What is preterm birth? Preterm birth, or premature birth, is usually an unplanned event. Depending on the causes of the birth and how premature the baby is, it may also be an emergency. A birth before 37 weeks is classed as a premature birth. In many cases, premature birth cannot be avoided. Causes of Premature Birth Premature birth can have many causes which include problems with the fetus, the mother, or both. Premature birth most frequently comes as a result of the onset of premature labour, specifically, a premature rupture of the fetal membranes, or a condition called incompetent cervix where the cervix opens up before the time that it should. Certain events can stimulate the onset of premature labour. These include: placental abruption, where the placenta separates from the uterus during pregnancy incompetent cervix, where the cervix painlessly and gradually opens before the time it is supposed to hormonal changes, which can cause stress in the unborn baby or mother infection Risk factors for premature labour There are a number of factors that can put a pregnant woman at higher risk for having a premature labour and delivery. If you had a previous premature labour, your chance of having another premature labour increases two and a half times. That rate jumps to 10 times if your previous premature labour occurred before the 28th week of pregnancy. It is important for you and your health care provider to keep this in mind, so that he can provide you with appropriate care throughout your pregnancy. Another major risk factor for premature labour and delivery is being pregnant with twins or multiple babies. The rate of twins and multiple babies has increased over the past few years, mostly because of the use of fertility drugs and other assisted reproduction techniques. About half of all twins deliver at 36 weeks or less. Half of triplets deliver before 32 weeks. Many mothers of twins and multiple babies go into premature labour spontaneously. Others may need to have premature labour induced because of complications during pregnancy. One important risk factor is infection. Some types of infection that can result in premature birth are as follows: Untreated urinary infections: These double the risk for premature birth. Urinary infections are screened at each medical visit, and can be treated with antibiotics. Bacterial vaginosis: These also double the risk for premature birth. The main symptoms of vaginosis is a light or heavy vaginal discharge with a slight “fishy” smell. Vaginosis is treated with antibiotics. There are a number of other risk factors for premature labour and delivery. Some of these risks, such as anemia, slow maternal weight gain, stressful work habits, smoking, drinking alcohol, and using drugs like cocaine, can be rectified during pregnancy. Other risk factors, such as structural abnormalities of the uterus, can be corrected with surgery before you become pregnant. Other risk factors for premature birth include age under 17 years or over 40 years, prior multiple abortions, and low pre-pregnancy weight. Knowing these risks can help you and your health care provider determine whether you will need special care to prevent premature labour. If you are at high risk of going into premature labour, your health care provider can take special precautions to ensure the best outcomes for you and your baby. Preventing premature labour Although there are some risk factors that you cannot change, there are a few general ways in which you can reduce your odds of having a premature birth. These involve behaviours that encourage a healthy pregnancy. Quit smoking before your pregnancy or as early as you can during pregnancy. Avoid drinking alcohol and using recreational drugs. Advise your health care provider of all medications that you are taking, because some may be harmful to your pregnancy and might need to be phased out. Maintain an adequate amount of weight gain throughout your pregnancy, depending on what your health care provider thinks is right for you. Eat a nutritious and well-balanced diet. Nutrition and optimal pernatal care are especially important if you are under age 17 years, over 35 years, or carrying twins or multiple babies. Avoid heavy lifting and work, and standing for long periods of time. Minimize the stress in your life whenever possible, and deal with stress using relaxation techniques, exercise, nutrition, and rest. Avoid infections as much as possible. If you have a history of premature birth caused by structural abnormalities of the uterus, these abnormalities may be corrected with surgery before you become pregnant. Premature delivery due to incompetent cervix can be reduced with a surgical procedure that closes the cervix from the 14th week of pregnancy until the ninth month. Some chronic maternal illnesses can lead to premature birth if they are not treated properly during pregnancy. They need to be appropriately managed during pregnancy. If your health care provider thinks you are high risk for premature labour, she may suggest that you refrain from having sexual intercourse. Transport to Specialized Neonatal Facilities Depending on how premature a child is at birth and whether there are other complications, it may be necessary for the baby to be transported to a specialized facility called a neonatal intensive care unit (NICU). NICUs are designed and equipped to support premature babies and full-term newborns with other types of conditions. There are also several different grades of NICU. Most hospitals will have a Level I NICU, which are for the less serious cases. Levels II and III are for babies requiring more support at birth. Not every hospital and community has a Level II or III NICU, so transport will be arranged. Usually the baby is transported in an ambulance, though sometimes a helicopter or other aircraft will be used. Sometimes it is known that the pregnancy is high risk and transport of the still-pregnant mother to a hospital with an NICU may be arranged. More frequently, since the birth was not expected nor recognised as high risk, transportation is arranged for the baby very quickly after the birth. Neonatal transport, whether by land or air, is a highly specialized ambulance service specifically designed with the newborn baby in mind. While premature babies may be more fragile, at least initially, than most babies, the concept of transporting them to an NICU is sound. It is much better to move babies to be taken care of by experts in a specialized facility than not. As a result, many more babies are saved and fewer suffer additional complications than in the past. Life in the NICU At first, a neonatal intensive care unit (NICU) is often a shock to parents. The room is filled with what appear to be impossibly small babies, most of whom are hooked up to high-tech looking machines with tubes and wires. Some of the babies are so small they may not even look real; in addition to being very small, their skin seems discoloured, perhaps nearly transparent. This initial experience is intensified by the fact that most parents were not expecting to be there and are therefore further