BAGHDAD, Iraq—Dr. Dalia Hatem was helping to deliver another woman's baby at Baghdad Teaching Hospital when the heat and noise became too much for her. Dr. Hatem went into premature labor.
When the gynecologist saw her own 35-week-old son for the first time last month, there were tears in her eyes. He had been crying—a tiny, shriveled but healthy infant in an incubator—but as soon as he heard Hatem's voice, he quieted.
"The stress of the labor room got to me, and I started to go into contractions," she said. "I tried bed rest and drugs, but it didn't work."
Amid the daily bombings and mortar attacks, life goes on in postwar Baghdad. People continue to have families, even in the midst of one of the most serious security crises since the war began. But that stress and worsening violence are causing infant mortality rates to rise, according to maternity ward doctors and nurses. They say they're seeing more non-hereditary birth defects and premature births.
Women, frightened by lawlessness and economic instability, have an increased likelihood of giving birth prematurely, doctors say. And because more women are afraid to go out, more are giving birth at home.
"Half our population prefers home delivery, for now, because of the security situation. It's a higher risk for the baby, but they are afraid to go out," said Dr. Afrah Saleh, a senior specialist in the 10-room premature unit of Mansur Pediatric Hospital, which allows new mothers to rest beside incubators holding their fragile infants.
"Premature labor has a lot of psychological causes," Saleh said. "Really, we are under stress. Definitely, the premature deliveries are on the increase after the war."
She also said she'd seen three cases of congenital birth defects in the last three months. Usually she sees just one or two a year.
Infant mortality in Iraq is estimated at 103 deaths per 1,000 live births, compared with 6.8 per 1,000 in the United States, experts say. According to UNICEF, one in eight children dies before his or her fifth birthday. A fifth of Iraq's children are malnourished, and a quarter are born underweight.
Recordkeeping has been disrupted by the war and by bureaucratic problems, related to setting up a new government, but anecdotal evidence suggests postwar chaos continues to make life difficult for some of Iraq's most vulnerable victims.
At Yarmuk Hospital, one of Baghdad's largest and busiest, mothers are in one room, babies in another. Flies enter from the broken window that once surrounded the air conditioner. A dozen new incubators sit next to a broken heating table with a burned-out lamp.
Half the incubators were donated by the Americans, half by the United Arab Emirates. There are no service agreements and no one to maintain or repair the machines. Workers hang onto two broken incubators to cannibalize them for spare parts when the new ones break down.
"All our work is in disruption," said Dr. Tala al Awqati, chief of pediatrics at Yarmuk. She said she feels abandoned by the Americans and by humanitarian groups.
"It's a disaster. This is a chaos environment for babies," al Awqati said. "We are all suffering fear, stress, a lack of transportation. We get out of our homes and are afraid. Women are afraid of abductions and kidnappings. Then there's the stress of pregnancy. And for many families there is malnutrition, because of sanctions."
A gaunt-looking Sabah Abid, 41, recently gave birth to her fourth child, a baby girl named Mariam Zuhair who was born at 32 weeks. She weighed a bit more than 2 pounds and lay motionless in an incubator, her eyes swathed with bandages to protect them from the ultraviolet light meant to remove the jaundiced tones from her wrinkled skin.
"My first child was also born premature and died. Of course I feel affected by the war and the economy. I'm thinking all the time about how to support my children," Abid said. "My husband is working as a bus driver, but during the war and immediately after he was not working. I don't know the price of meat because I don't buy it."
Last month, Yarmuk Hospital admitted 48 babies and 19 of them died. "That's about 40 deaths per 100. It was about half that at the same time last year," al Awqati said. "The mortality has risen since the war, that's for sure."
Hospital conditions were abysmal before the war because of sanctions and neglect. Since the war, American aid has provided new hospital equipment, including six generators for Yarmuk Hospital.
But doctors say they also need medicines.
In the United States, babies born at 23 or 24 weeks are considered very premature, but they are viable and can be brought back to health with medicine, ventilators and good nursing care. But in Iraq, without proper medicine, babies delivered before they are 30 weeks old stand almost no chance of survival.
At Mansur hospital, Suha Abbass, 23, was recovering from giving birth to a 34-week old boy. Her previous three children were all born premature. The first died at six months, the second at seven months, the third at birth. After five days of oxygen therapy, little Ali Raed seemed to be beating a severe respiratory problem and was scheduled to be discharged.
"He is a very, very precious baby. I'm very happy because I didn't believe he would make it with all his problems," Abbass said. "I'm grateful to God."
(c) 2003, Knight Ridder/Tribune Information Services.
PHOTOS (from KRT Photo Service, 202-383-6099): USIRAQ+BABIES