Preventing Premature Births -- April 6, 2009 -- Dr. Connie Graves - | Nashville News, Weather & Sports

Preventing Premature Births -- April 6, 2009 -- Dr. Connie Graves


Preventing Premature Births
Connie Graves, MD, maternal fetal medicine
Monday, April 6, 1009


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What is premature birth?

Pregnancy normally lasts about 40 weeks. A baby born 3 or more weeks early is premature. Many premature babies-those born closer to 37 weeks-do not have problems.

Babies who are born closer to 32 weeks (just over 7 months) may not be able to eat, breathe, or stay warm on their own. But after these babies have had time to grow, most of them can leave the hospital.

Babies born earlier than 26 weeks (just under 6 months) are the most likely to have serious problems. If your baby was born very small or sick, you may face a hard life-or-death decision about treatment.

Doctors and nurses often call premature babies "preemies."

Why is premature birth a problem?

Babies who are premature may not be able to feed by mouth, breathe without stopping, or stay warm. Their bodies simply need more time to fully develop and grow. After they outgrow the problems caused by being born too soon, most babies can safely go home from the hospital.

When a baby is born too early, his or her major organs are not fully formed. This can cause health problems. Any premature baby can have medical problems. But those who are born before 32 weeks are more likely to have more serious problems.

Having a premature baby is stressful and scary. To get through it, you and your partner must take good care of yourselves and each other. It may help to talk to a spiritual advisor, counselor, or social worker. You may be able to find a support group of other parents who are going through the same thing.

What causes premature birth?

Premature birth can be caused by a problem with the fetus, the mother, or both. Often the cause is never known. The most common causes include:

  • Problems with the placenta.
  • Pregnancy with twins or more.
  • Infection in the mother.
  • Problems with the uterus or cervix.
  • Drug or alcohol use during pregnancy.

What kind of treatments might a premature infant need?

Premature babies who are moved to the neonatal intensive care unit (NICU) are watched closely for infections and changes in breathing and heart rate. Until they can maintain their body heat, they are kept warm in special beds called isolettes.

They are usually tube-fed or fed through a vein (intravenously), depending on their condition. Tube-feeding lasts until a baby is mature enough to breathe, suck, and swallow and can take all feedings by breast or bottle.

Sick and very premature infants need special treatment, depending on what medical problems they have. Those who need help breathing are aided by an oxygen tube or a machine, called a ventilator, that moves air in and out of the lungs. Some babies need medicine. A few need surgery.

Breast milk can give a baby extra protection from infection. So your hospital may urge you to pump your breast milk and bring it in for at least the first few weeks after the birth.

NICU doctors and nurses are specialists in premature infant care. If your premature baby is in NICU, you can learn a lot from the medical staff about how to take care of your baby.

Does premature birth cause long-term problems?

Before the birth, it is hard to predict how healthy a premature baby will be. But your doctors can prepare you for what may lie ahead. They can base this on your condition and how many weeks pregnant you will be when you give birth.

Most premature babies do not develop serious disabilities. But the earlier a baby is born, the higher the chances of problems.

  • Most premature babies who are born between 32 and 37 weeks do well after birth. If your baby does well after birth, his or her risk of disability is low.
  • Babies most likely to have long-term disability are those who are born before 26 weeks or who are very small, 1.7lb or less. Long-term problems may include mental retardation or cerebral palsy.

What can you expect when you take your baby home?

When you're at home, don't be surprised if your baby sleeps for shorter periods of time than you expect. Premature babies are not often awake for more than brief periods, but they wake up more often than other babies. Because your baby is awake for only short periods, it may seem like a long time before he or she responds to you.

Premature babies get sick more easily than full-term infants. So it's important to keep your baby away from sick family members and friends. Make sure your baby gets regular checkups and shots to protect against serious illness.

Sudden infant death syndrome (SIDS) is more common among premature babies. So make sure your baby goes to sleep on his or her back. This lowers the chances of SIDS.

Premature Infant - Delivery of Your Premature Infant

Preparing for the premature birth

A premature delivery may happen suddenly or after days or weeks of waiting and worrying. If you know you may deliver early, you, your partner, and your doctor can prepare for a premature birth.

