Obstetricians, like most physicians, have been attracted to the diagnosis and treatment of those disorders in which the traditional medical model appears to be operative: identify and correct an alteration in physiology, and an improved clinical outcome will naturally follow. Maternal diabetes mellitus is the most obvious example of this approach: correction of maternal hyperglycemia results in nearly normal pregnancy outcome. Problems such as maternal urinary tract infection, anemia, hypertension, and fetal compromise during labor have also been approached in this manner, with variable but generally favorable results. Conversely, disorders in which the pathophysiology is not clear, and especially in which social factors play a large role, are less attractive medical foes to the majority of physicians. We do not know how to write a prescription or perform an operation to correct disorders of uncertain sociomedical origin.
Unfortunately, the problem of premature birth is just such a disorder. The dictum