Preterm Babies, Fetal Patients, and Childbearing Choices

From Basic Bioethics

Preterm Babies, Fetal Patients, and Childbearing Choices

By John D. Lantos and Diane S. Lauderdale

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





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

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.


$32.00 X ISBN: 9780262029599 232 pp. | 5.375 in x 8 in 7 graphs


  • 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


  • With engaging prose and scientific rigor, Lantos and Lauderdale upend conventional wisdom about what is right—and wrong—with modern maternity care, and point us compellingly toward a new paradigm for evaluating and advancing the health of pregnant women and the children they bear.

    Anne Drapkin Lyerly, MD

    Associate Professor of Social Medicine, University of North Carolina at Chapel Hill; author of A Good Birth

  • 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

    Neonatologist, Director of Medical Ethics, University of Oxford; author of Death or Disability?

  • 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

    Professor of Clinical Pediatrics and Professor of Clinical Epidemiology and Population Health, Albert Einstein College of Medicine; former Medical Director, March of Dimes Foundation