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Saint Thomas Health Medical Mondays: Childbirth & Premature Babies

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MEDICAL MONDAYS News Notes
TOPIC: Childbirth & the Premature Baby
Kelly Williams, MD | OB/GYN
Janet McIntosh, RN | Director of Nursing, Saint Thomas Rutherford
SAINT THOMAS HEALTH

News notes via www.webMD.com

 

The SAINT THOMAS RUTHERFORD HOSPITAL's NICU is celebrating their 15TH YEAR OF SERVICE THIS MONTH (July 2013)

 

More mothers are choosing Saint Thomas Rutherford (STR) for the birth of their baby.  has a comprehensive maternal infant center that has delivered more babies than ever before (see stats below) with a Level IIIa neonatal intensive care unit and childbirth education and lactation services. STR is also helping raise awareness about the importance of prenatal care and preventing prematurity and infant mortality through its sponsorship of Rutherford County's March for Babies.

  • Growth – STR (Saint Thomas Rutherford) has seen a steady annual increase in babies born in the past three years with a record 2,613 births in 2011. That growth continued into 2012 as the hospital has delivered more babies each month last year over 2011. In addition, more babies were cared for in the hospital's neonatal intensive care unit in 2012.
  • NICU – For when the unexpected occurs, STR is prepared with a 16-bed neonatal intensive care unit (NICU). The Level IIIa NICU provides subspecialty care for the tiniest and sickest newborns with severe and complicated neonatal disorders, as well as those who require normal or intermediate care. As a level IIIa NICU, care is provided for infants born at more than 28 weeks gestation and weighing more than 1,000 grams or approximately two pounds. Level III-A units also have the capability to provide sustained conventional mechanical ventilation and perform minor surgical procedures. The STR NICU just celebrated its 15th year of caring for families in the community.
  • Childbirth Education – Childbirth can feel like a great leap into the unknown, especially if you're about to be a first-time parent. We believe that sharing our knowledge can help you overcome any fears and concerns you may have. STR's Bright Beginnings program offers a variety of classes, taught by Certified Childbirth RN Educators, for new and expectant parents, siblings, and grandparents. Certified RN Lactation Consultants teach the breastfeeding classes.
  • Breastfeeding Support & Lactation Boutique – We believe that breastfeeding should be a positive and natural experience. To help make that possible, all nursing staff have been trained to assist patients with their breastfeeding experience. We also offer group classes, consultation services and an on-site Lactation Boutique that has a complete line of breast feeding supplies, including breast pumps and nursing bras.
  • Community Support – STR is the presenting sponsor of the March of Dimes March for Babies in Rutherford County. In addition, STR offers an Infant Loss Support Group.
  • For more information on maternal infant services and women's health services at Saint Thomas Rutherford Hospital –www.strutherford.com. The following phone numbers may also be helpful – Childbirth Education (615.396.4502); Lactation Boutique (615.396.4167); Breastfeeding Support (available seven days a week from 8 a.m. to 4 p.m., 615.396.4167).

Pregnancy and the Stages of Labor and Childbirth

Pregnancy labor happens in three stages and lasts on average 12 to 24 hours for a first birth. Usually, labor is shorter for subsequent births.

The First Stage of Labor

The first stage is the longest part of labor and can last up to 20 hours. It begins when your cervix starts to open (dilate) and ends when it is completely open (fully dilated) at 10 centimeters. When the cervix dilates from 0 to 3 or 4 centimeters, contractions get stronger as time progresses. Mild contractions begin at 15 to 20 minutes apart and last 60 to 90 seconds. The contractions become more regular until they are less than 5 minutes apart. This part of labor (called the Latent Phase) is best experienced in the comfort of your home.

When the cervix dilates from 4 to 8 centimeters (called the Active Phase), contractions get stronger and are about 3 minutes apart, lasting about 45 seconds. You may have a backache and increased bleeding from your vagina (called the "bloody show"). Your mood may become more serious as you focus on the hard work of dealing with the contractions. You will also depend more on your support person.

Tips to help you through the Active Phase of labor:

  • Try changing your position. You may want to try getting on your hands and knees to ease the discomfort of back labor.
  • Soak in a warm tub or take a warm shower.
  • Continue practicing breathing and relaxation techniques.

If your amniotic membrane ruptures -- or your "water breaks" -- the contractions may get much stronger. When the cervix dilates from 8 to 10 centimeters (called the Transition Phase), contractions are 2 to 3 minutes apart and last about 1 minute. You may feel pressure on your rectum and your backache may feel worse. Bleeding from your vagina will be heavier.

It may help to practice breathing and relaxation techniques such as massage or listening to soothing music. Focus on taking one contraction at a time. Remember that each contraction brings you closer to holding your baby.

It is during the active phase of labor that you will go to the hospital or birthing center. Upon arrival, you will be asked to wear a hospital gown. Your pulse, blood pressure, and temperature will be checked. A monitor will be placed on your abdomen for a short time to check for uterine contractions and assess the baby's heart rate. Your health care provider will also examine your cervix during a pelvic exam to determine how far labor has progressed.

An intravenous (IV) line may be placed into a vein in your arm to deliver fluids and medications if necessary.

The Second Stage of Labor (Delivery)

The second stage of labor begins when your cervix is fully dilated at 10 centimeters. This stage continues until your baby passes through the birth canal, vagina, and is born. This stage may last two hours or longer.

Contractions may feel different from the first stage of labor -- they will slow to 2 to 5 minutes apart and last from about 60 to 90 seconds. You will feel a strong urge to push with your contractions. Try to rest as much as possible between intervals of pushing, and only push when the health care provider tells you.

