In South Africa, about 14% of all babies are born premature and the trend is on the increase. Although our hospitals have highly-trained doctors and the best technology, the race to save the tiniest life is given a boost by the involvement of loving parents. The fight for life that your little gladiator shows is one of the most remarkable birth experiences you could have. And because your love and care can make such a difference to your baby’s development, she needs you more than ever.
Additionally, there are many support organisations for parents of prem babies, so you should never feel alone when faced with the challenges your tiny baby brings.
What is prematurity?
Babies born before 37 weeks of pregnancy are considered premature. Welma Lubbe, clinical education specialist and head of the South African Neonate, Infant and Toddler Support Association (SANITSA), says prematurity can further be classified according to a baby’s birth weight:
Low birth weight: 1500g to 2500g
Very low birth weight: less than 1500g
Extremely low birth weight: less than 1000g
Why is a baby born prematurely?
There are two main causes of prematurity. Firstly, lifestyle and environmental factors, which include late or no antenatal care, stress, smoking, alcohol and drugs. Secondly, certain medical conditions during pregnancy may increase the likelihood of premature labour, such as multiple pregnancy, high blood pressure, diabetes and structural abnormalities of the uterus.
Welma says that statistics show that premature birth seems to be on the increase. One factor could be the increased numbers of pregnant moms in high stress jobs. Another influence could be an increase in infertility treatments, leading to multiple pregnancies, which can result in premature birth. A third factor could be the high incidence of poor antenatal care and malnutrition.
Challenges your prem baby may face
Welma explains that because your prem baby is so abruptly removed from the soothing protection of the womb, she may experience short-term challenges such as temperature instability, feeding and breathing difficulties and jaundice.
Emotional and behavioural challenges may also result from an immature nervous system.
Long-term challenges may only be evident after discharge from the hospital and may include visual, hearing and motor challenges, poor emotional and self-regulatory abilities and later, possible behavioural and learning challenges. These challenges should only be diagnosed by medical professionals, because a wide variety of other factors need to be considered and prematurity is not always the only cause.
Milestone development for preemies is different than for other babies – after all, she came into the world ahead of her time.
Early caring for your prem baby...
Treatment – what to expect
Although the medical equipment used to help your tiny baby are alarming to look at, they are easier to cope with if you understand their purpose. For instance, because she has immature lungs, your preemie may need to be connected to a ventilator or oxygen to help her breathe. The oxygen levels in your baby’s blood are measured by a saturation monitor, which is a little probe with a red light connected to her hand or foot. In addition, she may be connected to a cardiorespiratory monitor that monitors her heart rate, breathing and blood pressure.
A warmer or incubator is used to keep your baby warm, because she can’t maintain her own temperature yet. But if you’re able to give your baby skin-to-skin care, that’s even more effective than an incubator. Tube feeding via her nose or mouth will provide your baby with milk until she is mature enough to take it by mouth.
Kangaroo care is defined as a universally available and biologically sound method of care for all newborns – but premature babies especially. Kangaroo care, was inspired by kangaroo mothering, where the baby kangaroo is born prematurely, crawls into the mom’s pouch and stays there until it’s mature enough to cope with the world.
Research by Dr Bergman has shown the benefit of kangaroo care for the tiniest, sick babies who are still ventilated. The benefits include improved physiological stability, better levels of alertness, improved nutrition with better growth and less crying at 6 months of age. More benefits are better temperature regulation, sleep synchrony and optimal development of the prem baby.
The hours after birth
“The hardest part of NICU is being separated from your child,” explains Lavonne. “It might be some time before a mom can see her baby, depending on the reason for the premature birth and the method of birth.”
It’s common for moms to describe feelings of anger, depression, helplessness and guilt while their preterm baby is in the NICU, says Welma. This is made worse when you’re well enough to go home, but your little one has to remain in the hospital.
It’s difficult not being able to hold and cuddle your newborn baby. She may experience all touch as pain, due to an immature nervous system and become overstimulated very easily. Ask the nursing staff to help you give positive touch to your prem baby. This may include her holding onto your finger or sucking on a dummy.
Playing your part
Lavonne says that nursing professionals try to concentrate their care into sessions to allow a baby periods of uninterrupted sleep. She advises, “If you time your visits to coincide with these activity periods, you’ll have more opportunities to help care for your baby.”
- Get to know the NICU staff, as well as the routine of the unit and respect house rules, such as visitation policies, since they are there to protect your baby, says Welma.
- Get the correct products for your preemie. Read more about this in Prematurity – Adjusting Your Dream by Welma Lubbe (Little Steps), or visit the SA Preemies website
- Get involved with the basic care of your baby, such as cleaning her eyes and mouth, changing her nappy and feeding her
- Keep a progress diary to record each day’s events and your feelings. Share these feelings with a friend over a cup of coffee
- Get support for your needs, from organisations such as SA Preemies, Little Steps or SANITSA
- Counselling, medical advice, financial support and treatment suggestions can be gained from a team of professionals, such as a counsellor, your doctor and social workers.
Feeding your preemie is such a big subject it can’t be covered in detail here, but there is a lot of research available on the internet. In the meantime, here are a few tips to follow:
“Breastfeeding is the most suitable feed for a preterm baby,” says Welma. Soon after birth your baby may not be getting a lot, if any milk and then mom needs to express her breastmilk and store it correctly. Store the milk in small quantities to prevent wastage when your baby is starting to take small volumes of milk. An electrical double breast pump may be the most suitable while your baby is still in the NICU.”
Giving your baby a dummy to suck on will help her feeding development, digestion and breathing. It’s important to offer her a dummy only when she is in a drowsy, or quiet but alert state. Preemies may be slower to feed, need to be winded properly and must be watched closely for any signs of respiratory distress.
“It’s natural to feel daunted about leaving behind all the highly specialised professionals and having to look after your baby by yourself,” says Lavonne. “Just remember what you’ve learned from NICU and make these routines part of your life at home:”
- You and your visitors must wash your hands before touching your baby.
- Ill visitors shouldn’t visit, because your baby’s immune system is still immature.
- Call the neonatal unit about any concerns you may have.
- You may be advised to get an apnoea monitor, which sounds an alarm if your baby stops breathing for 20 seconds.
- Your preemie is used to lights and noise, so don’t put her in a quiet, dark room.
- She may confuse day and night sleep and this may take some time to correct.
- Try to sleep when your baby sleeps and let family and friends do cooking, cleaning and shopping, if they offer.
- Don’t take your baby into crowded areas for the first few months and minimise visitors.
- Regularly visit your paediatrician, prem baby clinic or early intervention centre, to monitor your baby’s progress.
- If your baby is sick, remember to tell pharmacists, doctors or clinic sisters that she was born premature. Give them the statistics: born premature at x weeks, birth weight, current weight and so on.
- Do a CPR training course before leaving the hospital.
Treatment for your prem baby doesn’t end on the day she leaves hospital. Early intervention clinics such as the Baby Therapy centre can be visited as early as 4 months corrected age and offer valuable assessments that can help set your mind at ease. Any development barriers your baby may have will be identified so that she can reach her full potential.
Your prem baby is a miracle. She arrived ahead of schedule and you and the doctors have helped her survive. Now you’re playing the biggest role in her development towards a happy, healthy future. Even if the challenges look daunting now, the following story shows how rewarding persistence is.
- The SA Preemies Association. 0860 SA PREM or 0860 727 736, firstname.lastname@example.org, www.sapreemies.za.org
- www.babytherapy.org.za for babies who are disabled and have slow development
- SANITSA, www.sanitsa.givengain.org
- www.littlesteps.co.za and email@example.com for help with NICU babies