What to watch for and how to help lessen the negative effects of pre mature birth
When I ballooned with pre-eclampsia 31 weeks into my second pregnancy, I thought my ob-gyn might prescribe daily periods of bed rest. Instead, he shocked me by saying: “We have to get that baby out — soon!”I panicked. We hadn’t moved our 2-year-old, Mathilda, out of her crib yet. We hadn’t discussed names or bought baby clothes. Damn it, I was in the middle of several writing assignments — I wasn’t ready to have a baby!
Ready or not, my son AJ was delivered, via C-section, the next afternoon. He weighed in at just 3 pounds 6 ounces and fit neatly into my husband Tony’s hand. Not that we got to hold him at first. He was whisked away (after one hearty, reassuring cry) to receive oxygen. After a lengthy assessment, he was snuggled into the incubator that would be his home for the next five weeks.
Those surreal days were filled with emotional highs and lows as we got used to life in the neonatal intensive care unit (NICU). Some days, I spent more time with my hospital-grade breast pump than I did with my son. When AJ finally came home, three weeks before his due date and still half the size of a “normal” newborn, I couldn’t cuddle him enough.My story is hardly unusual — one in eight babies is born prematurely (before 37 weeks completed gestation) in the United States each year, says the March of Dimes.
Although the rate dipped slightly in 2010 (to just under 12 percent of all births), preterm birth is a serious health problem. It is the leading cause of newborn death, and preemies are at risk for long-lasting health concerns, including breathing and vision problems, cerebral palsy and learning disabilities. Generally, the earlier the baby is born, the greater the chance of serious health problems.
The good news? Preemies are fighters, and modern medical technology can keep incredibly tiny babies alive. The survival rate for infants born at 26 weeks is now 80 percent; at 32 and 33 weeks, 98 percent; and between 34 and 36 weeks, 99 percent. A recent report on a study following two of the smallest preemies on record — born weighing less than 10 ounces each — found that both children have experienced normal motor and language development at 3 years old as well as hit developmental milestones at appropriate age levels.
I’m Having a Preemie — What Now? If you go into labor or need a C-section early, you may be transferred to the nearest hospital that can accommodate your needs. (Hospital nurseries offer different levels of care: Level I nurseries are for healthy, full-term babies; level II for babies born at 32 weeks and older; level III are for the smallest, youngest preemies, with specially trained medical staff and high-tech equipment.) If you know you’re going to deliver early, Scott Berns M.D., senior vice president at the March of Dimes, recommends visiting the NICU beforehand. “It can feel intimidating,” he says. In the NICU, babies are in enclosed incubators, often with feeding tubes, IV lines and heart rate and oxygen monitors attached to their tiny bodies. Visitors are limited, and they must scrub in upon entering the unit.
“There are 30 to 50 beds in some NICUs filled at one time; you’re seeing other families come and go, and it can be very stressful,” says Kelli Kelley, executive director of Hand to Hold (handtohold.org), a support organization for parents of preemies. Once you deliver, don’t be afraid to quiz the doctors and nurses about unfamiliar equipment, terms and procedures, says Burbank, California, dad Steven Worley, who has been through the NICU experience twice — with Maggie, now 5, and Sam, now 3. “You really need to educate yourself on what it means to have a premature baby,” he says. “It’s OK to ask, ‘Can you explain exactly what that means?’”
Why Me? There’s no single cause of preterm birth. Risk factors include smoking, obesity, chronic medical conditions (diabetes, high blood pressure) and having had a previous preemie. Medical reasons include pre-eclampsia, infection and placental abruption. Women carrying multiples (who compete for space and nutrients and become stressed) are also much more likely to give birth early. However, a large percentage of babies are born early for no known reason. “You can do everything right and still have a baby born too soon,” says Dr. Berns. “Almost half the time, we don’t know why it happens.”
Bonding, Interrupted It’s a tricky business with preemies — usually, you can’t even hold your baby at first. Parents often feel shock, numbness and disappointment. “You have this image in your head about how the perfect birth and bonding should be,” says Beth Maclin of Hazel Crest, Illinois, whose son Carter was born at 29 weeks. “The worst thing about having a preemie was the feeling of the rug being pulled out from under you. You feel so helpless.” Still, there are ways to get to know your newborn.
HOLD HIM CLOSE As soon as you (and dad) are allowed, hold baby with his bare chest against yours. It’s called kangaroo care, and numerous studies have shown preemies who have skin-to-skin contact gain weight faster, have a more stable heart rate, are able to nurse and go home sooner.
BREAST IS BEST Breastfeed if you can; pump if you can’t. Every drop of your breast milk is lifesaving to a preemie — plus, you’ll feel a real sense of purpose. You can rent a hospital-grade pump — its motor can handle the demands of pumping around the clock.
CHAT HER UP Sit close and talk, sing or read to your baby; she’ll find the familiar sound of your voice comforting. Ask staffers if you can leave an inexpensive digital voice recorder so they can play a recording of you talking or singing lullabies to your infant when you’re not there.
MAKE IT HOMEY Make your little corner of the NICU more pleasant — and positive — for you and your baby by bringing in family photos, a special blanket or a couple of stuffed animals to place around the area. Bonus: Your scent on a cloth or toy will comfort baby when you’re not around.
TAKE CARE OF YOU You can easily get burned out by spending too much time at the hospital. “It’s OK to take a day off from the NICU,” says April Kinker of Hammond, Indiana, whose daughter Sophia was born at 24 weeks. “You’ve just been through a traumatic event and have to take care of yourself as well.” Eat healthful foods, catch up on sleep and try stress-reducing tactics (meditation, long baths, aromatherapy) when you’re home.
BE THERE Take part in your baby’s care as often as you’re allowed. “Get to the NICU at feeding time, diaper-changing time and temperature-taking time,” says New Yorker Dunica Charles, whose daughter Dahliah was born weighing 2 pounds 2 ounces. “It not only frees up the nurses, it helps you feel useful.”
BIG BROTHER Some NICUs across the country offer password-protected Webcam access to babies through Nicview (nicview.net). If your hospital offers this service, you can watch baby on any mobile device when you can’t be at his side.
“NEST” IF POSSIBLE Before we ventured home with AJ, I stayed overnight at the hospital in a private room set aside for preemies and moms. (It was an option at our hospital; at some, it’s mandatory.) Nurses were available, but I took care of him by myself — a real confidence-booster.