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Preterm Babies, Fetal Patients, and Childbearing Choices

Why preterm birth rates in the United States remain high even as access to prenatal care has improved and infant mortality has steadily dropped.

John D. Lantos, Diane S. Lauderdale

The MIT Press

ISBN-13: 978-0262029599

The United States has one of the highest rates of premature birth of any industrialized nation: 11.5%, nearly twice the rate of many European countries. In this book, John Lantos and Diane Lauderdale examine why the rate of preterm birth in the United States remains high―even though more women have access to prenatal care now than three decades ago. They also analyze a puzzling paradox: why, even as the rate of preterm birth rose through the 1990s and early 2000s, the rate of infant mortality steadily decreased.

Lantos and Lauderdale explore both the medical practices that might give rise to these trends as well as some of the demographic changes that have occurred over these years. American women now delay childbearing, for example, and have fewer babies. Doctors are better able to monitor fetal health and well-being. Prenatal care has changed, no longer focusing solely on the health of the pregnant woman. Today, the fetus has become a patient, and many preterm births are medically induced because of concern for the well-being of the fetus. Preterm birth is no longer synonymous with a bad outcome. Sometimes, it is necessary for a good one.


"Preterm Babies provides a fascinating look at the changing face of childbirth in this country and presents premature birth as a deeply personal, as well as a medical and political, issue." - Health Affairs

Lantos and Lauderdale provide a thoughtful, comprehensive, and data-driven analysis of modern obstetric care. They conclude, paradoxically, that better access to high-quality perinatal care has increased preterm birth while decreasing infant mortality. They argue that the challenge for clinicians and patients alike is to embrace the more technological and medicalized obstetric interventions while eliminating those early inductions and caesarian sections that are not medically indicated. - Alan R. Fleischman, MD

"This is a fascinating, accessible, and insightful analysis of a revolution in reproduction over the last half-century. Lantos and Lauderdale provocatively challenge conventional ways of thinking about prenatal care, and rates of preterm birth and caesarean section. They provide a radical new look at perinatal health, and at the costs and the benefits of reproductive freedom." - Dominic Wilkinson, MD

About the Author

John Lantos Portrait

John Lantos grew up in the rugged mountains of western Pennsylvania coal country. His father, a physician, was his childhood hero and role model.  His mother, a poet at heart, inspired him to become a writer.  He is an award-winning pediatrician, a prolific author, a beloved teacher, and an inspirational speaker.


Lantos was a resident in DC during the national controversy about Baby Doe, a baby with Down Syndrome.  That sparked a lifelong interest in bioethics and led to a post-doc fellowship at The University of Chicago. There, his groundbreaking work on neonatal bioethics and health policy led to leadership roles as Chief of General Pediatrics and Associate Director of the MacLean Center for Clinical Medical Ethics, and Associate Editor of Pediatrics.  Fifteen years ago, he moved to Kansas City to create and develop the Children’s Mercy Bioethics Center. 

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