Preemie Watch: Dealing with the Worry Amid the Joy

By Andrea Renskoff

"The way you had imagined it is now a loss," explains Kelly McCord, whose now 9-month-old son was delivered prematurely at just shy of 35 weeks and spent 13 days in the NICU (neonatal intensive care unit). McCord had no idea when she arrived at her obstetrician's office one Tuesday for a routine prenatal visit that she was already dilated three centimeters and would be sent directly to the hospital.

"I didn't have my bag packed or anything," McCord recalls. "Suddenly you're in the throes of caring for the baby when you thought you had more time to prepare."

McCord's birth experience is not unique.

The March of Dimes estimates that one in eight births in the United States are preterm, defined as delivered at less than 37 weeks' gestation. But the more stunning statistic is that the number of premature births has increased more than 30 percent in the past two decades. And although the vast majority of preterm babies go home healthy, there's very little in the way of scientific findings that explain the dramatic increase in early births. Expectant mothers using alcohol or drugs, or those who smoke, are certainly at higher risk, as are women who are victims of domestic violence. Women in occupations that require them to be on their feet for long periods of time are also more likely to go into early labor.

The exact causes of premature labor are not fully understood. Spontaneous rupture of the membranes from the sac inside the uterus that holds the baby, as well as infections involving the amniotic fluid or fetal membranes, seem to be the most common triggers. Women who've experienced previous preterm labor, such as McCord, are more susceptible, as are those who have uterine or cervical abnormalities or who are pregnant with multiple babies. And the modern world's epidemic, stress, is thought to be a factor.

"Worry, disappointment, fear, guilt are some of the emotions parents are likely to feel," says Dorothy Williams, who has been a hospital liaison with NICU parent support groups for the past 20 years. "There's also excitement, joy - and hope is very important," she adds.

There are a variety of medical options, as well as side effects and risks, to be considered with premature labor.

"I was given medication to delay the labor so that they could do an assessment of the baby's development to see if they should stop labor," says McCord. Sometimes an expectant mother will be sent home to take medication orally and be put on bed rest to delay delivery; other times, they are hospitalized. If it is decided that labor won't be suspended, an expectant mother may be transferred to a hospital with a NICU, which can monitor and treat conditions premature babies might encounter, such as respiratory distress, bleeding in the brain and intestinal and feeding problems. Many premature babies do not need such assistance, but it's safest to be at a hospital where advanced care for preemies is available.

The Role of NICUs

The NICU can be a scary and unfamiliar place. In worst-case scenarios, says Williams, "The newborn might need an incubator to keep body temperature up." She adds, "Or they might need help breathing with oxygen delivered in a nose tube or through a ventilator, feeding by tube through the nose or mouth, IVs for nutrition or medication, leads to monitors and lots of poking for blood sampling. It can be very upsetting to parents."

McCord's son did need help breathing and feeding. "You're in a little bit of shock, a little bit numb, just going through the motions," she says of the NICU experience. "You wish he wasn't going through all of this. That this is his first experience in life - all the tubes and getting pricked every day." McCord also pumped breast milk to be fed to her son intravenously. "It (pumping) was the one thing you felt like you had control of and could do for your baby."

As for navigating the NICU, Williams says, "Be sure to ask the staff all of the questions you want to ask and don't be afraid to ask them multiple times if you need to. Some parents want to know everything and some want to only know the bottom line."

Williams reminds parents to be part of the team. "Parents are the two people paying the most attention to the baby," she says. "Nurses change shifts, and doctors are on rotation. Don't be afraid to say, 'What I'm noticing today is different.' Share your observations with them."

"We tried to have someone there for every feeding and during shift changes," says McCord. "And we had a lot of support. They sent over a social worker to help us with our insurance coverage, a nutritionist, a lactation consultant, an occupational therapist. There was a parent support group that offered classes and coffees if you wanted to talk with other parents who were in a similar situation - or if you wanted to talk on the phone with parent alumni, a peer counseling type of thing."

Williams says many hospitals have support systems for NICU parents and there are also online resources and support. Above all, Williams urges, "Seek out and accept the support of others."

Premature Labor Alert
amily: Verdana; font-size: 12px;">1. Contractions every 10 minutes or more often

amily: Verdana; font-size: 12px;">2. Vaginal leaking of fluid or blood

amily: Verdana; font-size: 12px;">3. Pelvic pressure - feeling that baby is pushing down

4. Cramps

According to the March of Dimes, if you experience any of the above symptoms of early labor you should:

    span style="font-family: Verdana; font-size: 12px;">Call your doctor.
    span style="font-family: Verdana; font-size: 12px;">Rest on your left side.
    span style="font-family: Verdana; font-size: 12px;">Drink 2 to 3 glasses of water or juice.

Going Home

Preterm babies may need to stay in the hospital after the mother has been discharged. This separation period is often heart wrenching.

"I wanted to have my maternity stay at the hospital be as long as possible because at least you're just down the hall from the NICU," says McCord. "Once you get out, you're driving back and forth to the hospital, and I needed to find care for my other kids." She also remembers how hard it was to leave the hospital without her baby. "I cried in the car on the way home."

By the time most preemies are discharged, they are strong and stable, but occasionally they need to go home with oxygen or an apnea monitor to check breathing and heart rate. And underweight babies might need a special carseat. In light of the health issues, it's helpful to select a pediatrician who has experience with premature babies. And support groups are still available long after the hospital stay. Developmental follow-ups are also essential.

The March of Dimes reports that most babies catch up to their full-term peers within the first two years of birth. Staying abreast by attending required follow-up appointments also helps in monitoring for asthma as well as neurological or behavioral problems.

McCord is closely watching her son's development. "He's caught up with weight and growth, but other babies are ahead of him with reaching some milestones like smiling and rolling over and sitting up," reports McCord.

"Going home can be very exciting but very frightening," adds Williams. "It's a mixed blessing. You've had experts taking care of your baby, and now it is your responsibility."

Andrea Renskoff is a freelance writer and mother.

Resources: Books

    strong>The Early Birds, by Jenny Minton, Knopf, 2006. The author and mother of premature twins candidly shares her experiences, including her heart-felt agony of watching her sons spend 64 days in NICU.
    strong>Preemies: The Essential Guide for Parents of Premature Babies, by Dana Wechsler Linden, Emma Trenti Paroli and Mia Wechsler Doron, M.D., Pocket, 2000. A comprehensive guidebook written by two mothers of premature babies and a neonatologist.

  • The Premature Baby Book: Everything You Need to Know About Your Premature Baby from Birth to Age One, by William Sears, M.D., Robert Sears, M.D., James Sears, M.D., and Martha Sears, R.N., Sears Parenting Library, 2004. The noted pediatric experts' guide to the essentials of premature birth.

  • Parenting Your Premature Baby and Child: The Emotional Journey, by Deborah L. Davis, Ph.D., and Mara Tesler Stein, Psy.D., Fulcrum, 2004. Covers the emotional aspects of having a premature birth with testimonies from parents who have been through it.


  • The Alexis Foundation - 877-ALEXIS-0 (253-9470), - Provides assistance for both families and healthcare workers in caring for premature infants.

  • March of Dimes - 914-997-4488, - This international organization is dedicated to the health of babies. Offers resources on premature birth.

  • Parents of Premature Babies Inc. (Preemie-L) - - Offers resources as well as a support group for families to share experiences, questions and concerns.

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