Watch Over Me: Delivering a Preemie

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Some babies born early are small enough to fit in the palm of a hand, chest heaving with each heartbeat. A preemie delivery brings an emotional, tense and uncertain time.

“Pure panic ran through me the day I was told I would be delivering a preemie … and soon,” says Christina Davis, a Bell Buckle mom of two girls with her first child, Kendri (pictured above), born at 29 weeks. “Not knowing what was going to happen or if our baby would even survive was what was scary,” she adds.

A preemie is any baby who is born before 37 weeks of pregnancy, according to the March of Dimes, and while the baby is small, the issue is not. Last year, Tennessee earned a 12.5 percent rate — a lowly “C” — on the March of Dimes’ 2013 Premature Birth Report Card.

Doctors acknowledge that there’s a lot more work to be done in Tennessee to partner successfully with the March of Dimes in the national quest to reduce the country’s pre-term birth rate to 9.6 percent or less by 2020.

“A baby born three or more weeks early is premature,” says Cornelia Graves, M.D., OB/GYN and medical director of both Tennessee Maternal Fetal Medicine and perinatal services at St. Thomas Midtown and St. Thomas Rutherford hospitals.

“Many premature babies — those born closer to 37 weeks — do not have problems. Babies who are born closer to 32 weeks (just over seven months gestation) may not be able to eat, breathe or stay warm on their own,” she adds.

After delivery, preemies are placed in the Neonatal Intensive Care Unit (NICU) to receive the best possible care for the best possible outcome. It’s a difficult time for new parents.

“A premature delivery may happen suddenly or after days or weeks of waiting and worrying,” says Graves.

Is there anything an expecting couple can do to somehow make the situation easier?

“If you know you may deliver early, you, your partner and your doctor can prepare for a premature birth,” Graves says.

Risk Factors

The cause of a premature birth is often never known and this is where the bulk of research is focused. It could be an issue with the placenta, a multiple birth, an infection in the mother, a physical problem with the mother’s uterus or cervix, or the use of drugs and/or alcohol during pregnancy. Other factors that put moms at risk include African-American status or a previous pre-term birth. And then there’s the boy thing: A 2013 report from a series of international studies showed that males are slightly more likely to be born premature than females.

One in Nine Pregnancies

There are two broad classes of pre-term delivery and birth. One is spontaneous where the mom starts premature labor on her own for unknown reasons; the other cause is medically indicated, which means the mom or baby is having a problem with the pregnancy where their health is compromised such that a physician must step in.

Knowing the signs of premature labor makes a difference.

“I was having pain that felt like severe constipation,” says Davis. “That’s what made me go to the doctor,” she adds.

Low back pain and abdominal pressure should alert women that there could be a potential problem, but this is tricky since many women with normal pregnancies deal with low back pain as well. Many women will not recognize non-specific abdominal stress, while others clearly will feel forceful contractions. About one in nine pregnancies results in a pre-term delivery; a greater fraction of those have signs suggestive of pre-term labor.

Be Prepared

First, it’s helpful to know that Middle Tennessee’s loaded with excellent NICU care (Vanderbilt’s Level IIIc is highest; the medical center provides sub-specialty care for the most severe cases).

You and your infant are deemed high-risk when pre-term labor begins. Know that because of this, your carefully constructed childbirth plan and expectations about your delivery will no longer match up to what may happen. Even outspoken moms will run into the shock of pre-term labor: You will not have the freedom to make birth-related decisions and to move about freely if you or your baby show signs of distress.

The Delivery

The earlier your baby’s born, the higher his chances for health problems. Obviously this is a worrisome, difficult time for a new mother and father. To get through it, they will need to lean on one another in addition to family and friends.

An obstetric team and a neonatal team will be present in the delivery room. The neonatal team will bring special equipment including resuscitation equipment.

“Babies who are born earlier than 26 weeks (just under six months gestation) are the most likely to have serious problems,” says Graves. “If your baby is born very small or sick, you may face a hard life-or-death decision about treatment,” she adds. Babies who are very small (1.7 pounds or less) face long-term problems that may include mental retardation or cerebral palsy. Babies who are born between 32 and 37 weeks do well after birth making the risk of disability low.

Preemies go to the NICU after delivery where they’re watched closely for infections and changes in breathing and heart rate. Until they can maintain their body heat, they are kept warm in special beds called isolettes.

Little can be predicted about how well or how poorly your baby will do — certainly his age at birth is key — but during the first hours and days of his life, any birth defects and complications due to prematurity will become apparent and discussed with you and your partner.

Very premature infants need special treatment, depending on their issues. They may need breathing help from an oxygen tube or ventilator; some will need medicine, some surgery.
Preemies are usually tube fed or fed intravenously, depending on their condition, and tube feeding will last until the baby is mature enough to breathe, suck, swallow and take all feedings by breast or bottle by himself.

Going Home

It’s a happy — but also careful — day when parents are finally permitted to take their preemie home. That day won’t come, however, until the time that he was normally due to be born.

“Our little girl stayed in the NICU for 78 days,” recalls Davis. “As a mom, I wanted her to know I would be there for her. So, I spent every minute I could visiting her in the NICU. We would kangaroo, sing and talk to her,” says Davis. “It’s important to keep that special bond even though you aren’t getting the first few weeks at home together,” she adds.

Your days back and forth to the NICU for your baby will help to educate you on his care, but managing a preemie on your own at home can be frightening.

“I was scared to death,” says Davis. “But I could call the NICU at any time, day or night, with any concerns, and I did,” she adds. Davis’ baby came home with an oxygen tank that went with them wherever the baby went.

Sleep patterns for preemies are different from full-term babies.

“Premature babies are not often awake for more than brief periods, but they wake up more often than other babies,” says Graves. Because your baby is awake for only short periods, it may seem like a long time before he responds to you.

Know that premature babies get sick more easily than full-term infants, so it’s important to keep your baby away from sick family members and friends.

The good new is, thanks to medical advances, preemies are surviving and going on to lead normal, productive lives. Davis’ daughter Kendri is a healthy and thriving 7-year-old today.

More Tennessee women are becoming aware of premature birth in general, and just last month, the March of Dimes’ Tennessee chapter awarded grants across the state to help address the unmet maternal and child health needs of the unborn. Successful fundraising — such as March for Babies (happening this month and next) — have made it possible to support new efforts to help more babies be born healthy in Tennessee.

 

TOP TIPS FOR A HEALTHY PREGNANCY

• Take a prenatal vitamin every day as directed by your obstetrician

• Eat five or six well-balanced  meals each day

• Don’t drink alcohol. Don’t smoke or allow yourself to be exposed to secondhand smoke

• Get adequate sleep — at least eight hours a night

• Drink at least 10 glasses of water a day

• Don’t take herbal medications without the input of your obstetrician

Source: National Women’s Health Information Center
 

MARCH FOR BABIES

On Sunday, April 13, come walk during the March of Dimes’ annual MARCH FOR BABIES fundraiser and help support programs aimed at helping premature babies.

March for Babies
12:30 p.m. registration
LP Field (1 Titans Way, Nashville)

Sign up to walk and raise pledge dollars. Registration begins at 12:30 p.m. with the two-mile walk starting at 2 p.m. There will be another walk in Murfreesboro on Sunday, May 18.

Visit marchforbabies.org.

Jamie Lober is dedicated to providing information on women’s and pediatric health topics.

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