Labor and delivery
Sometimes it is not possible to delay premature labor and your baby must be delivered preterm. Any baby that is born before the 37th week is considered preterm. The closer you are to 37 weeks at the time of delivery, the more developed the baby will be and the less likely it will have serious problems.
Likewise, the earlier you are in your pregnancy when you deliver, the higher the likelihood for the baby to have more serious complications. If it is possible to delay your delivery, even for just 48 hours, your doctor may try to do so. You will usually receive an injection of corticosteroids, medications that help the baby's lungs mature before delivery.
The prognosis for a premature baby depends on the baby's age and size at the time of delivery. Statistically, the chance for a premature baby's survival is based on the baby's age, weight, ability to breathe, and how other factors present at the time of delivery.
A preterm baby’s gestational age (in weeks since the mother’s last period) is probably the most important predictor of survival, followed by the baby’s weight at birth. Less than 25 percent of babies born at 23 weeks survive, about 50 percent of babies born at 24 weeks survive, and nearly 92 percent of those born at 29 weeks will survive. If you are at risk for delivering preterm, ask to meet with a neonatologist, a pediatrician who specializes in the care of preterm babies. He or she can assess the specific risks for your baby, based on where you are in your pregnancy.
With the modern advances in medicine and technology, many preterm babies with appropriate care may survive. While some may not have any problem in the future, many others may experience mild or severe developmental difficulties.
What To Expect After Delivery
Most preterm babies will need special medical attention after birth. If preterm delivery was anticipated, you would be advised to deliver your baby in a hospital that has a neonatal intensive care unit (NICU). You may have to deliver your baby at a different hospital than originally planned. If you have an unplanned premature delivery, the baby may have to be taken to another facility that has an NICU to receive the best quality care.
When premature babies are born, they have not completed the normal development that is needed inside your uterus. So, they will look different than what you expected. The baby will appear to be red and very little. You may notice that you can see all the blood vessels through fragile-looking skin because there has not been enough time to develop any fat underneath.
Where Will My Baby Go?
The baby will probably be put in an incubator (an enclosed, see-through plastic crib) in the NICU. This environment allows the baby's temperature to be stabilized enough to keep it warm without needing to be wrapped up in blankets. This also decreases the risk of an infection. The humidity is controlled to help maintain the baby's hydration and prevent water loss. A cap may be kept on the baby's head to help limit heat loss.
There will likely be tubes and wires attached to the baby, and this can sometimes be intimidating or disturbing to new parents. The wires allow the medical team to keep a close watch on your baby's health status continuously. They will be monitoring the baby's breathing, heart rate, blood pressure, and temperature constantly.
There may also be other things that are monitored specific to your baby's problems. It is possible your baby may need to be on a respirator to assist with breathing for a short period of time. The baby may need extra oxygen as well.
What Will My Baby Eat?
Babies who are born prematurely often may not be developed enough to breastfeed or bottle-feed. Some babies are fed intravenously through a vein initially, depending on how premature they are. However, after just a few days, the baby may be ready to be given food that goes through a tube in the baby's nose to the stomach.
It is extremely helpful to give premature babies breast milk because it has proteins and antibodies that help prevent infection and encourage growth. Some babies still need added vitamins and proteins to supplement your breast milk. The breast milk may be given through the tube until the baby is ready to breast feed or bottle feed.
There are some common problems or diseases that occur in babies born prematurely. Some babies have more complications than others and this is generally related to the age of the baby at the time of birth. Some of the complications include:
- Jaundice: yellowing of the baby's skin from build-up of bilirubin in the blood.
- Respiratory Distress Syndrome (RDS): difficulty breathing due to immaturity of the baby's lungs.
- Anemia: lack of red blood cells that provide the baby with enough oxygen.
- Apnea: periodic or irregular breathing pattern.
- Bronchopulmonary Dysplasia (BPD): the baby is not able to wean off the ventilator and may need further medication and oxygen.
- Patent Ductus Arteriosus: a blood vessel that normally closes at birth remains open. This can cause breathing problems and sometimes heart problems.
- Infection: from having a weak immune system and not having the antibodies to fight off infection.
- Retinopathy of Prematurity: incomplete growth of the vessels in the retina of the eye. This is more common in babies 24-26 weeks and uncommon in those 33-34 weeks and after.
- Low Blood Pressure: blood does not circulate appropriately. This is most common immediately after birth. Usually it can be treated with increased fluids and medication. Occasionally, a blood transfusion may be needed.
- Necrotizing Enterocolitis: poor blood flow in the baby's intestines. This may lead to an infection in the wall of the intestine or bowel.
- Intracranial Hemorrhage: bleeding inside the brain. Occurs more often in babies born at 24-26 weeks.
Interacting With Your Baby In The NICU
It is not unusual for parents to feel awkward, anxious, and uncomfortable in the NICU. It is important for you and your baby to have physical contact as early as possible. The highly qualified medical staff will help you with all the equipment and show you what to do.
If your baby is very premature, you might not be able to do anything more than to stroke your baby through the openings in the incubator. As your baby grows and becomes more developed, you will be able to help with bathing and be able to hold, talk to, and sing to the baby. Cuddling with your baby directly against your skin, called “kangaroo care,” is an especially good way to bond with your baby. It won't be long before you start seeing all the things that you may have seen if the baby had been born full-term.
Through all of this you may experience a variety of emotions. You will need to take time to recover physically so that you can be strong for your baby. You might experience anger, fear, guilt, and depression (all of which are normal emotions to go through). Even women with healthy, full-term babies can develop depression from the hormonal changes of childbirth – and it’s only logical that mothers with preterm babies have a more difficult time. Talk with the social workers in the NICU or with your health care provider if you are feeling overwhelmed. You may be developing post-partum depression.
The important thing is to recognize that even though your baby needs special medical attention, the baby also needs you and your love and affection. This is equally important for the baby's development and adjustment outside the uterus.
Review Date: 10/22/2008
Reviewed By: Peter J. Chen, MD, Department of Obstetrics & Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network.