unprepared for the sights and the sounds of the NICU. One minute they were only just beginning to think about what colour to paint the nursery, the next they are in the NICU. As if that is not enough, the mother has just given birth, probably unexpectedly, and has to recover from her experience while she is thrust into another intense situation. All the while parents want to know, “Will our baby be all right?” Given these circumstances, it is no wonder that many parents feel disoriented and emotionally affected for the first few days in the NICU. Getting help Health care professionals know that parents are often overwhelmed at first by their experience in the NICU. For this reason, many hospitals have specific staff and programs available to help parents cope with both the practical problems and the emotional issues brought on by the intensity and complexity of the situation. It is highly recommended that you take advantage of whatever services are available in this regard. Addressing practical and emotional problems, no matter how difficult, is always a better option than ignoring them. Communication is key. Do your best to be open about what you are feeling to your spouse, the staff of the NICU, the rest of your family and, above all, yourself. In the long run, no matter how long your stay and now matter what your baby’s outcome is, communicating with those around you is one of the best things you can do. Emotions Life in the NICU is often one of intense and conflicting emotions. The combination of stress, fear of the unknown, worry for your baby, and many other considerations can be overwhelming at times. Parents often liken it to an emotional roller coaster ride, with some days being exhilarating and others despairing. The progress of your baby plays the central part. Some days, your baby will be growing and progressing and just when you think everything is finally all right, she may have a setback. Conversely, some babies may suddenly turn around for the better when the expectation was poor. These types of events frequently trigger emotional highs and lows that change from day to day. Even with the prospect of a happy and healthy outcome, parents often feel a sense of loss during the first days in the NICU. Though the baby might be doing fine, her mother and father must come to terms with the fact that however they imagined the birth and the arrival of a new baby, something else entirely has happened. Family and friends often don’t know how to react either, which reinforces parents’ sense of loss. For example, it may be many weeks before someone says “congratulations” even though you’ve just had a baby. Guilt Many parents, especially mothers, feel a sense of guilt; they imagine that they have done something to create this situation. The reality is parents have little control over the events that lead them to the NICU. In general, guilt is not a particularly useful emotion and often becomes a barrier to positive behaviours and thoughts. Do whatever you need to do to shed the guilt. If there is some connection between a parents behaviour and the outcome of their baby, dwelling on it will not change what has happened nor help the baby recover. Sometimes, parents are reluctant to bond with their baby in the NICU; they fear getting close to their child who may not live. With the intense emotions and dashed expectations, the thought of bonding emotionally to their child with the possibility that the bond will be taken away can be fearful for parents, especially at first. Parents usually get over this fear, perhaps with encouragement, but then have to get over the guilt of not immediately investing emotionally in their child. Fathers often feel guilty about their feelings of weakness and fear because, as culture dictates, they are supposed to be strong and be a pillar of strength for the rest of the family. In the NICU, with a sick baby, a wife who has just gone through labour and may be ill herself, family responsibilities to uphold, and financial pressures, many men have difficulties in fulfilling all these roles on behalf of everyone all the time. Experiencing this may cause guilt. Practical matters While parents and babies settle into life in the NICU, life goes on in the outside world and a balancing game begins: how much time can we afford to spend with our child? While parents are encouraged to spend as much time as they can with their baby, this should not be done by neglecting the rest of the family or their own peace of mind. Even though you naturally want to stay in the NICU as much as possible, you should get out at least occasionally going for a walk, getting some air, and clearing your head. Finding a balance between commitments in and outside the NICU can be difficult. Parents should speak with the staff and seek help when they need it. These types of issues can be compounded when the NICU is far from the family home, perhaps even in another city. Parents find themselves torn, with one parent always at the NICU and the other running around trying to maintain an income and keep the rest of the family going, all the time worrying about what is going on with their child and their spouse. Coping In the NICU, the over-riding concern for parents is their baby’s condition. As they become more familiar with the routines and setting of the NICU, parents often feel a desire to “do something” to help. While much of what goes on in the NICU is out of their hands, parents can focus on several things. They can learn about their child’s condition and the treatments and procedures that apply to the best of their ability. Health care professionals can help in this regard as well. Becoming informed is a positive development which can increase the communication between a parent and the team in the NICU. Having a better idea of what is going on can improve your peace of mind and reduce the sense of helplessness that parents often feel in the NICU. At the same time, focussing entirely on the details and the numbers does not necessarily contribute to an improved understanding of what is going on. Some parents begin to pay attention to the incredible amount of detailed information that the various machines are giving and may become fixated with the numbers. Interpreting numbers is not as simple as it may seem. Indicators can fluctuate naturally from day to day or even minute to minute. Most of these fluctuations are not an indication that something has suddenly and dramatically improved or become worse. Parents should focus as much as possible on the longer view and soak up the positive aspects of what is going on as much as possible. Additionally, parents should do what they can to make their baby as comfortable and welcome as possible. This can mean many things; parents can whisper to or gently touch their baby. At some point “kangaroo care,” which is a skin-to-skin holding of the baby, will be possible, as will breastfeeding. Beyond the baby, parents should also make efforts to remain connected with other members of the family. If you have any other concerns regarding your premature baby http://www.bliss.org.uk/ can be very helpful.