Kim’s baby

Big News everybody: Kim Kardashian had her baby!

Wait, what? You already heard? Did you also hear she had her baby a few weeks early and that her labor was probably induced due to preeclampsia? While all the Kim and Kanye baby-news is still speculative, we think births like Kim’s offer great opportunities to discuss issues that affect women having babies all over the world…yes, even those who aren’t celebrities.

The media is split on whether Kim had her baby three or five weeks before her due date, but regardless, her baby is considered premature. The technical definition of “premature” is a birth occurring before 37 weeks. If they occur three to six weeks early they’re called “late premature” or “near term.” The earlier a premature birth occurs, the more complications babies have.

While babies at 35–37 weeks gestational age do best if they stay inside mom until their due date, most critical fetal development is complete and most babies born at this stage are fully capable of surviving outside the womb. They might be underweight (like Kim’s tiny under-five-pound daughter) because baby fat and muscle mass develop during the last weeks of pregnancy. They also might not be able to regulate their own body temperature right away, which is why Kim’s baby was in an incubator for a few days. Most have no trouble breathing though some need supplemental oxygen for a day or so after birth (and a very few need ventilator support) until they get the hang of things. Some premature babies have undeveloped sucking instincts that interfere with breastfeeding, which is why they might receive IV fluids with glucose and formula and hopefully, lactation support services.

Late premature babies born in developing country that don’t have oxygen, incubators and NICUs, still stand a good chance for survival if mom keeps the baby close to her body for warmth, is able to breastfeed and the baby isn’t exposed to infections. In too many cases, those conditions can’t be met and babies born just a few weeks shy of their due dates die from hypothermia, dehydration, malnutrition and infection.

It’s speculated that Kim was developing preeclampsia. We did a “preeclampsia 101” blog with all the details on this condition back when Lady Sybil died on Downton Abbey. The short story is that preeclampsia is a pregnancy complication that affects 5–8% of all pregnancies or about 6.6 million women worldwide every year. It is rapidly progressive and characterized by high blood pressure, swelling and protein in the urine. While most cases can be managed with hypertensive medications and IV magnesium sulfate administration, preeclampsia can be fatal and is a leading contributor to maternal deaths. The only cure for preeclampsia is delivery of the baby.

Kim Kardashian recently tweeted a picture of her swollen feet, which is totally common in healthy pregnancies, but is also a classic sign of preeclampsia. Since her physician decided she needed to have her baby immediately, we’re guessing she may have had elevating blood pressure, protein in her urine and perhaps some of the other telltale signs of preeclampsia like visual changes, headaches and upper abdominal pain.

Once the decision is made to deliver a baby before labor starts on its own, there are only two choices — induction of labor and c-section. We’re hearing that Kim had a vaginal birth and it’s encouraging to hear her doctors didn’t just jump to do a c-section. Preeclampsia doesn’t usually require emergency surgery and in fact, mothers and babies generally do better when they deliver vaginally, even when facing complications like this one.

Over the past decade there’s been a serious overuse of inductions of labor, especially for non-medical purposes. These are called elective inductions and are often done for either physician or patient convenience. We’re starting to see them go out of fashion because they often fail to deliver patients vaginally and instead dramatically contribute to a dangerously high national cesarean section rate, which is linked to increased maternal mortality rates.

That doesn’t mean, however, that all inductions are a bad idea. Sometimes, inductions can be lifesavers. If Kim had preeclampsia that was a bad enough case to warrant early delivery, then it’s a darn good thing inductions are available. They aren’t in many countries where women deliver at home without skilled healthcare or access to emergency medical assistance. That’s why so many die in late pregnancy and labor.

(Photo: Photo: Chris McKay/WireImage)