The Pre-Term Infant

 

Just as we so often take for granted our ability to conceive, until otherwise experienced - so do many mothers expect to sail through pregnancy, bringing a full-term healthy infant into existence, without even considering that they may become prey to early labour and have to cope with a small, often sickly underweight baby. And while many of us, in our last tiring weeks, wish for the day to arrive, so as to be freed of this heavy load, there are those mothers who under difficult circumstances earnestly pray that their pregnancies will hold out for just another few weeks, so that their unborn child will be given the advantage to be born healthy and go on to lead a normal care-free life.
Many parents are far from ready when baby makes an unexpected arrival, often a good few weeks before his anticipated due date, and looking nothing like what you expected. Parents in this position are overcome with worry over their baby's health, and live from day-to-day in the fear that their tiny miracle may at any moment be swept from their world. And what should be a joyous time spent bonding and loving your infant, now becomes a terrible time of sadness, as you watch helplessly from a distance.

Causes of Premature Delivery

Placenta praevia
Uterine abnormalities
Cervical incompetency
Maternal illness or infection
Age
Physical or emotional stress
 

Appearance

The parents of full-term newborn infants are often amazed at how small and fragile they are, so you can imagine the shock parents of premature babies have to face, especially when their baby's only weigh in at somewhere around a mere 1,700 grams. The baby's weight at birth all depends on how prematurely he was born, with some being a little larger and more developed, and others being so tiny that they are able to almost fit into the palm of an adult hand. The premature baby's skin may seem almost translucent, and will probably be covered in a fine layer of hair, commonly known as lanugo. Because he has not had sufficient time to be able to fully develop, his ears may take on a floppy appearance, due to the lack of cartilage being formed, and his sexual characteristics will not usually be fully developed. Muscular development will also be incomplete, so your baby's reflex abilities will also be absent, causing difficulty in feeding, through not being able to suck properly. These conditions are only temporary, and should be viewed optimistically, as difficult as it may be at the time. Once your baby reaches his so called 'due-date', he will resemble that of a newborn, and with plenty of love and guidance will continue to flourish.
 

The Special Care Unit

At first glance, special care units clad with tiny immature infants, all hooked up to special monitoring devices, can come as quite a shock to parents, especially if your baby happens to be one of the babies in care. An intensive care unit, caters for the needs of sick and pre-term infants alike, with each receiving the best in medical care. Those who are unable to feed themselves, are attached to appropriate nourishment giving devices, and their temperature monitored through placing them in incubators. As the baby gradually makes progress, she will be moved out of the incubator, but will still need the ultimate in care so will be left in the special care unit until the hospital staff feel she is ready to cope in the normal baby ward.

Feeding whilst in the Special Care Unit

The best thing you can offer your pre-term infant is 'mothers milk', so if possible this should be made readily available. At this early age, her digestive system is still very immature and she is prone to infection. Breast milk contains special ingredients, designed to protect against infection and allergy, and will boost her growth and development far better than bottled milk would.
Deciding whether or not to breastfeed, may be quite a sensitive area amongst parents of pre-term babies, especially when you are, for whatever reason unable to breastfeed, and are pressured into offering the best there is. For this reason, it is suggested that you at least try and offer her expressed breast milk, even if it is just for the first few days, before changing to formula milk. This way at least she will have gained some of the protection.

Pre-term babies are not always able to suck, so you may have to resort to expressing your milk, which will then be fed to your baby via a nasogastric tube. The tube will be left in position between feeds, and changed on a regular basis. The use of this tube enables the baby to receive enough nourishment without using any energy, this allows for the milk to be directed solely to her growth and development.

In the beginning, some mother's find that apart from the difficulties experienced when having to express milk, they do not actually produce sufficient for their babies feeds. In this instance, it may be suggested that a little formula milk be mixed with it to create the desired amount. This however, should not affect the way you feel, as it is important to remember that smaller babies do normally require more in the way of feeding than a full-term baby would. The main thing to remember is that, by perseverance you are offering your baby the best start to a wonderful life!

Coping with the demands of a Premature Baby and Family Life

If you happen to be discharged before your baby, you may find it quite difficult to schedule your life accordingly. Most of your time will be taken up by hospital visits, expressing milk and feeding, which will leave minimal time to spend with your partner and the rest of your family. This can weigh heavily on the new mother, who is feeling naturally low after the birth and distressed at the thought of having to be separated from her baby. These feelings if left untreated, can result in severe postnatal depression, with the mother viewing her baby as an object in a glass cage rather than the little person conceived out of marital love.

Partners will also feel immensely drained at the thought of having to share 'their' time, to care for a sick, underweight baby, especially when it is clear that there is little they can personally offer. This need not become too much of a problem, if you openly discuss your feelings right from the beginning, giving each other plenty of emotional support and involving your partner as much as possible.

In the case of there being other children, it may be very difficult not to neglect them, although this is definitely unintentional, they will probably have difficulty understanding why the new baby is gaining so much of your attention. Try to let them visit the baby in the hospital, and gently explain why it is that their new brother/sister has to remain in hospital care. Involving them right in the beginning is a very important step for family acceptance, which may otherwise create problems when the baby is discharged.

Making the change from Tube to Breast

After a given period, your baby will be allowed to be taken out of the incubator for a short time, and these first few cuddles may be particularly nerve-wracking for the mother, especially when the baby is so small and frail. Take time to get to know her by just holding her the first few times, then when you feel ready you may like to offer her your breast.

Patience and perseverance is definitely the key to success here, as these first feeds are likely to be very time consuming. Try not to expect too much, as she will need time to master the act of sucking, and will tire easily during the feed.
There is no reason why you should stop expressing your milk just yet, as this can be used for feeding when you are unavailable or just discarded. This will ensure that you maintain an adequate supply, especially seeing that your baby has yet to gain stronger sucking actions, and her stimulation alone may not be adequate enough to increase the milk supply.

Leaving the Hospital

Finally the long wait is over, and your little bundle of joy is ready to come home and join the rest of the family. This can be quite a frightening time, as you wonder how you are going to cope, especially after all the help you received from the nursing staff. To help you through this period it may be a good idea to ensure that your baby is feeding properly from both breasts without the need of additional milk or method. Some hospitals will allow the mother to spend the few days prior to the baby's discharge, in the ward, where she can become totally used to feeding and handling the baby herself.

At this stage your baby will still need to be fed more frequently than a full-term baby would, so it may be wise to continue expressing your milk, until a firm routine has been established.