Special delivery: Preemies

The road to delivery is paved with a slew of questions and concerns. For the parents of babies born prematurely (before 37 weeks of gestation), the lack of knowledge about what’s happening can be a source of anxiety and extreme worry. In case you should happen to have one of these eager beavers in your belly, you’ll want to familiarize yourself with the practices surrounding premature birth so you’re as prepared as possible.
The 411
The Centers for Disease Control and Prevention (CDC) states that over half a million babies (that’s one in every eight) is born prematurely in the United States each year. Yvonne Bohn, MD, Allison Hill, MD, and Alane Park, MD, a group of Los Angeles-based OB/GYNs widely known as “The Mommy Docs” and authors of The Mommy Docs’ Ultimate Guide to Pregnancy and Birth, point out that women at the highest risk for preterm birth have the following factors in common:

• Prior preterm birth
• Multiple gestation
• Smoking
• Poor nutrition
• Use of infertility treatments
• African-American descent
• Infection of the lung, kidney, appendix or genital tract
• Unexplained vaginal bleeding in the second or third trimester

“In over half of the cases of preterm birth,” they note, “there are no known medical causes.”
By quitting smoking, treating pelvic infections, and identifying and correcting uterine abnormalities prior to conceiving, The Mommy Docs suggest a woman may be able to lower her risk of preterm birth.
For women who have a history of early labor, medicinal options are available to help. “In February of 2011, the FDA approved the use of a medication called 17-hydroxy- progesterone caproate for the prevention of preterm birth,” explain The Mommy Docs. The medication is administered as a weekly injection beginning at 16 to 20 weeks until 36 weeks and 6 days, decreasing the chances of delivering early by 50 percent.
The symptoms
One sign of preterm labor is regular uterine contractions that cause the cervix to open. If you’re less than 37 weeks and experiencing contractions, see your doctor to distinguish between Braxton Hicks (during which your cervix will remain closed) and the real deal. Ruptured membranes (aka your water breaking) and heavy vaginal bleeding that resembles a menstrual period are also indicators of preterm delivery.
“If you suspect you are going into labor, the first thing you should do is go to a quiet area, lie down, and count how often your contractions are occurring,” advise The Mommy Docs. “If they are not true labor contractions, simply drinking water and lying down will make them go away. But if they persist and you have more than four contractions in an hour—or you’re just not sure—call your doctor or head to the hospital to be evaluated.”
The delivery
If you find yourself in labor, there are several options for delivery. If your baby is positioned head down and is tolerating your labor contractions without stress, you may be able to have a vaginal birth. If not, your doctor will most likely recommend a Caesarean delivery.
The complications
When a little one enters the world before his gestation is complete, there are several health problems that can ensue. Most issues involve breathing, digestion and potential bleeding in the brain. “Depending on how premature, he may need a ventilator or oxygen supplied through the nose or mouth. Digestive problems may occur because the immature intestines cannot break down food easily. Or if the mouth of a preterm infant is not developed enough to suck well, he may need to be fed through a tube,” The Mommy Docs note. Infants that have very little fat content will have a harder time maintaining their own body temperature and may need to be placed in an incubator. Early babies are also susceptible to infections, so they are often given antibiotics intravenously.
The NICU
Once born, your preemie will be placed in the neonatal intensive care unit (NICU) at the hospital for anywhere from a few days to several months so the doctors and nurses can give your baby the special care he needs. “If you have never been in a NICU, it may seem like another planet. Monitors are everywhere, staff members are in gowns and masks, and babies are in all sizes,” describe The Mommy Docs. The NICU will do an initial evaluation to assess breathing, heart rate and blood sugar levels. “Some babies may need just a little assistance with oxygen while others will need multiple IVs and ventilator assistance,” they explain. “Blood tests, ultrasounds of the heart or brain, and chest X-rays will be performed.”
You might feel completely helpless if your baby is in the NICU, but there are several ways to help. Continue to pump breast milk frequently, even if your little one isn’t able to nurse just yet. Visit each day and talk to your baby so he can hear and recognize your voice. And ask as many questions as possible to learn and understand every part of your baby’s daily schedule.
To be discharged from the hospital, your baby will have to meet several milestones. “He must be a certain weight (this varies but is usually 5 pounds) and able to maintain his temperature, eat a sufficient amount of food without vomiting, and maintain adequate oxygen levels in the blood. He must be with-out any signs of infection and have a stable heart rate,” note The Mommy Docs.
Before leaving the hospital, talk to your baby’s medical team about any lingering questions or concerns. The more knowledge you have, the more equipped and confident you’ll be with your new baby at home.