While every parent ― especially the mum ― aims to have a fit pregnancy, give birth at full term (39 to 40 weeks) and leave the hospital with a healthy bundle of joy, sometimes, the reality may fall short of your expectations.
The fact is that one in 10 pregnancies will end in a premature birth. So, there’s always a chance your baby might come sooner than expected.
“The universal definition of premature babies is any baby born before 37 weeks,” notes Associate Professor Zubair Amin, head of the Department of Neonatology at the National University Hospital (NUH). “The earlier they are born, the more vulnerable they are.”
There are many reasons why a baby is born prematurely. Most times, it’s a spontaneous preterm birth which might be due to a mum’s age or health. Other times, doctors themselves decide that baby has to come out earlier because of medical reasons or because it’s a multiple birth.
Sometimes, a birth may be so early ― two or three months in advance ― that not only is baby not physically equipped to survive in the outside world, but parents are also not mentally ready to welcome their little one.
Plenty of important things happen to your baby in the last few weeks of pregnancy in terms of organ growth, brain development and breathing capabilities.
“When our son arrived suddenly at 36 weeks, my husband and I were not prepared for him,” recalls Jacintha Naidu, 40. “We thought we still had time to do up his nursery, buy a diaper bag and for me to plan my birth with a doula. But everything went out of the window when my water broke out of the blue. It was a complete shock.”
Plenty of important things happen to your baby in the last few weeks of pregnancy in terms of organ growth, brain development and breathing capabilities. So, when bubba leaves the womb unexpectedly, the weeks following his birth can be very chaotic. Your little one will be subjected to back-to-back medical tests, and as overwhelming as it sounds, you’ll have to make medical decisions on the spot for newborn health issues you know nothing about.
Handling the aftermath of a preterm birth is never easy, since you are almost never prepared for it. However, this is what you can expect to happen after baby arrives and how to cope with the situation.
#1 You’ll be in shock, so accept all the support you can get
Doctors work hard to prepare parents every step of the way. However, Prof Zubair admits that they might not always have the time to do so, especially if the mother delivered the baby quickly and unexpectedly. “Sometimes, we may not have time to counsel them in detail as we are focused on stabilising the baby first and then updating them,” he points out.
In other cases, they will have quite a bit of time, so they’ll share all the information and visual aids they have to make sure the parents are up to speed on their baby’s condition. This way, they are able to make informed medical decisions moving forward. “It can be very overwhelming, so we make it a point to go back to them and ask if they have any follow-up questions for us.”
Doctors and nurses will become your new BFFs during this time, so work closely with them and trust their medical opinions, because ultimately, they do know what’s best for your baby. Most hospitals, including NUH, also have their own in-house parent support group.
Counselling sessions start from the point of delivery, or even prior to that if you know you’re about to have a premature birth, and it’ll extend all the way until after you leave the hospital. You will experience different hurdles at different points, so make use of every resource you have.
“Counselling before delivery will focus on your baby’s prognosis, what problems to anticipate and how to mitigate them,” explains Prof Zubair. “Later on, the focus will change to baby’s current status and how to transition them to their homes.”
#2 Baby might spend some time in the Neonatal Intensive Care Unit (NICU)
Not all premature babies end up in the NICU. They will receive different levels of care, depending on how early they were born and how much medical intervention is needed. “The babies who will come routinely are those who are 35 weeks and below, for a variety of reasons, like low blood sugar or a drop in temperature,” notes Prof Zubair. As for how long they’re expected to stay, there are no hard or fast rules he adds. As a general guideline, the earlier the baby is born, the longer they will need to stay in the NICU. “So, at 24 weeks, they would be expected to go home somewhere around the mother’s EDD or later, which means they will stay for around four to six months,” he points out.
#3 The NICU is not as scary as you think it is
Sure, there’s a scary alarm going off now and then, and it’s never easy to see fragile newborns hooked up to tubes and machines. However, once you get over the initial shock of how scary the NICU looks, you’ll realise it’s actually a sanctuary dedicated to making sure your child gets the best possible care.
NUH has an open-concept NICU, so all the babies can be monitored at a glance. At other hospitals, like KKH, babies are kept in cubicles in groups of three or four. Some hospitals also offer a single room for each baby. Most of the time, it’s a 2:1 nurse-to-baby ratio. “Babies who are more unwell and need more care get one-to-one nursing care. When they are more stable, it will be two nurses taking care of five babies or one nurse taking care of two or three babies,” explains Prof Zubair.
While the NICU is kept highly sterile to avoid an outbreak of diseases of infections, parents are allowed to decorate their newborn’s incubators with little toys or blankets to give it a warm, cosy feeling. Neonatal nurses also work hard to do everything they can in their power to make the babies comfortable, including soothing them on a rocking chair and playing lullabies for them.
