Healthy Pregnancy Series: Premature Delivery

When expecting, most women usually assume that they will carry their babies until somewhere around their due date, then give birth to a healthy baby.  And this is usually the case.  Unfortunately, sometimes babies are born earlier than they’re meant to.  This is called premature delivery.  It is one of the largest causes of neonatal problems in the U.S.

Can We Prevent Prematurity?

In many cases, yes.  There is a lot we can do to prevent prematurity.  The following things can reduce your risks of having a premature baby:

• Being at a healthy weight
• Gaining an appropriate amount of weight during pregnancy (too little can lead to prematurity)
• Consuming an excellent diet full of healthy fats
• Not smoking
• Not drinking alcohol
• Not using drugs (legal or otherwise) except where absolutely necessary
• Paying attention to your body (if you notice unusual or worrying symptoms, call your doctor immediately so that you don’t miss a problem in its early stages, when a premature delivery may be prevented)

By keeping your body as healthy as possible during pregnancy, you reduce the risk of having a premature baby quite a lot.  In other cases, if you are high-risk or are having unusual symptoms, bed rest may prevent you from delivering dangerously early.

It is important to note that excellent nutrition can strengthen the amniotic sac, making it less likely to rupture prematurely.  Mothers who are nutritionally depleted (common in mothers who have several babies close together) are more likely to deliver early, too.  Nutrition has a lot to do with prematurity and is crucial.

Some moms have weak cervixes, that, for whatever reason, dilate prematurely (as early as a few weeks into the second trimester).  This is called cervical insufficiency.  In most cases, it is not caught until a woman has had a late miscarriage.  But in subsequent pregnancies, doctors can perform a somewhat controversial procedure called a cerclage, where they actually stitch the cervix closed until a woman reaches full term.

What if I Go into Labor Early?

Many women start labor too early or believe they are (sometimes Braxton-Hicks, which are normal, can feel like the real thing for a short time).  However, beginning labor does not mean that you absolutely will deliver your baby.

Early labor can start for a number of reasons.  You may not be receiving adequate nutrition, you may have overdone activity and need more rest, you may be under a lot of stress, or there may be the beginnings of a problem in your body (preeclampsia or another issue).  In most cases, if you can get to a doctor quickly, you can stop labor.

Very minor labor (early contractions that are not causing much, if any dilation) can often be stopped by resting and drinking water at home.  In fact, if you call your doctor with early and minor labor symptoms, you’ll probably be told to lie down or sit with your feet up and drink water.  If it doesn’t stop the contractions within an hour, you may be asked to come in.  If you ever experience an unusual amount of Braxton-Hicks contractions or are unusually tired, pay attention to your body and rest and drink plenty of water.  (Dehydration causes contractions.)

If you do need to go to the hospital (and don’t hesitate to go if you’re worried), doctors can give you drugs to stop labor.  As long as your water hasn’t broken, this usually will work.  In some cases, if something is really wrong with your body or your baby, there is nothing the doctors can do.  But often times, labor can be stopped.  You’ll likely be on bedrest for the remainder of your pregnancy, or at least until you reach full-term.

What if My Baby is Born Early?

In some cases, there is nothing that can be done.  Sometimes a baby just comes early.  In rare cases, your water will break very early, or your body will just spontaneously dilate (occasionally without you even feeling it).  Sometimes an early delivery is required through induction if mom has severe preeclampsia or another condition that immediately threatens her life or her baby’s life.  But, for a variety of reasons, babies do come early.

It is important to note that while babies born from 37 – 40 weeks are not technically premature, dates can be wrong sometimes, and some of the earlier babies may require some help similar to late premature infants (34 – 36 weeks).  It is crucial never to choose an elective (i.e. not for a medical reason) induction that takes place before 39 weeks.  Waiting until 40 – 41 weeks is even safer.  We will take about inductions more in another post.

Girls who are born at or after 34 weeks’ gestation usually do just fine.  They are clearly early and usually have a low birthweight (4 to 5 lbs.), but many do not need much, if any, help with breathing or other crucial functions.  They may struggle slightly to eat — smaller mouths and weaker muscle tone — and will need extra help regulating their body temperatures at first (which is not uncommon for all newborns, but these babies need extra help).  Many girls born this early can go home in just a few days and are not very different from full-term newborns.  Their long-term prognosis is excellent.

Boys that are born at or after 34 weeks’ gestation usually need a bit more help than girls, but typically do fine.  They may need to stay in the hospital for a week or two and need some help with breathing, but they, too, usually do fine in the long run.

Babies born between 28 and 34 weeks’ gestation have a very high survival rate — over 90%.  They are often born weighing just 2 – 4 lbs. Each week “older” that they are, the greater their chances.  There are many babies born at 28 weeks’ gestation who grow into normal adults.  These babies, however, will need a lot of help initially.  The “younger” they are, the longer they will need to stay in the hospital.  They will usually need to be fed by tubes, they will stay in an isolette to keep warm, and they will often need help breathing.  If the early delivery is predicted by even a couple of days, steroids are often administered (before 32 weeks) to develop the lungs more rapidly and increase the chances of survival.

