US Infant Mortality Statistics

11.11.09 What a difference a couple weeks makes

LaborNurse1_27.jpg Headlinephoto / Splash News

The United States ranks 30th in the world for infant mortality. Last year, we were 29th. We lose more babies than most developed countries in the world. What’s going on here? Why are our babies dying? It’s an extremely complicated tangle of poor healthcare access and decisions, race, poverty, infertility, substance abuse, malnutrition and many other factors.

The biggest reason why newborns die is because they’re born too soon. More than 50% of these are born less than 32 weeks gestation. A startling percentage (about 32%) though, are born at 37 weeks or older. Being born even a few weeks early makes an important difference in fetal lung and immune system development and can mean the difference between life and death. While most babies born after 37 weeks are fine, some obviously aren’t.

Neonatal Intensive Care Units do a great job keeping premies alive. The problem is i keeping babies from being born too early. Here in the United States, we deliver babies prematurely a lot – sometimes intentionally and sometimes because our calculations vary from when a baby is actually due.

Determining an accurate due date isn’t always simple. It’s based on the first day of your last period. Countless super-organized women log that date in red ink on their calendar every month. Plenty more of us though vaguely remember the approximate date, more or less, give or take a few days. “It was the night of that dinner party because I had to buy tampons on the way. Or wait, maybe that was last month.” A first trimester ultrasound helps dial in a due date by estimating fetal age. There’s a reason though, why it’s called an Estimated Due Date.

We’ve been tinkering with delivery dates a lot in the past few decades. Our induction and c-section rates have risen along with the number of premature babies we deliver in this country. There’s a pretty clear connection here. Of course, inductions and scheduled c-sections aren’t the only reasons why babies are born prematurely, but these are two factors we have some control of.

Most 38-week babies are in the safe zone for delivery though 40 weeks is officially full term and the day of your Estimated Due Date. Let’s set up a little scenario to illustrate what a difference a couple weeks can make. I’ve totally made this patient up but I’ve seen this happen many times.

Susan was almost 38 weeks with her first baby and really uncomfortable. At a routine doctor’s appointment, she was told her cervix was one-and-a-half centimeters dilated and “things were on their way.” Then her doctor said, “Susan, you’re almost due and I know you’re tired of this. Why don’t we get this show on the road?” Susan decided an induction sounded like a pretty good plan. Officially, she was 37 weeks and five days gestation - so close to full term she wasn’t worried.

After hours Pitocin, ruptured amniotic membranes, an epidural and not much progress, Susan had a cesarean section. When her son was born, it was immediately clear something was wrong. Nurses flew into action and her baby was rushed to the NICU.

The next few days were a nightmare. Her son was hooked up to a ventilator, IVs trailing out his arms, countless lab tests and needle pokes were done and x-ray after x-ray taken. The pediatrician suggested that her son looked and acted like a 35-36 week baby, not “almost full term.” Susan’s records revealed her due date might have been off a couple weeks. Her son wasn’t mature enough to breathe on his own and soon, he developed pneumonia.

I’m giving this story a happy ending because I just can’t inflict the kind of pain, regret and suffering I know thousands of parents go through every year. Susan’s baby went home healthy a couple weeks later.

Sometimes, tragedies happen and we don’t know why. Sometimes, we can prevent them by avoiding all the “bad stuff” we know causes prematurity. Evidence is mounting that avoiding unnecessary induction and cesarean is key to avoiding prematurity too. Hang in there. Those last couple weeks of pregnancy are important. You won’t regret it.

Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to and it may be answered in a future blog post.

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