  • Use a hospital with a neonatal intensive care unit (NICU). If you deliver in a hospital without an NICU, your infant may need to be moved to the closest hospital that has one.
  • Get to know the NICU. If you can't visit the unit, someone from the NICU can visit or call you to discuss your questions.
  • Mature your fetus's lungs over a 24-hour period by taking a course of corticosteroids. A tocolytic drug also may be used, to delay labor while the corticosteroids work. Corticosteroid treatment is considered the single most effective measure for preventing infant complications of prematurity.1 For more information, see the topic Preterm Labor.

If you deliver after 36 weeks of pregnancy, your infant's risks of problems are very low. Although a special medical team is usually nearby for such a delivery, most 36- and 37-week newborns aren't treated any differently than full-term newborns.

The premature delivery

Unlike many full-term or near full-term childbirths, you and your premature infant (preemie) are considered high-risk during preterm labor. As a result, you will have less freedom, both to make birth-related decisions and to move about freely. You can expect the following:

  • Your birth plan and birthing choices will be less useful during this birth. You can refuse medicines such as painkillers during preterm labor. But other treatments such as antibiotics or corticosteroids can be important to ensure your infant's chances of good health after birth. Be sure to ask as many questions as you can think of about your medical care. The more you understand about your doctor's decisions, the less anxious you will feel.
  • You will be on intravenous (IV) medicines and fluids. (For more information about medicines, see the topic Preterm Labor.)
  • You will be on constant electronic fetal heart monitoring. You also will be checked regularly for changes in heart rate, body temperature, and uterine contractions.
  • You will probably deliver vaginally, rather than by cesarean section (C-section), as long as you and your fetus show no signs of distress.

A childbirth (obstetric) team and a new baby (neonatal) team will be present for your delivery. The neonatal team will bring special equipment with them, including a bed with an overhead heater and resuscitation equipment for your infant. You may deliver in a surgical room that is ready for cesarean delivery, or you may deliver in your hospital room.

After the premature birth: The infant

As soon as the umbilical cord is cut, the neonatal staff will watch over and stabilize your infant. If your infant is less than 36 weeks' gestation at birth, he or she will then be moved to the NICU for observation and specialized care. If you deliver in a hospital without an NICU, your infant may need to be taken to another hospital. This typically requires a specially equipped ambulance.

At birth, little can be predicted about how well or how poorly your premature infant will do. If there are no signs of problems, you can feel cautiously hopeful. But during the first hours and days, your infant will adjust to living outside of the maternal "life-support system." This is a time when birth defects and complications of prematurity often become apparent. For more information, see The Premature Newborn and The Sick Premature Infant sections of this topic.

How can I make informed decisions about my extremely premature infant?

After the premature birth: The mom

While the neonatal staff attends to your infant, the obstetric staff will care for you. Depending on your condition, your postpartum care and recovery time will take at least a few hours. Meanwhile, your birth partner may want to accompany your infant to the NICU.

Before your breast milk comes in (3 or 4 days after childbirth, or postpartum), you will be asked to decide whether you plan to breast-feed your premature infant. If you decide to breast-feed, expect initially to pump milk for feedings until your infant is mature enough to feed orally. Providing breast milk for and later breast-feeding a premature infant can be an emotional and logistical, yet rewarding, challenge. You may have mixed feelings about it and worry that it may be too difficult. Before making your final decision, consider the following.

  • Breast milk contains antibodies that help protect your vulnerable infant against early, serious infections, including sepsis and necrotizing enterocolitis, as well as ear and upper respiratory infections during early childhood.
  • The benefits of breast milk over formula include better nutrient absorption, digestive functioning, and nervous system development.
  • Both specialized formula and breast milk can offer your infant excellent nutrition.
  • Pumping and breast-feeding can be one of the most beneficial and rewarding things you do for your premature infant, but it may also be exhausting and difficult. If you cannot breast-feed, decide not to breast-feed, or find that you have to discontinue doing so, formula feeding will meet your infant's nutritional needs.

Because formula does not give your infant added protection from early infection, your hospital may strongly encourage you to pump milk for your infant during the first weeks of life, at a minimum. Your hospital's lactation consultant can be very helpful with pumping and breast-feeding questions and problems, both before and after the birth. For more information, see the topic Breast-Feeding.

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