When we first see those two little lines on that little stick, one can never imagine the joy and love that is about to come. We imagine little booties, fluffy blankets, chubby rolls and rosy cheeks. It truly is the most exciting time!
Sometimes those hopes and dreams can be turned upside down with bad news that the pregnancy is not going to plan. Instead, you get a journey that you never thought would happen to you.
Here in New Zealand approximately 7% of births are premature. A premature birth is considered before 37 weeks of gestation and can occur from a number of reasons.
Age of the mother
If the mother is less than 18 years of age or over 35 there is a higher risk of delivering prematurely.
Some viral, fungal and bacterial infections can lead to premature birth. These diseases include pneumonia, appendicitis, pyelonephritis, and bacterial vaginosis.
Physical Disorders such as Pre-eclampsia (high blood pressure), heart diseases, thyroid and diabetes…to name just a few. There are many more but keep in mind not everyone with these conditions deliver early. With regular monitoring and care most women will get to full term. Physiological stress is also thought to contribute, such as heavily pregnant women still working in full-time busy careers well into their late third trimester).
Consumption of Alcohol, drugs and cigarettes
These can severely affect the baby and pregnancy so should be avoided at all costs if possible.
A cervix normally starts to dilatate at the end of the pregnancy to allow the baby to pass through the vagina. Sometimes without knowing it, a woman can have a weak cervix which will dilatate much earlier, commonly in the second trimester when the weight of the baby starts to put pressure on the cervix. Women who have received a previous cone or LLETZ biopsy on the cervix can also experience a weakness in the cervix. If caught early or following a second trimester delivery last time, a ‘cerclage’ can sometimes be recommended. This is a cervical suture that can be placed in the cervix to assist to get the woman to term or near term.
There are many explained reasons why premature birth can happen but there are also many premature births that occur for unexplained reasons. Sometimes the membrane (waters) can break and labor is inevitable but with medicine today labour can be held off sometimes unless the baby or mother is very unwell.
Just remember, only a small percent of women experience these complications!
A few problems a premature baby can possibly be faced with…
Jaundice, chronic lung disease (which will possibly mean at the beginning your child will be resuscitated and intubated to help them breathe), Apnea spells (forgetting to breathe), Patent Ductus Arteriosis (PDA) which is when the valve in the heart that normally closes after birth in full term infants remains open in preemies, Necrotizing Enterocolitis, (NEC) a gastrointestinal disease), IVH (brain bleed) Retinopathy of Prematurity (an eye disease which is the leading cause of childhood blindness. If untreated in a timely manner the retina can detatch causing blindness), blood transfusions, bradycardia and tachycardia (heart rate drop or rise) and many more.
It is important to remember that not every premature baby will get these problems but it helps to be prepared. The younger gestation the baby is born the more at risk.
These days babies can be viable from 23-24 weeks, some even earlier but it is a very long road ahead for these ‘micropreemies’ and their parents. A baby born at 24 weeks is likely to experience severe lung disease and breathing issues as the lungs are the last to develop in mother’s womb. The baby may have trouble regulating temperature and may be in an incubator for many weeks. This makes it for a very difficult bonding process between mum and baby, not to mention dad!
If you are faced with Premature birth, depending on the gestation, you will be allowed a normal vaginal birth or a C-section may be planned for you. If the baby is especially small and sick you may not get to see the baby until much later. It is scary when you are flung in the deep end but the doctors and nurses are there to do everything they can to ensure you and your baby are well looked after. Every day counts in pregnancy. For example… A baby born at 25 weeks will possibly have a few more challenges in life than a 24 weeker. Ever the difference between a 27 and 28 weeker is huge. It can take a few years for the baby to ‘catch up’ to others their age but some may always be a bit behind developmentally. All you can do is listen to the advice if there is time to do so and get the treatment needed to keep baby in as long as possible if healthy. This may mean bed rest or medication.
While in the Neonatal Intensive Care Unit (NICU) or Special Care Baby Unit (SCBU)* the Nurses and doctors encourage parents to be hands on with baby’s care, such as nappy changing, washing and feeding. Kangaroo care (where the baby is held skin-to-skin with an adult) is also a lovely time for baby to bond with mum and dad. It has been proven to be very beneficial to the baby’s health and also the mother’s milk supply, the healing process and overall happiness.
The NICU / SCBU can feel like a rollercoaster of emotions to parents of these tiny babies. One day baby is having a great day (for example… bathing or feeding your baby for the first time!) which reflects on your emotions, and then the next can be not so great. Sometimes you may feel disconnected from the baby and as if you are visiting someone else’s child. Some parents may even hold back a bit which is completely normal as the fear of getting hurt if something awful happens would be too much to handle. This will improve over the weeks once your baby starts to get better and you feel more confident.
If you feel any of these emotions, the hospital will always have a social worker on hand to talk through it all with you, and it is important to do so to help through the grieving process. A mother can often grieve for the ‘normal’ pregnancy and birth process she expected to have even if the baby is doing well.
It may feel very difficult to come to terms with why your pregnancy went this way, especially if you are a healthy mum and did everything ‘right’ and by the book.
Many mothers feel guilt and overwhelming feelings of ‘why me?’ but it is important to remember it is not your fault. These things happen and coming from experience 14 months later I still wonder if there is anything I could have done differently. It will get better though over time.
As a mother of a ‘micropreemie’ born at 25 + 5 weeks, I can tell you now that although it may feel as if you cannot cope with it at the time, you can. My baby boy was born due to incompetent cervix. I had no idea! In fact, as a first time mother I actually thought experiencing a bit of leaking was normal. In fact it was not. I decided to go and get checked out, thank god I did! I was 2cm dilated with bulging membranes and brewing an infection.
After a week of bedrest, steroids and antibiotics, I spontaneously went into labour. Baby was born by C-section weighing in at a whopping 975 grams, not even a kilo. He was whisked away and I didn’t see him until 7pm that night. We spent overall 85 days in hospital, many infections, blood transfusions, exams and a lot of tears but we made it.
Today my boy is 14 months old and has the adjusted age of a 10 month old (you adjust their developmental age from the day of their due date. For example, if born at 30 weeks, that makes him 10 weeks early so if baby is 6 months old his development will be that of a 3-4 month old).
We were faced with quite a few challenges, the main one being ROP (and now vision impairment) but this is very rare these days. Despite his special needs, he is a very happy healthy little boy who is thriving and developmentally on track mostly. It takes a while to catch up so my main piece of advice is be there for them, help them in whatever they strive to do and give them more love than they can handle! They are miracles after all.
*NICU is the Neonatal Intensive Care Unit (generally for premature and sick babies of all ages). SCBU is the Special Care Baby Unit for less seriously unwell and less premature babies (such as the over 30-weekers).