On an uneventful Monday night, Kim Cowan, 31 weeks into her first pregnancy, was sprawled on the couch reading about ways to pay down her debt. Then, without warning, she felt a thrust in her abdomen. "There was a kick, a pop, and then a gush of water," says Cowan, 31. She yelled to her husband, Kelly, and ran to the bathroom. "Is your water breaking?" he asked. No way, thought Cowan, who still had a good two months to go.

"I was terrified," says Cowan, who didn't have any risk factors for pregnancy complications. Too panicked to drive, the couple had a neighbor rush them to the hospital, where their fears were confirmed: Cowan's water had broken and she was in labor. Suddenly, her life was in chaos. "Nurses and doctors were poking and prodding me, and asking a million questions." Her doctor was able to delay delivery with medication, so she could be given steroids to help her baby's lungs develop. Three days later, Cowan gave birth to a son, Cayce, who weighed only 3 pounds, 11 ounces. He was immediately rushed to the neonatal intensive care unit, where he stayed for a month.

Cowan's experience is becoming a more common one for moms-to-be. Rates of preterm birth -- one that occurs before 37 weeks of pregnancy -- have increased a frightening 28 percent since 1981. It affects about 480,000 babies annually, or one in eight live births, according to the National Center for Health Statistics. Experts say the increase is due to the widened use of fertility treatments (and the related rise in multiple births) and the older age at which women today begin having children.

Premature birth is not to be taken lightly. It's the number one cause of neonatal death in the first month of life, and it can trigger health problems such as developmental delays, chronic lung disease, and cerebral palsy. These conditions take an emotional and financial toll on families and doctors. The average hospital cost of a newborn is $4,300; for a preterm baby, it's $58,000, according to the March of Dimes. In addition, 65 percent of women and 59 percent of men mistakenly attribute preterm labor to risky prenatal behavior, according to a March of Dimes survey, though that link often can't be made.

While modern medicine has made great strides in treating premature babies, there have been few advances when it comes to preventing or stopping preterm labor. In fact, the American College of Obstetricians and Gynecologists (ACOG) recently stated that the effectiveness of common treatments for preterm labor -- such as bed rest, pelvic rest (abstaining from sex), and increased fluids -- is not known.

"We don't understand the mechanism of preterm birth enough to come up with safe, effective ways to prevent it," says Ronald Gibbs, M.D., chair of the department of obstetrics and gynecology at the University of Colorado Health Sciences Center, in Denver. "Strategies so far have focused on trying to stop preterm labor, but that's like closing the barn door after the horse is out." But new research is beginning to hint at both the causes of preterm labor and ways to prevent it. And more may be on the horizon: The March of Dimes recently launched a $75 million campaign dedicated to lowering national rates by 15 percent, and has designated November 18 Prematurity Awareness Day. Here's what you need to know now.

Senior editor Lisa Singer covers health for BabyTalk.

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