Preterm Birth in the United States

_____________This book presents a wide-ranging and critical view of the research literature relevant to preterm birth while examining six perspectives: clinical/biomedical, epidemiological, cultural, political, medical care system, and ethical dimensions. Preterm births, those that occur before a fetus reaches full term at about 37 weeks, is a phenomenon that occurs globally. However the US has a profile of premature births that is unique, with a rate almost double that of the developed countries of Europe and Asia. In our competitive medical system, hospitals vie for maternity patients by offering advanced and specialized services to care for infants born preterm. More and more women find their pregnancies categorized as "high risk" and are guided into the use of more interventionist obstetric care. This book takes a nuanced view of the occurrence of preterm delivery, recognizing the need to understand the issue from multiple perspectives. The clinical paradigm has a bias towards therapeutic action, so even observations about differing prevalence rates of preterm birth in different populations are framed towards remediating action - for example, how to erase the effects of a lifetime of poverty through prenatal and neonatal care. The epidemiological view is constrained by the selective availability of population-based data and the need to build causal models out of observations about associations. The availability of population-based data in turn is determined by political dynamics, influenced by concerns about population growth and sexual activity in particular sub-populations. Because of these concerns, we have access to data about birth outcomes by ethnicity, locale, maternal age and marital status, but these are not necessarily the data that are needed to truly understand patterns of preterm birth._