"The babies who will come routinely are those who are 35 weeks and below, for a variety of reasons, like low blood sugar or a drop in temperature.”
#4 Bub will be hooked on to several machines and tested regularly
NICU babies are kept in a very controlled environment. They are continuously monitored for heart and breathing rates, oxygen saturation, blood pressure and temperature. All of them are kept in heated incubators, while some require an additional humidifier to provide extra moisture because their skin is so thin, they can’t afford to lose any more water.
“These babies are not supposed to be out of the mother’s womb, their lungs are still growing, so they will require a lot of support and monitoring,” says Prof Zubair. “Others will need quite a bit of nutritional rehabilitation.”
Besides being on respiratory support, the babies are also hooked up to a central line, which provides them with nutrition. “It’s a very precious line and is attached to a bag that gets changed every 24 hours,” explains Prof Zubair. “They will also have a separate feeding tube for milk and medication and are also on a heart rate monitor.”
Some babies will need their blood pressure continuously monitored and their blood is drawn daily to test for electrolytes and blood gas levels. “The more delicate the baby, the more extraordinary the skills you need to get all these procedures and tests done,” he explains.
#5 You can visit your baby in the NICU anytime you want
At NUH, the parents have 24/7 unlimited access to their babies. Grandparents are also welcome, although only two people are allowed per visit. “Daily visits are very important for the emotional well-being of the parents and the baby,” says Prof Zubair.
A basic health screening is done prior to the visit to ensure that visitors are in good health. Since preemie babies have an immature immune system, anyone who has a cold, cough, fever or runny nose is discouraged from visiting for fear of passing the viruses on to the little ones.
If your preemie has a central line going through their body and near the heart, you will not be able to pick him up, but can always pat or touch from outside the incubator. “Once they are pretty much stable, we do something called kangaroo care. They can hold and spend time with the baby outside of the incubator,” Prof Zubair notes. “It has many benefits, baby sleeps better and their heart rate and weight gain improves.”
#6 Breastfeeding is encouraged, but not all preemies will be able to do so
Little tummies benefit from breastmilk, but not all premature babies have the right skills to suck and swallow since they are not fully mature yet. “Sometimes, when mums are breastfeeding, they cannot control the volume of milk, which could be too much for a premature baby,” adds Prof Zubair.
In such cases, mums are encouraged to express their milk, and store it in the dedicated fridge in the NICU in syringes. They are then warmed up to room temperature and fed to the babies as and when needed. Prof Zubair notes that the newly-launched breastmilk bank has also made breastmilk even more accessible for premature babies.
“Once baby is stable, mums can breastfeed directly. Most of the time, we will try to make sure the babies have graduated to the bottle or other types of oral feeding before they go home,” he adds. “Some babies, because of many different reasons, may not be able to go home with oral feeding, so they will go home with tube feeding.”
#7 Baby might need breathing support after he is discharged
Since their lungs are still developing, some preemie babies will go home with an oxygen machine that will let them breathe air with a higher concentration of oxygen. Some kids may continue receiving extra oxygen for several months or even a few years. Being on “home oxygen” will allow them to begin a normal life at home with the family, while continuing treatment. Parents get training on how to administer the oxygen at the hospital before baby gets discharged. Nurses also visit the homes ahead of time to set up the special medical equipment needed and do follow-up visits to check in on their little patients.
As for long-term health issues, 70 per cent of babies born from 24 weeks and onwards will not have any major disability, hearing or eye problems.
#8 Expect follow-up doctor visits and additional therapy
A premature baby’s overall growth will be much slower as compared to their peers. As advanced as modern medicine is, the external environment that these preemies were nurtured in will never be as perfect as nature. Because of this, some babies may end up with hearing issues or may need additional physiotherapy or occupational therapy.
As for long-term health issues, Prof Zubair notes that 70 per cent of babies born from 24 weeks and onwards will not have any major disability, hearing or eye problems. “Some of them may need extra support in school and in terms of learning as they may learn things at a later age than their peers,” he adds. “A baby that’s born at 24 weeks will more likely than not walk at 1½ years old.”
#9 There’s always a chance baby might need to be re-admitted to the hospital
“The main reason why premature babies come back to the hospital after being discharged is that they catch a cold, flu, cough from those around them,” notes Prof Zubair. “This can also happen when they come to the hospital for a visit.”
In an effort to make sure it doesn’t happen too frequently, as it can take a toll on your preemie’s health, Prof Zubair discourages the family from coming down to the hospital unnecessarily. After the initial follow-up one to two weeks of being discharged, he calls the parents or requests that they call him to troubleshoot any issues they might be facing.
“You must also remember these families have been with us for about six months on a daily basis, so we actually have a very good rapport with them,” Prof Zubair adds. “We trust them, they can trust us and we can communicate well and easily.”
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