Tips to help you push:

  • Try several positions -- squatting, lying on your side with your leg up, or resting on your hands and knees.
  • Take deep breaths in and out before and after each contraction.
  • Curl into the push as much as possible; this allows all of your muscles to work.

You may receive pain-relieving medications or have an episiotomy if necessary while pushing. An episiotomy is a procedure in which a small incision is made between the anus and vagina to enlarge the vaginal opening. An episiotomy may be necessary to assist the baby out quicker or to prevent large, irregular tears of the vaginal wall.

The location of your baby's head as it moves through the pelvis (called descent) is reported in a number called a station. If the baby's head has not started its descent, the station is described at minus 3 (-3). When your baby's head is at the zero station, it is at the middle of the birth canal and is engaged in the pelvis. The station of your baby helps indicate the progress of the second stage of labor.

When your baby is born, your health care provider will hold the baby with his or her head lowered to prevent amniotic fluid, mucus, and blood from getting into the baby's lungs. The baby's mouth and nose will be suctioned with a small bulb syringe to remove any additional fluid. Your health care provider will place the baby on your stomach and shortly after, the umbilical cord will be cut.

The Third Stage of Labor

The third stage of labor begins after the baby is born and ends when the placenta separates from the wall of the uterus and is passed through the vagina. This stage is often called delivery of the "afterbirth" and is the shortest stage of labor. It may last from a few minutes to 20 minutes. You will feel contractions but they will be less painful. If you had an episiotomy or small tear, it will be stitched during this stage of labor.

 

Premature Infant | Overview

What is premature birth?

Pregnancy normally lasts about 40 weeks. A baby born 3 or more weeks early is premature. Babies who are born closer to their due dates tend to have fewer problems than babies born earlier. But even those who are born late preterm (closer to 37 weeks) are at risk for problems.

Doctors and nurses often call premature babies "preemies."

Having a premature baby may be 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.

Why is premature birth a problem?

When a baby is born too early, his or her major organs are not fully formed. This can cause health 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 hard decisions about treatment.

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 able 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 gives your baby extra protection from infection. You can pump breast milk and bring it to the hospital for your baby.

NICU (say "NIK-yoo") nurses can teach you things you'll need to do at home to help your baby.

Does premature birth cause long-term problems?

Before the birth, it is hard to predict how healthy a premature baby will be. Most premature babies don't develop serious disabilities. But the earlier a baby is born, the higher the chances of problems. Work together with your doctor and other health providers to closely watch your baby's development and try to catch any problems early on.

  • 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, 1.7 lb (771.1 g) or less. Long-term problems may include problems with thinking and learning 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 chance of SIDS.

 

Premature Infant - The Premature Newborn

A premature infant's health at birth is influenced by many things, including:

Most infants born at 36 and 37 weeks' gestation are mature enough to be discharged from the hospital with the mother. But many premature infants need care in the neonatal intensive care unit (NICU). Hospital care will be needed for:

While in the NICU or at home, many premature infants also need treatment for jaundice, infection, and anemia.

 

The Sick Premature Infant

Many premature infants are resilient and surprise everyone by overcoming great odds. Expect that your infant can progress for several days but may then have a medical setback.

Premature infants are more likely than others to get an infection. And organs that have not had time to mature can cause a number of problems.

The more premature a newborn is, the greater is the baby's risk of having medical problems. Infants who have reached their 32nd week of development before birth are less at risk than those who are born earlier.

Infants born at 23 to 26 weeks' gestation are extremely underdeveloped and have a much higher risk of death or disability. Parents of these infants are likely to be faced with difficult medical decisions.

 

Getting to Know the Neonatal Intensive Care Unit (NICU)

If your premature infant (preemie) is admitted to the neonatal intensive care unit (NICU) after birth, you will find out about new technologies, new medical words, and new rules and procedures.

You will depend on the NICU staff members, including neonatologists and nurses, to know how to care for your infant and to be your teachers. With their help, you can quickly learn about your infant's needs and what you can do for your infant. Throughout your infant's stay in the NICU, you will want to keep open communication with the staff.

NICU technology

First you'll learn to scrub up before visiting your infant's bedside. When you're there, you may be surprised by the number of machines and instruments surrounding your child. Remember that because of these machines your premature infant has a much greater chance of doing well than ever before.

At a minimum, your infant will be warmed and watched over with equipment that includes:

If your infant has additional medical needs, other tests and equipment also may be used, including:

Your role in your infant's care

At first sight, you may question whether and even how to touch your tiny infant. Unless your newborn is very sick or immature, you will be allowed to touch and possibly hold him or her. But your infant's nurse or doctor will first need to show you how to work around the technology and to alert you to your infant's special needs. When visiting with your premature newborn, remember that:

  • A premature infant has limited energy for recovering and growing. Try not to wake your infant from sleep.
  • A premature newborn's brain isn't quite ready for the world. Be alert to signs that your infant is being overstimulated by your gaze, voice, or touch, or by sound and light in the room.
  • A stable, more mature preemie will thrive on periods of cuddling (kangaroo care), infant massage, and calming music.
  • If you're not able to hold or help your infant, you can give him or her an immunity boost by providing breast milk. Regardless of whether you plan to breast-feed or bottle-feed later on, pumped breast milk for tube-feeding reduces your infant's risk of infection.
  • As your infant grows stronger, you will be able to take on more caregiving tasks. These range from holding and feeding to changing diapers and bathing. You can count on the NICU nurses to teach you and answer your questions. If you are breast-feeding, you may be asked to spend the night with your infant to find out if he or she is strong enough to nurse around the clock.

 

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