Episode 1: Premature babies
Issues of concern
Mandy, John and Amelia
For the full term baby you expected
Parents would not have attended a child birth or early parenting course, so are experiencing a very traumatic experience in their lives with no training or support.
That the baby will deteriorate.
That if the baby recovers they may not recover normally.
About your ability to cope.
Why was I unable to carry my baby to term?
Did I do too much?
Was I eating properly?
Problems / issues associated with Premature babies:
Issues of lungs - Chronic Lung Disease:
Babies who need to be ventilated for long periods of time may get chronic lung disease depending on the level of ventilation or oxygen they need or if they develop an infection.
If a baby has CLD their lungs are stiffer and they have to work harder to get air into their lungs. They may also become more tired during feeds. Babies with chronic lung disease may need additional oxygen support for a while after they go home. Babies with chronic lung disease cannot go outdoors between October and March, which is very restrictive on parents.
Issue of eyesight - ROP:
Retinopathy of Premature Baby is a disorder of the retina of the eye which effects babies born less than 32 weeks.
Eyes checked routinely by an ophthalmologist usually resolves of its own accord and if it does not laser treatment can be done.
Issue of sleeping - Sleeping on Tummy:
Premature babies are nursed maybe for 16 plus weeks. When they go home the safest way to sleep your baby is on its back wit feet at the bottom of the cot, this can be really difficult and worrying for the parents if the baby wont settle to sleep on its back.
Supervise the baby as she goes to sleep on her tummy and then gently turn her on her back - won't always work - use a monitor to alert you if the baby pauses in its breathing.
Issue of Feeding - Cluster feeding
Premature babies tire easily during feeds and feed very slowly. It is important that the baby gets the required amount for its weight in the 24 hours, so you may have to feed smaller amounts frequently. That is what is referred to cluster feeding
Dangers associated with prem babies:
A pre-term baby takes pauses in their breathing and occasionally their breathing may stop. In this case the apnoea montior alarm goes off.
When a tear develops in the lining of the lung air leaks into the chest and the lungs can't expand properly.
Bradycardia - the heart beats slowly and this can scare parents - alarm goes off.
Premature babies ability to make blood is limited, may need blood transfusions.
A yellow discolourisation of the skin and eyes occurs because the liver is immature - treated under fluorescent lights called phototherapy. The baby is nursed without clothing and wearing eye pads. Parents find blindfold distressing as it inhibits contact with the baby.
For very ill babies
A high dependency area for babies who have come through an ICU 1.
Step up nursery
Step up nursery is a quieter area for growing babies who are preparing for home. In this nursery mum and dad can do nappy changing, feeding, cuddling and bathing.
Parents of premature babies are understandably very anxious. On entering ICU you see a lot of equipment - incubators, monitors, ventilators, drips, phototherapy units all designed to keep your baby warm, breathing and monitor heart rates. You get upset because your baby is small, fragile, wrinkled, red in colour and attached to a load of tubes and wires.
How to cope:
The special care baby unit becomes your home for the foreseeable future. The unit may seem impersonal but behind all the technology is a team of experts specialising in caring for premature babies and helping mum and dad. Your baby is treated like a baby still in the womb. You own your feelings and you can't block out your sad feelings. They are real and must be acknowledged.
- Talk with the ICU staff
- Visit your baby often
- Take pictures of your baby
- Touch your baby
- Keep a diary everyday
- Eat properly and rest between visits
- You're not available for any other duties like house work, shopping etc. Ask friends to help
- Get family to drive you and collect you from the hospital - traffic, parking, clamping all add to your distress
- Family and friends are shocked when a baby is born prematurely - they don't know what to say, and you don't have the same excitement and celebration as parents with a term baby.
- When the baby moves to the step up nursery you may bring in personal clothing, this will involve you in your babies care and help you to stop treating your baby as a sick baby.
- Hand washing is an effective way of preventing infection and safeguarding your baby.
Getting back to work:
With a premature baby spending maybe four months in ICU, all of your official maternity leave is gone. You can't put your baby with CLD into a crèche as the baby has to be indoors from October to March, is on antibiotics and may be on oxygen at home. The joy of having your baby home and getting well is undermined by the fact that your income has stopped but mortgage and all the other bills based on two salaries coming in up to now cannot be met. In the case of premature babies a mums paid maternity leave should be increased and this is something that should be lobbied for at government level. An option is to apply for your paternity leave in bulk in order to stay at home for one year. But this is unpaid leave.
Having a baby changes your life, lots of studies can show you that the birth of a baby can put enormous strain on a relationship and the birth of a premature baby even more. Overnight you become somebody's mum and dad and are completely responsible for that little persons welfare, with all the trials and tribulations, joys and triumphs that go with it. Most parents get nine months to adjust to the idea and to prepare for the changes parenthood will bring, in the case of a premature baby it happens instantly with no preparation and poses quite a challenge to a relationship. Your relationship with your partner will alter as your roll changes and the demands of your baby puts new demands on you. Equally the delights of your baby and each mildstone she reaches may bring you closer together in a new way. If you ignore your relationship - you are like a house plant that never gets water. If you don't spend time together your relationship will slip into autopilot.
Time Poverty Many couples complain of time poverty. Mums of premature babies find it a little harder than dads. They wake up and find there are no little cots and yet there is no baby in the cot next to them. So my advice would be to be gentle with one another, words can either depress or uplift so be careful in the use of them. Hug one another loads, it doesn't cost anything and can be very reassuring. Realise that complete freedom from stress is death so you have to learn to manage it by;
- Lighten up and lower yours standards
- Don't feel you have to live up to others expectations
- Prioritise - try saying no
- Give up trying to have your old life back - it's over
- Realise that no matter how tough things are now, how little sleep or sex you're getting, it will pass
- Work it off- physical exercise such as jogging
- Compliment one another, people can live for months on a good compliment
- Be flexible, much better to bend than snap
- Keep your sense of humour, perfection is only found in the dictionary.
Nannies Versus Creche
A crèche is not suitable for a premature baby up to one year. Nanny is an option but expensive.
How long will it take a premature baby to catch up?
It varies from baby to baby but usually when the baby is two years old based on corrected age which is when the baby reached two based on when the baby was due to be born, i.e. forty weeks.