PREDISPOSING FACTORS FOR PREMATURE BIRTH
•Smoking, drug abuse and alcohol use increase the possibility.
•Severe infections of the mother – in the urogenital tract especially but also systemic infections – may lead to premature labour.
•An incompetent cervix that has not been recognised and consequently sutured (stitched) might result in pregnancy coming to a sudden and early end.
•Malnourished mothers have a greater chance of giving birth prematurely.
•Deficiencies of zinc have especially been implicated in premature birth.
•Hormone imbalances may be a cause and are, to a certain extent, treatable.
•Multiple pregnancies often end sooner, probably because the womb is placed under so much more stress.
•Work hazards, like heavy physical labour, might occasionally induce prematurity.
•Mothers who suffer from chronic diseases like diabetes, hypertension and kidney problems often deliver their babies early.
•Bleeding in pregnancy is associated with premature birth, especially in conditions like placenta praevia, the medical name for a low-lying placenta. One can have this in varying degrees, the worst being when the placenta has implanted over the cervix, which leads to bleeding in pregnancy, especially as the womb stretches to accommodate the growing baby.
•Undue stress in one’s relationships or daily life, especially if prolonged, might lead to premature labour.
•Very young women (teenagers) and women over the age of 35 are more inclined to premature labour, and both groups need special care from their practitioners.
•Abnormalities of the uterus might, if uncorrected, precipitate labour.
WHAT TO EXPECT
You will experience all the same body and mind changes as a woman who has carried her baby to term, although, if you gave birth vaginally, you might have a quicker recovery to the perineal area. More preterm infants are delivered by Caesarean section so, if this is the case for you, you will experience the effects of major surgery as well.
It is quite normal to feel very alone at this time, as if no one else can really understand what you are going through. It is vitally important that you become actively involved with your child’s care from the outset, if your health allows. The emergency nature of extreme prematurity (from 20 to 34 weeks) keeps medical and nursing staff so busy that they might forget what you are experiencing. Many doctors and nurses, however, are very empathetic at this time, so do not hesitate to ask probing questions about every facet of your baby’s care and prognosis for recovery.
Nowadays there is also an initiative called ‘kangaroo care’ – actually as old as the hills – in which mothers are encouraged, under certain circumstances, to secure their babies, skin to skin, to their chests. These babies grow faster, have fewer illnesses and are ready to be discharged from hospital far sooner.
One of the first things you are likely to experience is dismay at the number of ‘pipes’ to which your baby is attached. Each one of these will be serving a life-saving function, in much the same way as the umbilical cord during the pregnancy.
These pipes are likely to include one or more of the following:
•An intravenous infusion drip, usually inserted into a blood vessel in the head, which is more easily accessed than those in the limbs. The purpose of the drip is to administer fluid, nourishment in the form of essential nutrients and medication to your child, so do not feel intimidated. It might be more awkward to hold your baby, but think of it as one of the most important allies you have in the struggle for your child’s health. The drip might well have to be renewed from time to time, as the site of insertion, or the blood vessel into which it has been introduced, might require it.
•Your baby might be on a ventilator to help him breathe. You might find this one of the more frightening aspects, and picking up your baby will usually not be possible, but remember that this is a most important tube, giving your baby the breath of life.
•Electrodes will be attached to your baby’s chest to monitor his heart rate and breathing.
•If your baby can be fed milk, a tube might protrude from the nose, secured by plaster. It goes via the nasal passage and back of the throat to the stomach. Many premature babies are not yet strong enough to suck, and would use up valuable energy resources in trying to do so. In time this will change and they will gradually be offered more by breast or bottle and less by gastric tube.
The beeping of monitors might be rather intimidating initially but will soon become familiar to you. Sometimes the alarms go off accidentally, or simply as a warning for the personnel to check one aspect or another, so do not be too frightened if you are present when this happens. Ask which ones register which functions, as this will lessen the fear you might feel.
The incubator in which your baby is likely to be kept serves various functions: it might be an open unit, as is usually the case in the high-care stage; or a closed, more conventional-looking incubator. These ensure a practical working area for the staff and a controlled temperature and oxygen environment for your baby. The incubator is the replacement for the womb, as it were, and you should concentrate on this aspect rather than seeing it as separating you from your baby. You will still be able to touch and stroke your infant through various ‘portholes’.
COMFORT, CARE AND STIMULATION
•You can ensure that the environment seems less cold and clinical by placing a few cuddly toys, cards and so on in the room, as well as a soft, cuddly toy close to your baby. Talk to staff about what you may bring to ensure the smallest risk of infection and hindrance to their task, while creating a more comforting environment. You will usually find them most amenable to this idea.
•Touch is of vital importance and even if there seems to be very little body surface uncluttered by tubes or plasters, you should stroke your baby as much as possible. In my opinion this can be as important for the survival and thriving of your baby as the ‘pipes’. If your baby is in a closed incubator, put your hands through the working apertures. As his condition improves, ask the staff if you can cradle him, even if only for a few moments at a time. This will mean a great deal to both you and your child.
•Music can be of as much stimulatory benefit to your pre-term baby as any other. Play soothing recorded music and sing or hum to her as well. This is obviously more difficult to implement if she is in a closed incubator, but with the aid of modern technology you should be able to rig up something.
•Talk to your baby frequently too. Remember, he recognises your voice as well as his dad’s! Knowing that you are in close proximity and rooting for him will be important stimulation for your child.
•Breastfeeding is one of the most important gifts you can offer your premature baby. Express milk from the earliest possible time and try especially to give your colostrum, by syringe or tube, to your baby. This is not such usual practice, as the quantity is fairly small and in those first few days she might not be taking sustenance other than through the infusion. Nevertheless, talk to your paediatrician about this, as colostrum is liquid gold, packed with all good things that will help your baby off to a better start.
•It is important that you keep expressing your milk to ensure continued production, even if she does not need it immediately. You can store your milk in sterilised bottles