Sometimes, before the 37th week the baby decides to be born and, as much as one may not be expecting the birth so soon, it is necessary to get used to this idea and to manage a whole new routine necessary for the new life.
When is a premature baby considered?
A normal pregnancy is from 37 to 42 weeks. If the birth occurs before the 37th week, the baby is considered premature, which means that, besides being born before the expected time, it is born before the time considered safe for the birth of a child. Thus, the baby is more vulnerable to complications and to external factors such as: light, noise and anything that can disturb the tranquillity it needs.
A baby born prematurely has not had the opportunity to complete his biological maturation process in the mother’s womb, so it is natural that he needs special care and will possibly be referred to a neonatology unit where he will remain under the care of specialists, until he has the necessary characteristics to be discharged, and can finally go home.
Its survival and the time it takes for it to develop, now in an extrauterine environment, depend on the week of gestation in which the birth took place and on the child’s weight. The lower the weight and the week of gestation, the more risks the baby runs.
What are the characteristics of a premature baby?
A premature baby is generally smaller than expected at the end of gestation, and will therefore have a low birth weight, thin and pinkish skin, and may have fuzz (a fine down that can appear on the skin), visible veins under the skin, little hair, a large head with a size disproportionate to the rest of the body, weaker muscles and therefore little physical activity, reduced sucking and swallowing reflexes and irregular breathing. Premature babies can be classified according to their week of gestation:
- Preterm Threshold: is born between 33 and 36 weeks gestational age and/or has a birth weight between 1.500 kg and 2.5 kg.
- Moderate Premature: born between 28 and 32 weeks of gestational age and/or with a birth weight between 1 kg and 2.5 kg.
- Extremely Premature: born before 28 weeks of gestational age and/or weighs less than 1 kg.
What care you must take with a premature baby
Generally, anxiety is already enormous when the pregnancy goes as expected. With the birth of a premature baby, it is natural for the parents to be frightened, even panic-stricken, especially if the baby needs special care in the hospital and has to remain for some time in the neonatology unit; this environment will be strange and unexpected for the parents. In this way the ideal image they had in their heads of taking the baby home at the same time as the mother is discharged, is annihilated and doubts about what to do next are the most common thing in these cases.
For this reason, you should know that the best way for this fear to disappear is to establish a bond of empathy with the new specialised team that is looking after your baby and to ask them all the doubts you have, without fear of being upset or even of the answer you will get. The sooner you are clear and informed, the easier it will be to manage the situation.
Visits to the premature baby
You must eventually manage the limitation of visits in this phase; and understand the limitations of visits in these special units, such as neonatology. Parents are allowed regular visits, but not the other members of the family. This is a normal procedure to avoid the transmission of germs to the babies under the care of these units, as they still do not have an organism mature enough to manage a response that defends the baby’s organism against the external environment.
Still in neonatology units, although visits are controlled and monitored by someone from the medical team, contact with parents is required, mainly with the mother. There are studies that show that this contact works as a calming effect, to relieve pain or stress, as the baby is subjected to many treatments and analyses, and it also helps to establish the beginning of the relationship between mother and child.
The importance of touch
Thus, parenting and the bond between parent and child is established through touch, and you can get to know certain individual characteristics of your baby just by observing his body language, how he moves, reacts to tactile stimuli and by listening to the way he expresses himself to complain about hunger or pain, or another cause that is bothering him.
Taking the baby home
Once home, after clinical discharge, the risks depend on the baby’s history, birth weight, the weight at which he leaves the hospital and if he has developed any other complications. However, you should reduce visits, even if friends and family insist. Explain the situation to them, at least during the first 2/3 months, and you can and must ask your paediatrician for advice.
The extra care that you should take, because your baby was born premature, is mostly related to the word double. You must redouble your attention and observe your baby’s behaviour and body shape, and see if there are any changes in the conditions in which your baby came home.
Signs to look out for
You should be attentive to the signs that your baby will give you so as not to overload him with stimuli. For example, yawning, hiccups, sneezing, facial grimaces or writhing movements, sudden movements, trembling or clenched fists are signs that your baby is not enjoying it and is under some stress, too much contact can overload him, so you should give him some space and try again later. On the other hand, grasping the parent’s hand, holding hands close together, gentle movements, sucking or putting your hand to the mouth are signs that your baby is enjoying the attention and contact with his parents and is satisfied.
