childbearing, for example, and have fewer babies. Doctors are better able to monitor fetal health and well-being. Prenatal care has changed, no longer focusing solely on the health of the pregnant woman. Today, the fetus has become a patient, and many preterm births are medically induced because of concern for the well-being of the fetus. Preterm birth is no longer synonymous with a bad outcome. Sometimes, it is necessary for a good one.

Product Details

ISBN-13:	9780262330817
Publisher:	MIT Press
Publication date:	08/07/2015
Series:	Basic Bioethics
Sold by:	Penguin Random House Publisher Services
Format:	eBook
Pages:	232
File size:	548 KB
Age Range:	18 Years

About the Author

John D. Lantos is Professor of Pediatrics at the University of Missouri at Kansas City and Director of the Children's Mercy Hospital Bioethics Center.

Diane S. Lauderdale is Professor of Epidemiology and Chair of the Department of Public Health Sciences at the University of Chicago.

Table of Contents

Series Foreword vii

Acknowledgments ix

1 Two Narratives about Pregnancy in the Twentieth Century 1

2 Individual Decisions: A 34-Year-Old Pregnant Woman 36 Weeks 23

3 Stillbirth 35

4 Late Preterm Birth 41

5 Are There Too Many C-sections? 51

6 Feminist Critiques of Obstetrics 63

7 The Debate about Home Birth 73

8 Are C-sections Good for Women (and Babies, Too) 87

9 The Fetus Becomes a Patient 95

10 The Pill (and Delayed Childbearing) 111

11 The Changing Demography of Childbearing 119

12 Maternal Age, Multiple Pregnancies, and Preterm Birth 127

13 Maternal Age and Infertility 131

14 Changing Demography and Preterm Birth Rates 135

15 Your Fetus Becomes a Baby 141

16 A Defense of Modern Obstetrics 143

17 Neonatal Intensive Care and infant Mortality 149

18 The Evolution of Prenatal Care 153

19 International Comparisons 169

20 The Paradox of Modern Prenatal Care 173

21 Conclusions 181

Notes 187

Index 213

What People are Saying About This

Dominic Wilkinson

This is a fascinating, accessible, and insightful analysis of a revolution in reproduction over the last half-century. Lantos and Lauderdale provocatively challenge conventional ways of thinking about prenatal care, and rates of preterm birth and caesarean section. They provide a radical new look at perinatal health, and at the costs and the benefits of reproductive freedom.

Anne Drapkin Lyerly

With engaging prose and scientific rigor, Lantos and Lauderdale upend conventional wisdom about what is right—and wrong—with modern maternity care, and point us compellingly toward a new paradigm for evaluating and advancing the health of pregnant women and the children they bear.

Endorsement

Lantos and Lauderdale provide a thoughtful, comprehensive, and data-driven analysis of modern obstetric care. They conclude, paradoxically, that better access to high-quality perinatal care has increased preterm birth while decreasing infant mortality. They argue that the challenge for clinicians and patients alike is to embrace the more technological and medicalized obstetric interventions while eliminating those early inductions and caesarian sections that are not medically indicated.

—Alan R. Fleischman, MD, Professor of Clinical Pediatrics and Professor of Clinical Epidemiology and Population Health, Albert Einstein College of Medicine; former Medical Director, March of Dimes Foundation

From the Publisher

With engaging prose and scientific rigor, Lantos and Lauderdale upend conventional wisdom about what is right—and wrong—with modern maternity care, and point us compellingly toward a new paradigm for evaluating and advancing the health of pregnant women and the children they bear.

—Anne Drapkin Lyerly, MD, Associate Professor of Social Medicine, University of North Carolina at Chapel Hill; author of A Good Birth

This is a fascinating, accessible, and insightful analysis of a revolution in reproduction over the last half-century. Lantos and Lauderdale provocatively challenge conventional ways of thinking about prenatal care, and rates of preterm birth and caesarean section. They provide a radical new look at perinatal health, and at the costs and the benefits of reproductive freedom.

—Dominic Wilkinson, MD, Neonatologist, Director of Medical Ethics, University of Oxford; author of Death or Disability?

Lantos and Lauderdale provide a thoughtful, comprehensive, and data-driven analysis of modern obstetric care. They conclude, paradoxically, that better access to high-quality perinatal care has increased preterm birth while decreasing infant mortality. They argue that the challenge for clinicians and patients alike is to embrace the more technological and medicalized obstetric interventions while eliminating those early inductions and caesarian sections that are not medically indicated.

—Alan R. Fleischman, MD, Professor of Clinical Pediatrics and Professor of Clinical Epidemiology and Population Health, Albert Einstein College of Medicine; former Medical Director, March of Dimes Foundation

Alan R. Fleischman

Lantos and Lauderdale provide a thoughtful, comprehensive, and data-driven analysis of modern obstetric care. They conclude, paradoxically, that better access to high-quality perinatal care has increased preterm birth while decreasing infant mortality. They argue that the challenge for clinicians and patients alike is to embrace the more technological and medicalized obstetric interventions while eliminating those early inductions and caesarian sections that are not medically indicated.

Editorial Reviews

Preterm Babies provides a fascinating look at the changing face of childbirth in this country and presents premature birth as a deeply personal, as well as a medical and political, issue.

—Health Affairs

From the Publisher

Preterm Babies provides a fascinating look at the changing face of childbirth in this country and presents premature birth as a deeply personal, as well as a medical and political, issue.

—Health Affairs

Reviews

Preterm Babies provides a fascinating look at the changing face of childbirth in this country and presents premature birth as a deeply personal, as well as a medical and political, issue.

Health Affairs