Premature Birth

It can be tough to predict and just as challenging to prevent preterm birth, which is defined as any delivery more than four weeks prior to the due date. About 10 percent of births are premature, and thanks to significant advances in medicine, premature birth is no longer as dangerous as it used to be. As a matter of fact, most preemies develop normally and have caught up with the norms by 18 to 24 months.

Until the age of 36 weeks, your baby's lungs are not mature, so if you go into labor prior to week 36, your doctor will try to delay birth. Sometimes it's not possible to delay delivery, and other times it's actually safer for your baby to be born that early. Babies as young as 25 weeks old have as much as a ninety percent chance of survival, so while premature birth is never the favorite option, it may be the best.

This is not to say that there aren't problems associated with being born too early. The most common conditions preemies suffer are jaundice, apnea, and an inability to breast or bottle feed. Jaundice is a yellowing of the skin associated with the overwork of your baby's young liver in trying to break down red blood cells that need to be processed. Apnea is a pause in breathing that lasts more than 15 to twenty seconds and causes your baby's face to turn pale or purple and their heart rate to slow. This is caused by the prematurity of respiratory centers in the brain, and is most common in sleep. It's treated in the short term with medicine, breathing machines, rocking, or periodic stimulation, and like jaundice, it should go away as your baby's due date and maturity approach. If your baby cannot bottle or breastfeed in their early days, they will be fed by tubes or intravenously until the age of 34 weeks when your baby will have the coordination to engage in the necessary suck/swallow/breathe pattern.

Problems preemies face less often include anemia, low blood pressure, sugar imbalances, respiratory distress syndrome, and infections. Between ten and twenty percent of premature babies suffer from intracranial hemorrhage, or bleeding in the brain, generally within their first week to ten days of life. These hemorrhages can cause developmental delays, seizures, learning disabilities, intellectual impairment, or hydrocephalus, fluid on the brain, which may require surgery. About one third of babies born very early, at 23 to 25 weeks, can develop lasting neurologic problems, developmental delays, cerebral palsy, hydrocephalus, or seizures. Mild cerebral palsy, vision problems or slight developmental delays affect about another third of these babies. Severe problems include blindness, deafness, mental retardation, inability to walk without assistance, vision problems, abnormal growth of blood vessels, and slow growth.

Should you deliver your baby prematurely, your caregiver is prepared for this possibility. Your baby will get the best of care to help them avoid or recover from any of these problems as they come up. In the neonatal intensive care unit (NICU), your baby will get round-the-clock care. Your baby will probably be placed in an isolette, an enclosed plastic box that keeps them warm. Tubes will be inserted and wires taped to your baby, and these will provide your baby with fluids, nutrition, and medication, and will provide your baby's medical team with information about your baby's blood pressure, heart rate, breathing, and body temperature. Your baby may also need a ventilator to help him or her breathe. Some moms worry that their babies will suffer long-term emotional effects from all this machinery, but there is no need to.

To make your baby more comfortable, the NICU will try to reduce the amount of sound and light your baby is exposed to. This prevents stress and damage to their hearing and vision. Your baby's medical support team will also provide your baby with a lot of physical support so that they can get in a comfortable position and remain in it without having to expend any of their precious energy. The nurses and doctors will also try not to disturb your baby with too much handling, which can be stressful for your baby. Your voice and your gentle touch, however, are helpful to your baby once your baby is past the 30 week mark: they will actually promote your baby's growth. Your baby will bring their hands to their face or into their mouth in order to quiet and comfort themselves, and your touch, too, can have this calming effect.

When your baby outgrows the need for the incubator, you can provide "Kangaroo Care." To do so, wear a loose fitting top or a scrub gown that opens in the front, and your baby, wearing only a diaper and hat, will be placed on your chest between your breasts, with the blouse or gown closed over your baby to hold in the warmth. This skin to skin contact keeps their temperature normal, and your body temperature can actually adjust to serve your baby's. Your baby's breathing, heart rate, and blood oxygen levels will also stabilize. Babies enjoying "Kangaroo Care" gain weight faster, cry less, have fewer breathing problems, and spend less time in the hospital.

Your baby can go home when he or she is:

• able to keep her temperature normal on her own;
  
  
• able to breast or bottle feed;
  
  
• able to gain weight on breast or bottle feedings; and,
  
  
• no longer suffering from breathing problems, a slowing heart rate, or changes in color.

When it is time to leave the NICU, your doctor will give you the information and guidance you need for taking care of your baby at home, and a follow-up visit will be scheduled so the doctor can check in with both you and your baby. Visits to the doctor will be more frequent when your baby is a preemie, and immunizations will begin at two months.