Kristi Burke was just 25 weeks into her pregnancy in 1999 when she awoke in the night doubled over with pain.

Within hours, she delivered two babies, each barely longer than a ruler, with transparent skin and eyes unseeing and barely open.

The babies - Ryan and Tyler - and their mother were in separate hospitals for the first four days of the newborns' lives. Kristi first saw her babies in pictures her husband, Michael, brought to her bedside.

She cried when she saw her bandaged boys in little boxes with tubes snaking everywhere.

"They were fighting for their lives, and all I could do is watch."

A pre-term baby is defined as less than 37 weeks' gestation, according to the March of Dimes, which this week released report cards on premature births in every state. In Idaho, 10.5 percent of babies were born prematurely. That's below the national average of 12.7 percent. The goal is 7.6 percent. Normal pregnancies last about 40 weeks.

The average grade was a D. Idaho fared better, earning a C, one of just seven states nationwide with a better grade this year than last. In 2008, the first year of the survey, Idaho received a D.

Idaho's grade improved this year because fewer babies were born at 34 to 36 weeks.

Nationwide, those early births have been linked to cesarean sections, and to using drugs to induce labor. March of Dimes wants every state to reduce C-sections and induced labor by making sure those choices are medically necessary and not a convenient way to fit a new baby into a family's schedule.

That is the work to be done, along with further reducing smoking rates and making sure women get prenatal care to catch problems - such as signs of labor - early enough to extend babies' time in the uterus.

Idaho already has a lower than average rate of C-sections, but induction rates were harder to pin down. Some inductions are performed for non-medical reasons, such as the desire to have the baby on a certain date, maybe because visiting relatives want to see the baby or help care for it.

"We have become the fast-food nation," said Dr. Stacy Seyb, who practices in the high-risk pregnancy program at St. Luke's Boise Medical Center. "We want (the baby) on demand."

Babies born four to six weeks too soon may be more likely to suffer from hyperactivity disorders or learning problems.

"Sometimes, the effects of prematurity don't show up until children start getting into school," said Karen Hodge, chief nursing officer at Saint Alphonsus Regional Medical Center and chairwoman of the March of Dimes' Idaho chapter.

But Hodge was quick to point out that research done to date is far from definitive. In up to half of pregnancies that end prematurely, no one knows why the baby is early. More research is needed, and March of Dimes helps pay for it.

Kristi did not smoke or have medical conditions that can cause early births. The boys born to the Burkes are 10 years old now, and Kristi is passionate about volunteering with the March of Dimes to help the public understand the problems premature babies face. She also has a part-time job at Saint Alphonsus helping families with babies in the neonatal intensive care unit. March of Dimes pays her salary.

Kristi says people sometimes don't take prematurity seriously enough, or really understand what it is. She runs into women who figure premature births are no big deal, because their own babies were born 10 days early and were fine.

The problem may appear less serious than it is because more babies born early are surviving - and thriving.

"Our nurseries have done such a good job taking care of those babies in the short term, getting them out of the nursery and on their way, that we haven't really stopped to see how many do have long-term problems," said Seyb, a March of Dimes board member.

Babies born as early as the Burkes' often stay months in neonatal intensive care units. Burke went home after four days and spent months going back and forth between the hospital, home and work. Ryan was hospitalized for four months, and Tyler for five months.

Burke pumped breast milk in the boys' room at home. "That's hard to do, when you don't have a baby and you have to sit in this empty room and cry," she said.

Both boys remain small for their age, but the family is grateful for the progress they have made. Ryan, who weighed just 1 pound 8 ounces at birth, has attention deficit hyperactivity disorder and problems with fine motor skills.

Brother Tyler, who weighed 1 pound 11 ounces at birth, has cerebral palsy, a brain disorder that can affect movement. He is able to get around without a wheelchair, but he wears braces and can't run and play at the same pace as other boys.

"We are made to have a child in our stomach for 40 weeks for a reason," Kristi said.

Colleen LaMay: 377-6448