| Q: |
What is meant by premature birth?
| | A: |
Premature means that a baby is born several weeks earlier that
the estimated “due date.” While only a tiny percentage of babies will
actually be born on the day that they are supposedly “due,” and
predicting exactly when the birth will happen is virtually impossible,
most women do have their babies somewhere between 37 and 42 weeks of
pregnancy. The due date (EDD, or expected date of delivery) is
calculated at 40 weeks
Technically, any baby born before the 37th completed week of pregnancy
is termed premature, but the closer to your EDD your baby is delivered,
the fewer problems he should have in coping with life outside the
uterus.
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| Q: |
Can I do anything to reduce the risk of my going into labor early?
| | A: |
It is not totally understood why women go into labor, although it
is thought that it is probably due to a combination of factors .
Unfortunately, most preventive measures to stop early labor have not
proved to be effective, so there may be little that an individual can do
to reduce the risk of this happening. However, the most effective
self-help measures to maintain a normal pregnancy, a positive outcome to
birth, and hopefully avoidance of a premature labor, are to adopt a
healthy lifestyle before and during pregnancy, including not smoking or
drinking alcohol, eating a well-balanced diet, and getting some form of
daily exercise. Also, good social support has been shown to help reduce
stress levels and worry during pregnancy, which can have a very positive
effect on your general health and well-being and, in turn, hopefully on
your pregnancy, labor, and birth.
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| Q: |
I'm pregnant with triplets—will my babies need to be delivered early?
| | A: |
A multiple pregnancy is more likely to result in a premature
birth and the more babies you are carrying, the higher the risk of this
happening. For triplets, the delivery that carries the least risk is an
elective cesarean section (although there is a measured risk with all
medical procedures) and, if this is the delivery method that is agreed
on with your doctor, a delivery date will be decided on that is in the
best interests of both you and your babies.
The doctors and
specialists will try to seek a balance between the risks associated with
premature delivery, such as the babies' immaturity and the risk of you
going into spontaneous preterm labor. Your doctor will then discuss the
timing of delivery with you and you will be involved in all the
decisions. Every maternity unit will have their own guidelines, but the
final decision will be based on not just your health, but on the health
of your babies. This will ensure that the babies are born at the optimum
time for them and it will reduce the likelihood of problems occurring
that are associated with premature deliveries.
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| Q: |
If I go into labor prematurely, can the doctors stop the contractions?
| | A: |
Usually, nothing can stop labor once it is far advanced, but your
contractions can be slowed down or sometimes stopped with drugs called
tocolytics. However, these do not always work over a long period of time
and can have side effects, such as increasing your heart rate,
affecting blood pressure, nervousness, flushing, and nausea. If they
hold off labor for this amount of time, steroids can be administered to
help to mature your baby's lungs before the delivery, and this also
allows you to be transferred to a hospital with an neonatal intensive
care unit.
Occasionally, if
there is an obvious cause for labor starting early, such as an
infection, treating the it with antibiotics may be enough to stop
contractions.
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| Q: |
My partner is in the hospital since there is a risk of early labor. How can I prepare at home?
| | A: |
If there is a high risk of your baby being born early, your
priority should be supporting your partner while she is staying in the
hospital. Tell her you will be there for her and the baby. Keep yourself
informed about her and the baby's status and what might be in store for
the family over the next few days and weeks.
While your partner is in
the hospital, she is likely to be feeling low, anxious, and possibly
fairly isolated. There are plenty of things you can do to boost her
morale and keep her feeling positive about her situation. You can talk
to her and make a list of things that need to be bought or done at home.
This will help to keep her involved and not feel so isolated in the
hospital, and will also help reassure her that things will be ready for
the baby. You will need the same items for your baby if he is born
prematurely as you would for a baby born full term. Concentrate on the
basics, such as warm clothes for your baby, a carriage or stroller, and a
car seat. If you haven't already done so, you could think about where
your baby will sleep. This should be somewhere comfortably warm and
close to you and your partner. If your partner is in the hospital for a
long period of time, collect catalogs so you can make your choices
together. You could also try to encourage your partner to read about
breast-feeding, which will be of particular benefit to your baby if he
is born early.
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| Q: |
Why do premature babies have breathing difficulties?
| | A: |
Respiratory distress syndrome (RDS) is the most common
complication of premature births and affects over 50 percent of babies
born before 32 weeks of pregnancy.
Lung problems occur
in premature babies for several reasons. The lungs are not fully
developed until the later stages of pregnancy, and an important
substance known as “surfactant,” which enables a baby's small lungs to
mature and function effectively, does not develop until after 36 weeks
of pregnancy. Also the earlier the baby is born, the more underdeveloped
the lungs and muscles of the rib cage are, which results in babies
becoming increasingly tired as they require more effort to breathe.
Breathing problems are the most common reason for babies being admitted
to neonatal units. Premature babies are much more prone to respiratory
infections than fully grown babies, and may require help breathing using
mechanical ventilators, which, although life-saving, can themselves
cause problems for the baby's lungs.
