System-wide Intervention Applications of Prematurity Awareness



Premature birth affects one in eight infants in the United States (11.5%) and is defined as any birth before 37-weeks gestation.  Over 450,000 babies are born premature in the United States each year and over four million babies worldwide.   Premature birth leads to significant health problems.  Half of all premature births are considered spontaneous; in other words, there is no known risk factor.  Of the fifty-percent of known causes, risk factors for prematurity include: stress, carrying multiples (twins or triplets), uterine or cervix problems, domestic violence, lack of social support, late or no healthcare during pregnancy, chronic health problems of the mother, certain infections during pregnancy and the use of cigarettes or illicit drugs ( & 

While prematurity is a national (and worldwide) crisis, more importantly are the cultural misconceptions of what families give birth to a premature child.  While prematurity affects a higher percentage of women who uses illicit drugs or smoke, are lower-income and of a minority race, it is this cultural stereotyping that continues to place low-risk families at risk.  This essay will explore the role cultural stereotyping plays in prematurity awareness and system-wide interventions that could be implemented towards growth. 

I am the mother of a micro-premature son born 2 ½ months premature at 2 ½ pounds.  At 4-years-old (12-12-09) Giovanni has led our family through exceptional challenges requiring resiliency, sacrifice and a commitment to his well being far exceeding that of a full term child.  In 2009, I left the workforce to become a stay-at-home mom and caretaker for Giovanni’s special needs.  This decision was furthest from my original plans as an entrepreneur insurance salesperson as I built a nursery adjacent to my office with a flexible schedule akin to that of a raising a normal full-term child.  Giovanni’s micro-prematurity and special needs led our family to relocate from Southern Oregon to Central California to ensure he received the medical and therapeutic care he needed.  In addition to the journey alongside Giovanni through the Neonatal Intensive Care Unit and four years of early intervention therapies, our relocation from Southern Oregon to Central California has challenged us with cultural perceptions of who gives birth premature.    

Many families who have been through the Neonatal Intensive Care Unit share an inexplicable bond resulting in shared stories, support and encouragement.  Southern Oregon readily accepts prematurity often embracing families whose children were born premature and supporting a family’s journey openly.  In 2011, our family relocated to San Luis Obispo, California (Central California) where the attitudinal changes towards prematurity are strikingly different.  San Luis Obispo was named “the Happiest Place in America” in 2011 and home to California Polytechnic University (Cal Poly), arguably one of the best universities in the nation (Buettner, 2010).  Yet, for a family whose children were born premature, San Luis Obispo often silences families whose children were born premature by the cultural perception of parental fault due to illicit drugs, income disparity or race.  Prematurity isn’t a happy topic and the community responds with nervousness, changing topics or simply glaring at me as if I am at fault. 

At this time there isn’t a system-wide intervention being played out in San Luis Obispo to effectively change the cultural attitudes towards families whose children were born premature yet there is hope.  In November 2013 the newly hired Director of the Neonatal Intensive Care Unit began reaching out to community non-profits that support prematurity.

Michael Sales (2006) writes, “those of us raised in cultures emphasizing individualism may have particular difficulty believing our actions are significantly affected by our positions in social groupings or by the dynamics of social groups.  We have been taught to see ourselves as autonomous agents who determine our own future” (Sales, 2006, pg. 322).  San Luis Obispo is fiercely independent and the thought that 50% of all premature births are from an unknown etiology is frightening to a culture so strongly self-reliant.  As a former self-reliant and independent entrepeurneur myself, being airlifted in critical condition with pre-eclampsia demanded I set down my pride and give everything up for my child. An application point towards a system-wide intervention is to identify ways of recovery that emphasize self-reliance through parental education and support networks while in the Neonatal Intensive Care Unit to post-Neonatal Intensive Care therapies.  While in our Neonatal Intensive Care Unit in Southern Oregon, our NICU nurses required I be fully engaged in and learn to care for the special needs of Giovanni.  As a parent, I became the primary caretaker from the moment of his birth with support from neonatologists, nurses, social workers and occupational therapists. 

San Luis Obispo is a highly successful community.  Chris Argyis writes, “because many professionals are almost always successful at what they do, they rarely experience failure.  And because they have rarely failed, they have never learned how to learn from failure” (Argyris, 2006, pg. 268).  Giving birth to a premature child is failure to achieve a full-term pregnancy, period.  Teaching the San Luis Obispo culture to step past single-loop learning (academic credentials and intellectual disciplines) to double-loop learning (cognitive application of learning skills to unique situations) may help unfreeze individuals facing prematurity by developing the resiliency, sacrifice and commitment needed to raise a premature child. 

Lastly, Sales (2006) highlights how social systems are on automatic pilot where “people operate reflexively without awareness of the interaction between deep system structure and everyday events”, “robust systems present a vision of organizational and social possibilities” and “interventions that move social systems from their default, automatic, low-learning state to robustness, dynamism and aesthetic beauty” (Sales, 2006, pg. 323).  Sales identifies a four-player model: tops (strategic responsibility), bottoms (workers), middles (managers/supervisors) and environmental players (internal or external customers).  While tops are often leaders and in full control, bottoms are often oppressed and lacking control.  Likewise, Sales identifies two additional dynamics: dominants and others.  Dominants have access to resources and familiar with cultural norms while Others often feel constrained, oppressed or angry by the dominant controlled culture.  The application point for San Luis Obispo is to introduce differentiation, accept prematurity as homogenization, emphasize integration of families with premature children and accept individuation of community members and their experiences.  Additionally, through education and transformation from being a reflexive single-loop learning culture to a robust, dynamic culture San Luis Obispo can better accept families whose children were born premature and let them come out of their silence. 

In conclusion, by accepting families whose children were born premature is one step towards more cultural inclusion not only of premature families but also other families who may have been affected by an adverse condition or circumstance. 



Argyris, C. (2006). The healthy organization. In J. V. Gallos (Ed.), Organization

Development – a Jossey-Bass Reader (pp. 267-285).  San Francisco, CA: Jossey-Bass.



Buettner, D. (2010) Thrive: Finding happiness the blue zones way. Washington D.C.,  

               National Geographic Society.


Sales, M.J. (2006). Understanding the Power of Position.  In J. V. Gallos (Ed.),    

             Organization Development – a Jossey-Bass Reader (pp. 322-343).  San    

             Francisco, CA: Jossey-Bass.