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PrematurityPrematurity

There are many reasons why babies are born early but, given time, most will grow fit and strong and suffer no ill-effects. Sometimes, however, premature babies need extra special care to help them on the road to recovery

Five to eight babies in every hundred are born before the 37th week of pregnancy -- they are premature. Twins, which occur once in every 100 pregnancies, increase the risk of prematurity by three to four times.

COMPLICATIONS

You may know beforehand if your baby is likely to be born early because of problems with your pregnancy or because of a pre-existing medical condition. However, many premature births are quite unexpected.

There are several reasons why you might go into labour early. The neck of the womb, or cervix, may be too weak to support the weight of the uterus, or womb, in later pregnancy -- a condition known as cervical incompetence. Sometimes an excess of amniotic fluid -- the fluid that surrounds the baby in the womb -- triggers a premature birth.

SEVERAL CAUSES
Vaginal infection is now being pinpointed as the cause of some premature births which were previously a mystery. Existing medical conditions, such as high blood pressure, diabetes or kidney disease are also thought to be contributing factors.

Complications of pregnancy, such as pre-eclampsia (raised blood pressure brought on by the placenta failing to function properly) or bleeding caused by the placenta separating from the wall of the uterus (abruptio placenta or placenta praevia), are also factors. There may be problems with blood compatibility, for example if you are rhesus negative and your baby is rhesus positive.

Another reason may be that the baby is failing to grow properly in the uterus, or if your waters break suddenly. However, in half of all premature births, doctors don't really know the cause.

PREMATURE LABOUR
If you do go into premature labour, you'll be admitted to hospital and kept in bed. A monitor will be set up to record the length and strength of contractions and your blood pressure and pulse will be checked at regular intervals.

If contractions are strong and the pregnancy has lasted fewer than 34 weeks, you may be given drugs to slow down or stop your labour, to try and give your baby a little more time in the uterus. However, they don't always work. If your waters have broken, or if the cervix has opened more than four centimetres (10cm is fully open), then the birth will almost inevitably proceed.

The labour itself is very similar to a full-term labour. However, the doctors will want to keep an extra vigilant eye on you and your baby. The labour will be supervised by a senior doctor and a paediatrician will be present for the baby's birth, so that he can have instant attention. You will be encouraged not to have the pain-killing drug pethidine within three or four hours of delivery as it can depress the baby's breathing, which is often a problem anyway with premature babies. An epidural or gas and air may be preferable alternatives.

THE BIRTH ITSELF
A gentle birth is vital, so that undue pressure is not put on the baby's immature skull. This may mean that you have to have a forceps delivery or, if your baby is very small, a caesarean section.

Even if you are allowed a normal vaginal delivery, you will almost certainly have an episiotomy (a cut to open the birth outlet) to minimize the length of time it takes for the baby to be born.

The paediatrician will resuscitate your baby if necessary, and you may have the chance to see and hold him before he is taken to the Special Care Baby Unit (SCBU).

If your baby is born during the last six weeks of pregnancy -- as most are -- the chances are he won't have any very serious problems.

Premature babies generally fall into three main groups. There are those who need the minimum of care and who may be nursed on the post-natal ward or in a special 'transitional care' ward -- a staging house between the SCBU and the normal post-natal ward. These may include babies who needed help to start breathing, those with jaundice (yellowing of the skin), babies who were born by forceps and some otherwise healthy babies who have to be tube fed.

TINY BABIES

Babies who need a slightly higher, more specialized level of care include those who were born before 32 weeks gestation, or those who weighed less than 2kg (4 1/2lbs) at birth or those who have continued to have particular problems with breathing, temperature control, heart rate, blood gases and so on. Such babies will be admitted to the SCBU, where they can be kept warm in an incubator and can have the extra care they need to grow healthy and strong.

The third category of babies are those who are very seriously ill or who need the help of a ventilator to enable them to breathe. If your baby falls into this category, he will generally be nursed in a Neonatal Intensive Care Unit (NICU).

TOO WEAK

Premature babies have three main problems. Their lungs are not fully developed, which leads to breathing difficulties; they have little body fat, which makes it difficult for them to control their own temperature and, if born before 35 weeks, they have weak sucking and swallowing reflexes, which make feeding from a breast or bottle impossible.

The equipment in the SCBU or NICU looks frightening, but it is designed to help your baby overcome these problems. For example, he is nursed in an incubator, which keeps him warm and reduces the amount of sweat evaporation from his skin surface.

He may also need an artificial ventilator to take over his breathing. Pads on his chest will trigger an alarm if his breathing becomes laboured. Even when he can breathe alone, he will be nursed on a special mattress which sets off an alarm if his breathing stops. He will be fed intravenously or by a tube passed through his nose and into his stomach until he is strong enough to suck.

JAUNDICE
Premature babies are also susceptible to jaundice because their immature livers can't process bilirubin -- the yellow pigment produced when blood cells break down -- so he may be nursed under a special light that helps clear bilirubin from his system.

At the same time, all his bodily functions such as heart rate, blood pressure, the level of oxygen in his blood and so on, will be carefully monitored by means of tiny electrodes placed in his body.

These days, thanks to modern technology, babies who would previously have died or been handicapped stand an excellent chance not only of surviving but growing up to be fit and strong.

Certainly, if your baby has spent more than 30 weeks in the womb, his chances of survival are very high. If he was born before 30 weeks gestation, he still has a good chance, though he will need a high level of nursing care, but today some babies as young as 23 or 24 weeks manage to pull through, even though it's a long slow haul.

EARLY DAYS
A very early baby needs a high level of nursing, but you can still be involved in his day-to-day care. If he is very tiny or sick, you may not be able to hold him but you can still talk to him and touch him through the holes in his incubator.

As he gets stronger, you'll be encouraged to hold him, change his nappies and perhaps tube feed him. You may also like to bottle-feed your baby with your own breast milk until he is strong enough to suck from the breast.

As your baby gets stronger and healthier, he will be taken off his life support and then transferred to 'transitional care' where you will be taught about any special needs he may have -- for example, you'll need to feed him more often than you would feed a full-term baby.

A special liaison midwife, or health visitor from the SCBU, may be able to help you in the first few weeks of having your new baby at home. He may be more prone to coughs and colds in his first year and his developmental milestones will be when they would be if he had been born full-term.

Some premature babies tend to be more easily distracted and have poorer manipulation skills than babies who were born full-term, so don't overload him with too many stimuli. He will have regular checks throughout his early years to make sure there aren't any after-effects of his prematurity. But, given time, and plenty of tender, loving care, your baby should make a complete recovery from his shaky start in life.

     
     

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