Most of these babies will stay in the hospital until their original due date (so, a 28-week baby would stay for three months).  As they get older, they will need less and less help.  They will eventually be taught to breast or bottlefeed, moved to a normal bed, and breathe on their own.  They will struggle to regulate their body temperatures for a long time and their immune systems are more fragile than full-term babies.  It is important to be very careful about exposure to illness in the early days (and breastfeed if at all possible to help boost the immune system!).

These babies will not develop on schedule during the first year or two.  Doctors will look at their adjusted age, rather than their actual age, when determining what is normal.  For example, a baby born three months early would be treated like a 6-month-old in terms of development, even when she is actually 9 months old.  That is, by 9 months, she should have an interest in sitting up and should sit supported (while many full-term infants are pulling to stand at that age).  Usually, development does catch up after 1 – 2 years.

A few of these babies will have long-term disabilities, depending on their exact birth circumstances.  These can include learning disabilities, physical weakness, mental retardation, hearing or vision loss, etc.  Most likely is learning disabilities.

Micropreemies

Babies who are born between 24 and 28 weeks’ gestation are called “micropreemies.”  The survival rate for these babies literally increases every day longer that they spend in utero, because they are developing so rapidly.  In many cases, if a mom goes into labor during this period of time, or if her water breaks, she will be kept on full bedrest in the hospital and given steroids and other medications to stop contractions and develop the lungs (and antibiotics if her water has broken, to prevent infection) in order to keep the baby in as long as possible.  Since every day makes a difference, it is crucial to wait as long as possible without endangering mother or child.

These babies are usually born weighing 1 – 2 lbs., though a few babies born weighing under 1 lb. have survived.  They will need immediate and extreme medical attention in order to survive.  Although many do survive, many also do not.  The chances depend on the circumstances and the exact days and weeks’ gestation.  This early, survival also depends on the medical facilities available.  Top-notch pediatric hospitals may be able to save babies that ordinary hospitals cannot.  Some babies may be life-flighted to better hospitals if the option exists.

It is important to note that some micropreemies pronounced “unlikely to survive” will do just that, against all odds, and may even grow up with no lasting effects.  It can happen.  It can also, unfortunately, happen that a late preemie (34 – 36 weeks) will not survive.  There are really no guarantees.

Many micropreemies will suffer some type of permanent disability (which can be minor).  These babies are at risk for muscular dystrophy, mental retardation, muscle weakness, learning disabilities, and so on.  Their development may be behind for about two years, and potentially (depending on disability) forever.  Their development will definitely be assessed by their “adjusted” age.

Babies that are born before 24 weeks’ gestation almost never survive.  The earliest survivor is around 23 weeks, 6 days.  Prior to 24 weeks, it is often considered “a late miscarriage.”  Prior to 20 weeks, it is definitely considered “a late miscarriage.”

What if My Baby Doesn’t Make It?

Unfortunately, in all categories, from micro-preemie through full-term infant, this sometimes does happen.  Remember that you have just been through a traumatic ordeal of pregnancy, birth, and loss. Take things very slow.  Do not rush your body; allow yourself to physically heal.  Do not rush back to work.  Allow others to take care of you, bringing you meals, doing your laundry, and helping with any other children you have.

Consider seeing a counselor and keeping a diary to record your feelings.  You may feel anger, sadness, and all other forms of grief.  It is normal.  Do not let anyone force you to move on or deny your feelings.

If you are wanting to try for another baby soon (some women will; some women won’t), make sure that you seek your doctor’s guidance on when it is physically safe for you to try again.

During recovery, make sure you receive excellent nutrition, as always.  It will make your recovery easier, and prepare you for another pregnancy down the line if you want that.

Once you are healed, you may choose to hold a memorial service for your baby (beyond the funeral).  Locally, a few women banded together last fall to hold a candlelight ceremony for all the babies they had lost.  A few friends attended and told me it was a beautiful and moving event.

(I have never experienced this so I do not know what else to say.  If anyone has experienced this and would like to weigh in, please feel free.)

Moving On

In many cases, parents of preemies are in for a very tense few weeks or months, as they are uncertain of their baby’s future: will she live?  will she be disabled?  will this affect the family permanently?  And there are no answers at first.

It’s an extremely difficult, trying time when a baby is in the hospital.  The parents are constantly driving to spend time with the baby; work may need to be put on hold; older children may need care.  Reach out to others around you and ask them to help.  Know that this time will not last forever.

Two and a half years ago, a cousin of mine was 30 weeks pregnant and not feeling well.  They had two adopted babies at home, who were just 6 months and 1 year.  They found out that she had preeclampsia and would need to deliver immediately.  It was an incredibly rough two months, but with the support of family and friends (who largely took their older children as much as they could), they got through it.  Their baby did extremely well and was released from the hospital almost a month before her original due date.  And today, she’s a happy, healthy, and very normal 2.5 year-old little girl.

Have you ever experienced a premature delivery?  What was it like for you?

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