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Preterm Birth Crisis in Puerto Rico

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By Jill—Unnecesarean


From Puerto Rico struggles with high preterm birth rate:

With nearly 20 percent of infants born before 37 weeks, Puerto Rico has the highest pre-term birth rate in the United States and one of the highest in the world.

Poverty in Puerto Rico, which has half the per capita income of the poorest U.S. state, can be a factor. Also, 48 percent of the island’s births are performed by Cesarean section, compared with 32 percent on the U.S. mainland. In some cases doctors opt to deliver babies by C-section before they reach term in hopes of avoiding complications. [Emphasis mine]

But researchers say that’s not enough to explain why the island’s pre-term birth rate has jumped more than 50 percent over the last two decades.

The National Institutes of Health last month awarded $9.9 million for a team of university researchers to study whether contaminants in Puerto Rico’s groundwater are contributing to the problem.


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Reader Comments (11)

Wow. That's money well-spent. Does someone need to hold a knife to someone's gut or something for them to get the message? :/

That's terrible- I can't imagine all of the trauma to families and babies behind those figures.

May 21, 2010 | Unregistered CommenterSara

Imagine what could be done for low-income pregnant women if, instead of expensive pre-emptive C-sections, the money were spent on prenatal care and education?

May 21, 2010 | Unregistered Commenterlarissa

I want to hear more about the groundwater contaminants. The US government has treated Puerto Rico as such a dumping ground in so many respects, including naval use as a bombing range and testing ground. I know we in the birth world are quick to blame practice management such as cesarean and induction, but I would not be surprised if there are additional causes to such a phenomenal preterm birth rate.

May 21, 2010 | Unregistered CommenterSarah D

"I want to hear more about the groundwater contaminants"

Me, too. I hope the study goes well.

There were quite a few sticky issues covered in the article, including not releasing babies to high-risk mothers and the label of "social deterioration." I'll be reading up on Puerto Rico.

May 21, 2010 | Registered CommenterJill

I WAS one of those women. :( My precious baby was ripped from my body in 2006 via C-section at 36.5 weeks when I lived in Puerto Rico. My OB (who had mocked and belittled me, and made it quite clear he hated that I wanted a natural, mobile birth) claimed I had pre-eclampsia. I had no symptoms and he would not show me my blood and urine test results. He also told me "I could induce, but it could take a couple days. I'm doing a C-section." I was young and scared, and didn't know what to do. It haunted me for months that I didn't stand up to him. I let him cut me open, and my child (healthy thankfully) was kept from me for 12 hours for no reason. That surgery and hospital stay was so traumatic I suffered from PTSD for months after.
I will say, as someone who lived there for 3 years, I submit that one factor in this epidemic is the culture of litigation that exists there. Over the years I was there, over and over I heard repeatedly about avoiding being sued, from many doctors. It was practically all-consuming. In fact, once you hit 20 weeks of pregnancy, you cannot switch OBs. It is called a liability. ?????????? And I had a friend whose baby was taken via repeat C-section (PR doesn't do VBACs *sigh*); her son had pulmonary hyertension and nearly died multiple times. He was airlifted to the States and saved after a million dollars worth of care. The next week I saw my OB for an appt; he was the same doctor who sectioned that baby. His first statement to me about it? "I hope they don't sue me." Mind-boggling. Why I didn't run for the hills STILL baffles and upsets me. :(

May 23, 2010 | Unregistered CommenterLauren

Lauren, I'm so sorry for what you endured. Thank you for your comment.

May 23, 2010 | Registered CommenterJill

This is outrageous, $9.9 million to study the water that we already know IS contaminated!!!!! Maybe that money could be used to educate doctors on normal birth, to support the midwifery model of care (last time I looked there were 3 midwives in the Island and midwifery is a-legal) and provide better prenatal care. There is a preterm crisis because almost 50% of the women in Puerto Rico are cut open. The fact that cesarean rates are higher on Mondays might give us cause to ponder. In 2007 a law was passed to force doctors to accept doulas in "their" hospitals and still doctors can find ways to get around the law. There are also laws to protect the initiation of breastfeeding, yet again hospitals get around it. The problem is not in the water.

PROMANI is one of the groups working in Puerto Rico working to change this madness. http://www.promani.org/ley_156.htm

May 23, 2010 | Unregistered CommenterEvelyn Ojeda

Thank you Jill! As a result of my experience, I have become very passionate and informed about birth. I had a fantastic VBAC this past October (planned UC in water that ended in the Naval hospital after a non-emergent transfer). It was a truly healing experience for me. :)

May 24, 2010 | Unregistered CommenterLauren

Whoa, I dunno how I missed this when first posted... I'm PRican and birthed my first son there in 1991. I had a wonderful, supportive OB -- he was the one who insisted I take the natural birthing classes. I went into pre-term labor at 33 weeks, got put on strict bedrest for two weeks, and my son was born at 36weeks. I was an educated, well-nourished pregnant woman at the time of my first pregnancy, with plenty of access to excellent medical care. My second son was born in the states, also at 36 weeks. I would look at not only groundwater contaminants but the long-term effects of the hormones given to the poultry and cattle that make up the food supply there. I was born at 42weeks, and I believe my mom was also born past her EDD, so there was no history of prematurity in my family until my sons were born. I have had hormone-related issues since puberty -- early menses, my gallbladder stopped working at 24yo (which the surgeon confided was something he saw a lot in PR in women with high levels of estrogen), hair loss, my thyroid is shot... I've always believed it was because of the crappy water and the "extra stuff" in the food supply in PR.

There is also a culture of doctors as gods there that needs to be addressed. It's very paternalistic and of course, machista. Of course, PR is also where women were sterilized for years, and where the birth control pill was tested, neither of which were done with true informed consent. (more on this can be found on libertadlatina.org)

Lauren - I'm so sorry for what happened to you, and I hate that it happened in my homeland. Congratulations on your healing VBAC!

May 24, 2010 | Unregistered Commentermicaela
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