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.
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.
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.

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.

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.

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.

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.
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.

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.
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.

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.
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.

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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