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| Q: |
My premature baby has jaundice—what will be done to help him?
| | A: |
Jaundice is one of the most common problems in all newborn babies
and premature babies are even more at risk as they have an immature
liver, which normally removes bilirubin, the substance that causes the
yellow tinge common to jaundice, from the body. Bilirubin is produced
when the body breaks down red blood cells. It is a yellow pigment that,
if not cleared by the kidneys and liver, builds up and is deposited in
the skin. Babies who develop jaundice are given blood tests to measure
the level of bilirubin, and the result of the blood test will determine
whether they require any special treatment. Treatment for jaundice is
given by phototherapy, which uses ultraviolet light to break down the
bilirubin beneath the skin so that the baby's kidneys can safely excrete
bile pigments.
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| Q: |
Our baby, born at 24 weeks, is doing well in the baby unit, but is he likely to have brain damage?
| | A: |
The risk of any sort of disability in a premature baby is highest
at around 23–24 weeks, becoming much lower at 30 weeks. The risk of
brain damage to your baby depends on whether he is experiencing problems
with his liver, kidneys, or breathing, is underweight, or has other
existing medical conditions in addition to being premature. Some of the
most common long-term problems in babies born very prematurely are those
to do with hearing, vision, or fine coordination skills. However,
overall, the majority of babies born at 24 weeks with few other medical
complications do well.
If your baby is doing
well after a few weeks this is a good sign. It is perfectly natural for
you to continue to worry, but you may find it reassuring to talk to the
doctors and nurses taking care of your baby and to participate in her
care as much as possible. If brain scans or any other type of
specialized testing is performed on your baby you will be informed of
the purpose and the result. The doctors assess premature babies on a
daily basis for any problems, especially those related to brain growth
and development.
Following discharge
from the neonatal unit, your baby will still be monitored very closely
in the clinic. Although most serious defects can be detected from birth,
it is often some time later before less obvious developmental problems
can be identified, which is why this follow-up period is important. A
full program of support should be available if any learning or sensory
problems were detected.
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| Q: |
How can we reassure our baby while he is in the neonatal intensive care unit?
| | A: |
Except in rare situations when your baby may be too ill to be
touched, or if there is a high risk of infection, you and your partner
will be encouraged to play a very important part in the care and
well-being of your baby. There are many things you and your partner can
do to ensure that your baby knows you are there for him and is reassured
by your presence. As well as having plenty of physical contact with
your baby, touching and stroking him to help with bonding (see Bonding with your special care baby),
your baby will also love to hear the sound of your voice, so spend lots
of time talking and singing to him. Skin-to-skin contact is the very
best. Ask the hospital staff about “kangaroo care.” Your baby will soon
come to recognize you as a comforting and loving presence.
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| Q: |
My baby is in the neonatal care unit. I'm trying to express milk every day—am I helping?
| | A: |
Breast milk helps ensure that the mother's natural immunity is
passed on to her baby via her milk. Since premature babies are more
prone to infection, expressing your breast milk is a great way to help
your baby while he is in the neonatal unit. Breast milk is also much
easier for a baby to digest, which is especially important for premature
babies since their digestive tract may be less developed. This is also a
great way for you to bond and develop a relationship with your baby.
This is a time
of considerable stress and mothers can feel helpless. Knowing that you
are doing such a great thing to help your baby will help enormously.
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| Q: |
Is it dangerous for my premature baby to have formula?
| | A: |
It is perfectly fine for a preterm baby to receive formula and is
not at all dangerous if the correct formula is given. Premature babies
are given formula that is produced specifically for their needs. These
formulas are very specialized and prescribed by a doctor to meet the
individual nutritional requirements of each premature baby as they grow.
All artificial milks or modified infant formulas are highly processed
products and have gone through rigorous health and safety checks.
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| Q: |
Do all hospitals have facilities for premature babies?
| | A: |
Facilities vary throughout the country, and while most maternity
units and hospitals have a special care nursery, not all have a neonatal
intensive care unit (NICU) where babies go if they need intensive life
support. This means that babies below a certain gestation, before 35
weeks, may have to be transferred either before or after the birth to
receive more specialized treatment, such as intensive assistance with
breathing.
If it is thought that
you are at a greater risk of having your baby prematurely, then you may
well receive some or all of your care at a hospital with more
specialized facilities and you will be able to visit the neonatal unit
before giving birth.
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| Q: |
My first baby was born prematurely. How likely is this to happen again?
| | A: |
About 12 percent of all live births in the US are premature, and
about two percent of live births are below 32 weeks' gestation. If your
first baby was premature, the chance of this happening again depends on
the reason for your premature delivery last time. If it was because you
went “naturally” into premature labor, with no identifiable reason, then
there is a risk that it may happen again. Sometimes there may be a
genetic link, which may be the case if your mother or sister had her
babies prematurely. However, if it was because of a medical condition
that affected you or the baby and which is unlikely to occur again, then
you are less likely to have another premature labor.
Medical and
obstetric conditions that can predispose women to have premature babies
include multiple pregnancies; high blood pressure; bleeding during pregnancy, especially later in pregnancy
; premature rupture of the membranes ; increased fluid around the baby, or the presence of any disease or infection in the mother or baby, also, if you have a weakened cervix,
where the cervix opens or shortens later in pregnancy, you are at a
higher risk of premature labor. If this is known to be a problem you
will be monitored during pregnancy. Some of these conditions are likely
to recur in subsequent pregnancies, making it likely that you will have
another premature labor, while others are less likely to reappear and
you would therefore be less likely to have a subsequent premature labor.
Some babies are at such increased risk that a cesarean is done and the
baby is delivered preterm. |
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