The first sensory organ to develop when the baby is in the womb is touch, once outside of the mother’s womb it is essential, as touch interacts in the alteration of oxytocin which, in turn, produces a sensation of relaxation, reducing the stress to which the baby is subjected. There are studies that identify contact, through placing the baby lying on top of the mother, resting the head on the chest so that it is possible to hear the heartbeat, as a means that helps babies to have a more regular heartbeat, oxygenation, and breathing, as well as relieving stress and pain.
Baby massage is favourable as a soothing and helps in your baby’s development as it benefits the communication between the body and brain through the stimuli caused by it. You must be careful with the strength you apply in the massage; you should ask your paediatrician for advice about the body oil you can use. Finally, you must pay careful attention to the environment, the temperature must be adequate as you are going to undress the baby, the light must be as little as possible and the noise almost non-existent, you can use your voice as a calming factor, as long as it is very soft.
What are the risks of later developing other problems?
The fact that the baby is born prematurely means that there is an increased risk of developing other problems in many areas. There are factors that influence the structure and function of the brain and can affect its development later on, for example, neonatal complications such as the loss of oxygen, postnatal nutrition, blindness, deafness and hydrocephalus. The areas that are generally most affected are cognitive status, learning, language difficulties, motor coordination, vision, deafness, hyperactivity disorder, among others.
What parents can do is just to be extra vigilant and observe the existence or not of signs in which the child shows a development below that expected for its age. In general, these signs are usually visible from the age they start school, when some learning difficulty may be noticed. However, it is always advisable to ask for the support of the medical team, specialist nurses or the child’s paediatrician, because this team will help you predict which examinations you should carry out and how often.
In the Neonatology Unit
Premature babies are sent to these units, usually located inside the same hospital where they were born, so that they can have the special care they need. These babies do not have their organism’s systems mature enough to be in a normal environment, so they are sent to these units so that they can enjoy a calmer, sterile place, with less noise, with appropriate material, such as incubators, phototherapy, among others.
You should know that the external environment is very different from the protected environment that was the mother’s womb, so it is essential to be careful. It is fundamental that there is not too much light and noise, and that repositioning is more frequent because the baby’s muscular strength is still too weak to make any movement, and that contact is not excessive so as not to cause more stress to the baby. These are points that can have negative effects on the child’s development in the long term.
The Importance of Silence
Too much noise in the neonatal unit is not advisable, you should speak in a low tone and softly, not insist on more visits when you are advised that it will not be possible, and act cautiously so as not to cause loud sounds with material or something that can be dropped on the floor as, apart from disturbing your baby’s sleep, this is a factor that can contribute to possible deafness.
The importance of light
Too much light directed towards the baby is also not advisable, and there should be as little artificial light as possible and use mostly natural light, closing curtains if necessary and placing a black cover over incubators when deemed necessary.
As far as positioning is concerned, the baby should adopt a position that stimulates good development and never positions that are harmful to motor development. You must therefore be able to count on the support of the specialist nurses on the unit, who will help you to learn all these positions and will look after the baby in the appropriate way for as long as he stays in the unit.
As the baby’s muscles still have little muscle tone, when you lay the baby down without support to help him stay in the proper position, he will assume a relaxed, stretched position, where the head rolls to one side, the pelvis is in an overly relaxed position and the shoulders and hips rotate. This is a position that could affect the baby’s mobility later on.
Therefore, equipment that helps the baby to adopt appropriate positions should be used and they should be alternated regularly. In this context, a good position is to place the baby on one side or with the stomach on the mattress, and positioning aids should be used, such as support pillows, appropriate for this purpose, that can be placed between the baby’s legs or on the back, so that the baby stays in the ideal position.
Help the medical team to help
Counting on the contact of the parents that is essential and the care of the medical team that is necessary, all the rest of the contact must be avoided and managed cautiously, so the baby does not waste energy that he will need in order to grow and develop more quickly.
This contact time can be managed by the parents, who should take their time when visiting the baby, so that they can wait for him to wake up, allowing him enough sleep for the best possible development. So, just as the medical team will certainly manage time, taking the opportunity to carry out most of the care when the baby is awake, or in case they have to wake him, they usually carry out most of the care and interventions in that time.
There are a huge number of factors that can make the world of parents of preemies confusing, full of anxiety and can become quite painful. What you should do is try to keep calm at all times, get advice from the medical team, ask all the questions and issues you have, ask for suggestions, get advice from people who have been through the same, there will be parents in the same situation with their children in the neonatology unit, support each other as much as you can and communicate with each other, seek clarification and everything will become easier to manage.
However, if you still have too much anxiety, sadness and signs of depression, ask to be seen by a psychologist, the only way to take care of a baby in a healthy way is for the parents to be healthy too.