Survival rates have risen for babies born before a mother's 37

The holiday season is always rough for Merlin and Nicole Pyrtle. The encroaching cold brings back harsh memories of loss. Two winter birthdays that are mourned rather than celebrated.

On Nov. 27, 2000, Nicole gave birth to the second of twins -- the first had been miscarried. But that baby boy was born dead, having died in utero when Nicole went into preterm labor after 18 weeks of pregnancy. Oct. 21, 2002, saw the birth of another Pyrtle son after 20 weeks of gestation. That child hung on for several months before succumbing to complications due to premature birth.

The National Institute of Child Health and Human Development reports that premature birth occurs in up to 10 percent of all pregnancies in the United States. It remains one of the top causes of infant death in this country. However, that fact comes as little comfort to parents who've gone through the loss of child born prematurely.

"The doctor told us, 'It's common,'" Nicole Pyrtle said. "It's not common to us."

According to the institute, labor is considered to be preterm if it starts before 37 weeks of pregnancy. Because a fetus is not fully developed at 37 weeks, it may not be able to survive outside the womb and is also susceptible to a plethora of health problems, including low birth weight, breathing problems and underdeveloped organs and organ systems. Dr. Michael Sherman, neonatologist at Saint Francis Medical Center, said the chances of the premature baby's survival are directly proportionate to the number of weeks spent in the womb as well as the size and condition of the baby.

Sherman said that although individual circumstances vary, typically a baby born at 28 weeks or above has a good chance of survival. Conversely, those born from 22 to 24 weeks are so susceptible to immediate death, as well as long-term disorders such as blindness, lung disease, developmental disabilities and cerebral palsy, that Sherman said the low chances of healthy survival often outweigh any attempt to resuscitate the child and keep it in continued hospital care. These hospital stays can last weeks or months, running hospital bills into the hundreds of thousands of dollars.

Sherman said few born under 22 weeks have much chance of survival at all.

Dr. Rick Flaksman, medical director of neonatology services at Southeast Missouri Hospital, said the chances of survival among babies born preterm have drastically increased over the past 25 years. This is due to both advances in technology for care as well as new techniques in delaying labor and accelerating the maturity of the child in utero.

However, the rate of preterm births is actually rising due largely to more multiple births (twins, triplets), advanced maternal age and induced deliveries.

But those are just a few of the factors that contribute to premature birth. Sherman said that almost half of premature births are caused by certain infections. The institute specifically identified a vaginal infection known as bacterial vaginosis, which is common among women of reproductive age, and can increase the risk of preterm labor. However, Sherman and Flaksman both emphasized that preterm labor can happen to any pregnant woman.

"Moms can do everything right and still go into preterm labor," Flaksman said.

This being the case, Sherman said there's usually no reason for a family that has lost a premature baby not to try again. However, he said those families usually take it upon themselves not to try because they aren't aware of the help available to them. He said that with the medical help of a paranatologist throughout the term and the emotional support available through counseling, those families can overcome their losses to experience a successful childbirth.

Getting help

After the heart-wrenching loss of two boys in two years to complications of preterm labor, the Pyrtles weren't ready to quit. But before they could move on and try to conceive again, they had to learn to cope with their tragedy.

Nicole Pyrtle said other parents would often pass judgment on her and her husband, not understanding why they couldn't let go and move on after the loss of two babies they hardly knew.

"Unless someone's been through it, they can't identify," Nicole Pyrtle said.

So in December 2002, just after the loss of their second premature son, the Pyrtles started attending the monthly meetings of the local chapter of a regional organization know as SHARE -- Source of Help for Airing and Resolving Experience -- at Southeast Missouri Hospital. The group is run by nurses who are trained as counselors to help those dealing with the loss of a baby through miscarriage, stillbirth or newborn death.

Along with nurse Gail Unverferth, Cathy Schloss coordinates the Southeast Hospital SHARE chapter. She said the group's meetings are open to all ages and family members from anywhere who've experience this loss, no matter how long ago it occurred.

Through the SHARE group, the Pyrtles drew from people who'd gone through the same tragedy and heartache, and were eventually able to move through their grief.

Saint Francis Medical Center doesn't offer a support group, but its nurses do offer one-on-one counseling and a list of professional counselors and support groups in the area.

Nurse Beth Kern is the coordinator of Saint Francis' bereavement program. She said the nature in dealing with the death of premature babies has become much more open in recent years.

The two Cape Girardeau hospitals help in memory-making for parents by constructing memory boxes for each parent of a preterm baby who's died. Nurses collect locks of hair, make castings of the baby's body and face, make hand and foot prints, name bracelets and tons of digital pictures when they're able to put in these boxes. Kern said parents aren't always ready for these boxes when they leave the hospital, so she promises to keep them forever, until the parents want them.

She said she doesn't have a single one left on her shelf.

Schloss said the entire staff of Southeast Missouri Hospital is also trained to deal with the parents of a recently deceased baby in a sensitive way. Stickers bearing the SHARE logo of a heart-shaped, grape vine wreath and a yellow rose losing a single pedal are place on the doors and charts of these parents so that staff members will know not to tip-toe around the loss in conversation.

Trying again

While hospital methods are evolving to better serve parents of dead preterm babies, so too are the those of paranatologists to better aid those parents who decide to try again.

That's why when the Pyrtles conceived for the third time in November 2003, Nicole went to one of these doctors to help see the term through to a successful childbirth. Since she was prone to preterm contractions and her cervix was deemed incompetent, Nicole Pyrtle underwent a series of medical treatments and procedures, including actually having her cervix stitched, throughout the term.

On June 13, 2004, Nicole Pyrtle gave birth to Madelyn Grace, a 4-pound, 8-ounce baby girl, still six weeks before the term was up. But the Pyrtles were relieved to learn that she was perfectly healthy, as she is today at 6 months of age. Madelyn won't erase the loss of her siblings for her parents, but she should help the Pyrtles get a little more joy out of this holiday season.

"She's the little miracle at the end of the tunnel," Nicole Pyrtle said.

trehagen@semissourian.com

335-6611, extension 137