Queston: Who should pick your baby's birth date?

Answer: Your baby.

The answer seems obvious, doesn't it? But in too many cases, factors other than a baby's medical readiness to be born determine the birth date. Doctors or parents sometimes have scheduled a date to induce labor or have a caesarean section so the baby could be born before dad or the doctor goes out of town, or in time for grandma to visit, or to coincide with a meaningful date in family history.

March of Dimes and leading medical societies such as the American College of Obstetricians and Gynecologists are clear on their recommendations: Deliveries should not be scheduled before 39 completed weeks of pregnancy unless there are clear medical reasons. Here's why:

Important organs, including the brain, liver or lungs, may not be fully developed.

Babies born early are more likely to have vision or hearing problems.

Babies born too early are often too small and have more trouble staying warm.

Babies who are delivered prematurely are more likely to have difficulty sucking and swallowing or staying awake long enough to eat.

The Post-Dispatch and March of Dimes first pointed out this trend of babies being born early by choice two years ago in an editorial marking November as Prematurity Awareness Month. Premature birth remains a serious health issue in Missouri and Metro East. March of Dimes released report cards earlier this month, noting that 12.1 percent of babies in Missouri and 12.2 percent of those in Illinois, are born too soon. Each state's premature birth grade is a "C," the same grade that the United States receives for its efforts.

But, in the last two years, there is progress:

Missouri's rate is down from the 12.5 percent reported two years ago.

In Missouri, the rate of late preterm births — those more likely to be scheduled — is down from 9 percent to 8.7 percent.

Missouri last year enacted a program providing $3 million to fund smoking cessation assistance for people on Medicaid. It became one of the last states to do so. The state is putting a special emphasis on helping pregnant women to quit smoking. Tobacco smoking is one of the known factors that can lead to premature birth. One way to access these services — whether on Medicaid or not — is to call the state Quit Line, 1-800-Quit-Now. It is free and confidential.

This year, the Missouri Legislature passed, and Gov. Jay Nixon signed, a measure creating a state Task Force on Prematurity and Infant Mortality. This 18-member group includes key legislators, medical professionals, insurance specialists and families affected by premature birth or infant mortality. Its task is to systematically study the problem and recommend "evidence-based" steps to help Missouri lower its premature birth rate. The task force is to complete its work by the end of 2013.

The Midwest Health Initiative, a non-profit regional health improvement organization, is bringing together physicians, hospitals, the business community, community organizations, health plans and others to reduce the number of early elective deliveries before 39 weeks. This effort hopes to utilize policy, measurement and education to support physicians and parents as they work to increase the number of babies delivered at full-term.

I recently visited an area newborn intensive care unit and watched little 1- and 2-pound babies fighting for life with every breath. They were connected to tubes, wires and monitors. While most moms, including myself, look forward to the joy of holding our newborn child right away, parents of these babies won't hold them for days or weeks.

To give an idea of just how small some babies born too soon are, look at the nearby photo. It shows a diaper worn by a full-term baby of six or seven pounds, compared with the preemie diaper worn by a 1-pounder. When I first saw one of these diapers, I was astounded by how small it was.

As March of Dimes redoubles its efforts to help all moms have full-term pregnancies and healthy babies, we especially urge that babies be allowed to remain in the womb at least 39 weeks, to give them a better chance for a healthy start.

Mary Elizabeth Grimes is state director of the Greater Missouri March of Dimes.