Preemie babies What to expect with

The idea of giving birth to a premature baby is daunting for any new parent. For the past 20 years I have been involved in looking after preemies in hospital and then following them up for a couple of years afterwards. It comes with huge ups and downs, not only for the parents but also for the medical personal.

By Dr Hedi van der Watt, Paediatrician, MBChB DCH FCP

In this article I will try to explain why premature births happen, what to expect while in the Neonatal Unit and what to expect when going home.

Premature (also known as preterm) birth is when a baby is born too early, before 37 weeks of pregnancy has been completed. The earlier a baby is born, the higher the risk of death or serious disability.

• Late preterm, born between 34 and 36 completed weeks of pregnancy

• Moderately preterm, born between 32 and 34 weeks of pregnancy

• Very preterm, born at less than 32 weeks of pregnancy

• Extremely preterm, born at or before 25 weeks of pregnancy

Most premature births occur in the late preterm stage.

What leads to premature birth

There are known risk factors contributing to premature births. These include:

• Previous premature birth

• Pregnancy with twins, triplets or other multiples

• Less than six months between pregnancies

• Conceiving through in vitro fertilisation

• Uterine, cervical, or placental problems

• Smoking cigarettes, e-cigarettes or using illicit drugs

• Infections of the amniotic fluid, urinary tract infections, gastroenteritis

• Underlying conditions, such as high blood pressure and diabetes in pregnancy

• Being underweight or overweight before pregnancy

• Stressful events

• Previous miscarriages or abortions

• Physical injury or trauma

• Pre-existing or underlying medical illness

A premature birth can happen to anyone. In fact, many women who have a premature birth have no known risk factors.

In most cases however, premature births are unexpected and not preventable, but by regularly following up with your Obstetrician and leading a healthy lifestyle at least you have a good chance of reaching full term or a healthy preterm baby.

The table (on the right) shows the median (average) birth weight of premature babies at different gestational ages:

What to expect during the delivery

Due to the unexpectedness of most preterm deliveries, you might not have had the opportunity to have met your babies paediatrician/neonatologist.

In most cases, due to the urgency of the delivery, it will not be possible to accommodate a birth plan.

Most preterm babies get delivered via caesarean section, but there are the exceptions.

Skin to skin after the delivery will in most cases not be possible.

As mother, you will most likely only see your baby the following day once you are stable and mobile. As the father or partner, you will be able to visit your baby as soon as he/she is stable.

Your baby will be admitted to the neonatal high care unit or neonatal intensive care unit to receive the necessary medical support and you will be updated by the caring doctor and nursing staff.

Neonatal units encourage as parent baby contact; however, they do also have visiting hours which will be communicated to you. This is needed so doctors can do their rounds and necessary medical procedures and nursing staff can do their cares.

Despite delivering a preterm baby, breastmilk gets produced nearly immediately. Until your baby can breastfeed, breastmilk production needs to be encouraged by either manual expression or by using a breast pump.

In the first 24 hours manual expressing has the best results, producing 2-5ml every 3 hours. In most cases the milk disappears for one or two days and then starts flowing. It is a good idea to invest in a good electric or manual breast pump. Your Obstetrician can prescribe medication to encourage breastmilk production if there is a need for it.

Your baby may need extra help feeding and adapting immediately after delivery. Your health care team can help you understand what is needed and what your baby's care plan will be.

Complications

While not all premature babies experience complications, being born too early can cause short-term and long-term health problems. Generally, the earlier a baby is born, the higher the risk of complications.

Some problems may be apparent at birth, while others may not develop until later and will be picked up on your follow up consultations with your paediatrician.