Premature birth – when babies arrive too soon

By Welma Lubbe – Author of Prematurity – Adjusting your dream.   www.littlesteps.co.za

 

A premature baby is born before 37 weeks of the pregnancy is completed.  In South Africa 12,4% of all babies – or one out of 10 – arrive early. Some arrive a little early, between 34 and 37 weeks and are known as late preterm babies, while others are born earlier and are known as preterm or even extremely preterm or micro-prem, when born below 1000 grams.

 

Who is at risk for premature labour?

Preterm labour and birth can be brought on by medical and lifestyle conditions. Medical conditions may include (but are not limited to) conditions such as maternal infection, low lying or ruptured placenta, premature rupture of membranes (waters breaking early), abdominal injury and foetal abnormalities. Pregnancy induced hypertension, resulting in pre-eclampsia and HELLP syndrome is a major cause for preterm birth. Multiple pregnancies also increase the risk for prematurity due to limited space in the womb, twin-to-twin transfusion in identical twins and intra-uterine growth retardation, which is also a risk for singleton pregnancies. A previous premature delivery and medical interventions, such as cervical cerclage or progesterone supplements may also cause premature birth. Other risk factors include previous preterm birth, miscarriage, multiple abortions, short period between pregnancies, obesity, diabetes and in vitro fertilization and the list goes on.

Your lifestyle may however also make you more prone to having an early arrival. Lifestyle factors include mothers holding high profile and stressful jobs or jobs that require long hours of standing. Late or no antenatal care, smoking, drugs and alcohol consumption during pregnancy and illegal drugs as well as a dangerous physical environment, such as exposure to lead paint, crowding and pollution are all contributing factors to the problem. Domestic violence, lack of social support and stress are all factors that increase the risk for preterm birth. And sometimes babies just arrive early for reasons not known.

 

Warning signs of preterm labour

When a little person plans to arrive early, her mom will experience the normal signs of labour, which include contractions every 10 minutes of more often, a change in vaginal discharge, such as water or bright red blood draining, pelvic pressure which may be described as a feeling that the baby will ‘fall out’.  Low, dull backache (which may be common in many pregnancies), period-like cramps and abdominal cramps with or without diarrhoea are also regarded as warning signs.  Seek medical help if you experience any of these symptoms.

 

Prevent preterm labour:  Mothers can lower the risk for premature delivery in some cases, but it cannot be prevented all together. There are a few precautions moms can take.

Control medical conditions

Problems such as high blood pressure and diabetes can be identified, monitored and controlled through antenatal care.

Healthy lifestyle

By not smoking, consuming alcohol or using drugs, risk factors are lowered. Dads should also stop smoking, since the nicotine inhaled through passive smoking is not good for the mom or her baby and has been shown to lead to intra-uterine growth restriction. Follow a healthy eating and exercise plan and relax! Stress hormones can cross the placenta and affect your unborn baby. A pregnancy massage may help you carry your baby full term, since it aids in decreasing stress hormone levels and this is a wonderful way in which dad can be involved in the pregnancy. Mothers who receive massage therapy during pregnancy feel less anxious after a massage session, and a foot massage has shown to lower the mother’s heart rate, blood pressure and respiration. Massage increases foetal activity and moderate exercise produces an increase in foetal heart rate and breathing, which is excellent for development of the foetus.

Prevent and treat infections

Vaginal and urinary infections can all cause premature labor. Have any symptoms of a vaginal and urinary infection checked out and treated, if necessary. In addition, women are more susceptible to gingivitis (gum infections) during pregnancy due to hormonal changes.  These infections can also cause preterm labour therefor regular dental cleanings can be very beneficial in preventing preterm labour.

Good hydration

When you become dehydrated the concentration of oxytocin can rise in your blood thus causing contractions, so remember to take lots of fluids, especially during the summer months.

Prenatal appointments

By keeping regular prenatal appointments, your doctor or midwife can help screen you for risk of preterm labour and treat it as early as possible if you do develop signs of premature labour.

 

Avoid oxytocin and prostaglandin

Oxytocin is the hormone that initiates contractions and is also released by means of breast or nipple stimulation, semen and having an orgasm. If you are at risk for preterm labour use a condom during sex or avoid it all together.

 

How to handle preterm labour

Be aware of the early signs of labour and make sure that you are able to monitor contractions and the movements of the baby at home. Contact your doctor immediately in case of an infection to prevent infection-related premature labour. Avoid high stress levels, such as work-related stress when pregnant, especially from the second trimester onwards. When receiving infertility treatment, request the implantation of only one embryo to decrease the risk of a multiple pregnancy, which often results in premature birth.

If you have five or more contractions in an hour, or the time between the beginning of one contraction and the beginning of the next is less than 15 minutes, stop what you are doing, empty your bladder, and drink some fluids and rest lying down on your left side for an hour.  Put a small pillow under your hip to support your back, if needed and feel for the uterus tightening. If this uterine activity persists while you are resting, then you may be in preterm labour and you should contact your healthcare provider.

 

Survival guide and challenges of preterm infants

The survival rate as well as expected complications decrease as the pregnancy (gestational) age at which the baby is born increase.

 

Completed weeks of gestation at birth (based on last menstrual period) Estimated chance of survival
21 weeks and less 0%
22 weeks 0-10%
23 weeks 10-40%
24 weeks 40-70%
25 weeks 50-80%
26 weeks 80-90%
27 weeks >90%
30 weeks >95%
34 weeks >98%

 

Preterm infants usually experience challenges that include continuing their normal development outside the supportive environment of the womb and with immature organs.  Stressors such as noise, bright lights, pain and disruption of sleep and rest, result in them not being able to reach physiological stability, such as a normal heart rate, breathing and temperature regulation.

They also experience behavioural problems, including difficulty with self-regulatory activities, sleep and calming.  Medical complications due primarily to the immature lungs and brain include: temperature instability, feeding difficulties, breathing problems (respiratory distress syndrome), tachypnoea, retinopathy, necrotising enterocolitis and jaundice. They are also at higher risk of longer hospitalisation and re-hospitalisation after discharge.

Preterm infants may or may not experience long-term challenges. The smaller the infant is at birth, the bigger the possible challenges and risks. Some developmental problems include mental and neurological problems such as problematic feeding (especially problematic for the mother), cerebral palsy, visual acuity and blindness, hearing and motor deficits, poor emotional regulation, emotional vulnerability and difficulties with self-regulation and self-esteem.

In the longer run, challenges may even include attention span difficulties and language delays which can lead to learning disabilities, lower IQ (which can be improved by doing skin-to-skin and breastmilk feedings), impaired executive function, attention deficit disorders, lower fatigue thresholds which may influence daily activities and lead to easy distraction, impulsiveness, concentration difficulties, spatial orientation disturbances and language comprehension and speech problems.

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