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Past Article of the Month
Originally Published 09/09/2012
When Babies Come Too Soon: The Crisis of Premature Birth
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But we're not ready! This can't be happening.
Your pregnancy may have been going smoothly and you may have been enjoying the experience thoroughly. And then maybe you feel a little cramping. Or the doctor tells you that you have an irritable uterus, or that you have already started effacing. Maybe you're pregnant with multiples. Maybe you have been on bed rest with labor-stopping medications. Maybe you have developed a life-threatening medical condition and the baby must be delivered to save you. Or maybe suddenly your water breaks and you are in full labor. Whatever the scenario, giving birth prematurely is rarely, if ever, part of how we expect our path to parenthood to unfold, rarely part of our reproductive story, and it is often a significant reproductive trauma.
According to data from the Center for Disease Control and the March of Dimes, premature birth, defined as delivery prior to 37 weeks gestation for singletons, occurs in approximately 12.3% of pregnancies in the US. Of these, more than 70%, considered late preterm,occur between 34-37 weeks. 12 % of preemies are born at 32-33 weeks, 10% at 28-31 weeks and 6% at less than 28 weeks. Overall, less than 1% of all babies born in US each year are born at less than 28 weeks.
There are many possible causes for prematurity, but in 50% of cases, no known reason can be found; it just happens. Risk factors include
 previous preterm birth, especially if pregnancies are close together
 carrying multiples
 uterine or cervical problems
 certain chronic health conditions in mother (prior to conception) including high blood pressure and diabetes
 preeclampsia
 cigarette smoking, alcohol use, age (younger than 18 and older than 30)
 poor nutrition (including extremely low BMI)
 untreated infections.
If you have any of the following signs and symptoms of preterm labor you should call your doctor immediately:
 more than 6/contractions/hour
 change in vaginal discharge, including either clear, watery liquid, or blood,
 cramping
 backache
 extreme pelvic pressure
 pain during urination (possible bladder or kidney infection).
There are a number of interventions that can stop or delay preterm labor. These include:
 staying hydrated
 bed rest
 medications such as magnesium sulfate, brethine or terbutaline)
 antibiotics to treat suspected infection
 when premature birth is inevitable, patients are often given steroids, which hastens lung development in the baby
Medical technology has advanced enormously in the last 20 years, and the age of survival of premature babies has dropped to as low as 24 weeks gestation. Most babies, especially late preterm, do well and emerge from their prematurity unscathed; the earlier the birth, the more likely there are to be lasting neurological and medical complications. For babies born extremely early, the outcome is often unpredictable, and parents may not know the extent of the effects until the child is older. While there are many factors that affect survival, 80% of babies born after 26 weeks survive, at 28-31 weeks, there is a 96% survival rate, and at 32-33 weeks, 98% of babies survive.
But facts and figures, while at times useful, do not really address the emotional trauma of preterm births. Regardless of how early your labor begins, giving birth even a little prematurely can be terrifying, especially if there is no warning. You feel helpless, out of control, every nerve in your body desperate to keep that baby inside, and yet the baby is coming anyway. Your own health may be in danger and the baby's health is uncertain. This baby whom you have longed for, perhaps have had to go to great lengths to create, is coming too soon.
A premature birth is often radically different from how we expected our birth experience to go. Rather than a beautiful moment when the doctor hands you your baby to put to your breast, the birth may be an emergency, the baby whisked away immediately to be cared for by people you don't know, in a place you've never imagined. A neonatal intensive care unit (NICU) is an unreal place, and even a day or two in such a setting can be traumatic. If your baby must stay in the NICU for a period of time, the experience of going home without your baby is very difficult. While the NICU environment has been improved in recent years in many hospitals, often it is a brightly lit, noisy room, with nurses and doctors and therapists working constantly, alarms going off, monitors beeping. Differences between day and night don't exist, the light and the air remaining the same 24 hours a day. It is a place that sometimes holds great sorrow, as parents and professionals grieve the loss of a little person born too early to survive. It is also a place of great joy, where miracles occur and amazing babies beat the odds and thrive. Sometimes it is both, if twins have been born, and one survives and the other does notand you feel both joy in the living and grief for the loss at the same time.
Giving birth prematurely can trigger a huge blow to self-esteem. You might wonder what is wrong with you that you can't carry the pregnancy to term when it seems that everyone else in the world can do so. You may have thought of your womb as a safe haven, a place of love and protection of this child you cherish, and you feel as if you have failed.
Seeing the baby can add to this trauma to your self-esteem. Prior to birth, you imagine your baby as beautiful, perfect, the best part of yourself. But babies born very prematurely can be very upsetting to see. They are tiny, their skin translucent, nothing like the baby we expected. They are attached to machines that keep them alive and sometimes we can't even touch them, to say nothing of hold and nurture them.
Babies in the NICU may feel as if they don't belong to us. And to an extent, that is true. For when they depart our bodies too soon, they must, if they are to survive, belong to the medical professionals who care for them, who save them. And that hurts sometimes. We want to be the ones to hold them the first time, to feed them the first time, to interact with them when they are awake, and that isn't always possible. Sometimes we feel jealous or angry with the nurses who get to do what we so desperately want.
Being angry with the medical staff creates another dilemma, for how can we express displeasure with those upon whom we depend? We worry that if we complain, or speak up, that our baby's care will be compromised, even if we know better. We worry that if we don't do everything perfectly, that we ourselves might accidentally hurt the baby.
When we give birth prematurely, we may be faced with thoughts and feelings that horrify us. A very premature baby is on a medical roller coaster, whereby s/he can be fine at 2:00 and battling a life-threatening infection at 4:00. As we ride the roller coaster with them, and face the fear that this time they might die, we get exhausted and scared and angry. We might even wish that they would go ahead and die already, to spare us the agony of waiting and wondering. And then we feel ashamed, and guilty and as if something must be terribly wrong with us for thinking such thoughts.
But these kinds of thoughts and feelings are completely normal. How can we not wish for an end to misery? How can we not feel hurt and angry at someone who is frightening us, even when we know that it is not their fault? It is natural to get angry with people who worry us, babies and doctors included.
When the baby is discharged from the hospital, which often feels sudden despite days or weeks of waiting for it, we may continue to worry. There may be special care that is needed, such as heart monitors or feeding aids, and multiple medical appointments. But even if the baby is healthy, we may feel extra anxious and protective, a natural response to a traumatic experience. We may also be grieving. If the baby is healthy, this may be confusing, not only for us, but for people who care about us. But as with every reproductive trauma, premature birth inflicts multiple layers of loss. These include:
 loss of the pregnancy itself, which is over before we are ready
 loss of our fantasy that our baby is perfect, and in fact may be quite ill
 loss of self-esteem when we cannot do what others can
 loss of control
 loss of feeling healthy and normal
 loss of some of the experiences of preparing to become parents that are fun and validatingbaby showers, getting the room ready, choosing names, dreaming of what life will be like.
Most fundamentally, premature birth causes the loss of our reproductive story. These losses must be grieved even as we learn to care for and love this baby that came too soon.
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