Whitney and David Coben were thrilled early this year to learn they were expecting their first child.
But the Saginaw couple never had a chance to leisurely shop for tiny outfits, attend a baby shower or even paint the nursery before their September due date.
When she was 17 weeks pregnant, Whitney Coben’s water broke unexpectedly. She spent 10 weeks on bed rest but still went into labor more than three months early. Brayden Scott Coben, born July 4, weighed less than 3 pounds and couldn’t breathe on his own.
Brayden was immediately transferred to the Neonatal Intensive Care Unit at Cook Children’s Medical Center in Fort Worth. The Cobens are still waiting for the day they can bring their son home.
“The hardest thing as the parent of a preemie is that you never know what you are walking into. We never know what each day holds,” said Whitney Coben, 26. “Whether he will have a good day or a bad day or be a pink baby or a blue baby or if he’ll be breathing on his own. You can’t even imagine how hard it is until you are here.”
Unfortunately, too many families are experiencing that fear and uncertainty in the NICU, health advocates say. One in 12 babies in the state and about 1 in 10 babies in Tarrant County are born too soon. Those babies are at greater risk of death or serious health issues, which cost the United States more than $26 billion annually.
Though not all premature births are preventable, the March of Dimes has been working the past few years to encourage North Texas hospitals to adopt policies and practices aimed at giving babies the healthiest start possible. As part of its “Healthy Babies Are Worth the Wait” initiative, the nonprofit is pushing for doctors to significantly reduce the number of elective inductions or cesarean sections before 39 weeks of gestation, unless medically necessary.
“Elective deliveries are a problem because it’s become very clear over the past few years that babies born between 39 and 40 weeks have the best outcomes,” said Dr. G. Sealy Massingill, March of Dimes physician champion. “They do better. They don’t go to the NICU. They don’t struggle with asthma. If we can delay delivery until 39 weeks just because we want to, that is going to give us lower [medical] costs and better outcomes.”
Though preterm birth remains the greatest risk factor in infant death in the first month of life, Dr. Rehka Hamilton, a neonatologist with the Pediatrix Medical Group, pointed out that the number of babies born in the United States between 37 and 39 weeks gestation increased 50 percent from 1990 to 2006. That trend needs to reverse, she said.
“Research clearly indicates that these babies born before 39 weeks face at least a 20 percent greater risk of complications than those that are born after 39 weeks,” Hamilton said. “There are key organ systems that are still developing during that period. It is indeed best for the baby … for pregnancy to be allowed to continue to at least 39 weeks and then to allow labor to spontaneously occur.”
For three years, the March of Dimes has worked with 13 Tarrant County-area birthing hospitals to reduce the number of elective inductions before 39 weeks, which has been as high as 28 percent, said Wanda Wesson, the nonprofit’s program services director. Those efforts are starting to pay off, she said.
This month, which is Prematurity Awareness Month, the March of Dimes recognized nine north Texas hospitals for reducing the proportion of elective inductions before 39 weeks to 5 percent or lower.
“We want to celebrate these hospitals. It’s a big thing to get doctors and moms not to want to deliver early because it’s a convenience,” Wesson said.
The March of Dimes recently presented special banners to John Peter Smith Hospital Fort Worth, Texas Health Harris Methodist Hospital Alliance, Texas Health Presbyterian Hospital Denton, Texas Health Harris Methodist Hospital Fort Worth, Texas Health Huguley Hospital, Texas Health Harris Methodist Hospital Southwest Fort Worth, Methodist Charlton Medical Center, Methodist Dallas Medical Center and Texas Health Presbyterian Hospital Dallas.
Premature birthrates are improving. Texas’ rate was 12.3 percent in 2013, down from 13.7 in 2006. And though the national preterm birthrate is at its lowest point in 17 years at 11.4 percent, health advocates say it is still too high for a country with so many resources.
The Cobens know their son’s early arrival may mean long-term health complications but only time will tell what challenges he might face as he grows up.
Brayden, now 11 pounds, 7 ounces, remains on a ventilator 24 hours a day and receives respiratory therapy as his immature lungs develop. The bleeding in his brain is no worse, and his growth is on schedule.
“We were told 2 1/2 weeks into his life that there was nothing else they could do for him,” Whitney Coben said. “He’s beaten the odds a thousand times over.”
The Cobens, who commute from Saginaw to spend time with their son every day, are learning how to care for Brayden’s tracheostomy and operate his ventilator so he can eventually come home. They look forward to finally using their baseball-themed nursery and taking their son for a walk to feel the sunshine, something he’s never experienced during his four months of life.
“I hope the hardest part of his life is over. I hope it’s a breeze for here on out,” Whitney Coben said.