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Preemie Parenthood: Preterm labour signs, milestones, and more

6 minutes

09/11/2020

Finding yourself in the neonatal intensive care unit (NICU) staring at your baby inside an incubator can feel like an out-of-body experience. Especially when your baby wasn’t supposed to be here for another few weeks, or even months.

Your baby is your special miracle. But it’s also completely normal for premature birth to feel anxious and disruptive, both emotionally and to your original pregnancy plan.

But every year, tens of thousands1 of preemie parents are thrown into a parenthood they never envisaged. If you’re sitting there right now, or you know someone who is, we hear you and we have some preemie wisdom and insights to share.

Learn more about premature birth, development, and how to spot preterm labour signs with our guide. Read personal stories from parents who’ve been there before. We can’t expect the unexpected, but we’re certainly not alone.

But every year, tens of thousands1 of preemie parents are thrown into a parenthood they never envisaged. An experience made even more challenging when combined with the uncertainty and restrictions of a global pandemic. If you’re sitting there right now, or you know someone who is, we’re sharing some wisdom and insights from those who’ve been there.

What is considered premature birth?

A premature birth is when a baby is born before 37 weeks of pregnancy.2 Typically, pregnancies will last up to 40 weeks, but babies may be born earlier or later for various reasons.

Almost 10 per cent of babies born in Australia are premature and are typically born between 32 and 36 weeks.3 We understand that having your baby earlier than you planned can feel distressing. But preemie babies born around this time often grow to be just fine without serious long-term problems.3

To make sure your baby is developing as expected, parents need to have regular check-ups with their doctor or nurse at the corrected ages of4:

  • Four months

  • Eight months

  • One year

  • 18 months

  • Two years

Corrected age is the age of your baby after accounting for how many weeks they were born prematurely.5 It’s a good idea to keep seeing your doctor until they turn at least four years old to see how they’re developing.

How premature can a baby be?

Very premature babies may be born between 23 and 24 weeks.3 Babies born this early can be known to survive, but they are usually at greater risk of health issues. Tiny preemies of this age, or babies weighing 2.5 kilograms or less, are likely to need breathing support.3

Usually, babies born before 32 weeks are cared for in a neonatal intensive care unit (NICU) until they get stronger and can be transferred to a special care nursery (SCN)3.

What are the different levels of prematurity in babies?

The World Health Organization groups premature (or preterm) babies into three gestational ages2:

  • Extremely preterm – Less than 28 weeks

  • Very preterm – 28 to less than 32 weeks

  • Moderate to late preterm – 32 to 37 weeks

What causes early labour?

Early labour can happen for many reasons, and sometimes there may be no clear reason at all. Many premature births can happen randomly, while others may be due to medical complications that call for early induction or a caesarean section.2

Other causes may also include2,3,6:

  • Diabetes

  • High blood pressure

  • Multiple pregnancies (such as twins or more)

  • Infections

  • Genetics

  • Cervix issues

  • Placenta issues

  • Early water breaking

  • Uterine abnormalities (unusually shaped womb)

  • Bleeding

  • History of premature labour

Sometimes, early labour is planned to save the life of the mother or baby. This could be due to serious complications such as pre-eclampsia, infection, or fetal growth restriction.

Risk factors

Risk factors for early labour can include things such as7:

  • Stress

  • Lack of nutrition

  • Substance use, such as smoking, alcohol, or other drug use

  • Weight (under or overweight)

  • Lack of early pregnancy care

While it’s difficult to say how you can avoid early labour, there are ways to help minimise extra risk by attending your regular antenatal appointments. Follow your doctor’s guidance surrounding eating well, avoiding substances, and maintaining good physical and mental health7.

Facts about early labour and premature babies in Australia

  • More than 26,0008 babies are born prematurely each year.

  • Babies whose mothers smoke throughout pregnancy are five per cent8 more likely to be born prematurely.

  • More than 60 per cent of twins and 100 per cent of triplets are born preterm, compared to seven per cent of singleton babies8.

What are the preterm labour signs?

Common signs of preterm labour include3:

  • Contractions

  • Waters breaking

  • A ‘show’ of mucus from the mother’s vagina

  • A change in vaginal discharge

  • Vaginal bleeding

  • A sudden decrease in the baby’s movements

  • Pressure pushing down on your pelvis from your baby

  • Cramping in the lower belly

  • Diarrhoea or vomiting

  • Consistent lower back pain

Whether it’s before or after 32 weeks if you’re feeling signs of premature labour, the sooner you see a medical professional the better. Sometimes they can delay or put a stop to preterm labour signs7, but this might not always be the best course of action.

If you find you’re experiencing swelling in your face, hands, or feet, or issues with your vision3, contact your doctor or midwife right away. It could be a sign of pre-eclampsia3, which can be known to trigger premature births.

How to make sense of becoming a preemie parent

If you find yourself next to a tiny baby who you weren’t expecting to meet for quite some time, you may feel like you’ve landed in an alternate universe. The fact is, the NICU is just that. And until you've experienced it, it’s hard to imagine what it’s like until you become a preemie parent yourself.

Your head will spin, you may be in shock (mum’s body almost certainly will be), and the fear is real. It will take time to come to terms with a situation that you weren’t emotionally or physically prepared for. You never dreamt you’d be caring for a premature baby, and you have every right to feel overwhelmed. The first hours, days, and weeks can be all-consuming and scary, so try to focus on just the minutes and hours ahead of you instead of looking too far ahead.

One mum told us: “In the first few days I asked every doctor and nurse who’d listen how long it’d be until we could take our baby home. But no one could answer me. It took me a few days to realise that every preemie is different, and I just had to take it one hour, or one day at a time.”

Premature baby milestones

26 weeks

A preemie baby at 26 weeks may fit in your hand. 9 The NICU doctor’s main concern will be to help them stay stable so they can sleep and grow stronger.

Even though they may open their eyes occasionally, your baby won’t be able to focus them yet. 9 They’ll be too small to breastfeed at this stage too. 9

Their skin will be very fragile and sensitive. Your medical practitioners will be to give you the best advice for premature baby skin care, which might include gentle comfort holds, rather than stroking them. 9

26 to 28 weeks

Beginning to grow eyebrows and eyelashes, at 26 to 28 weeks, preemie babies are known to start blinking. 9 However, they may still not be able to focus on things yet.

Preemies at this age are still too young to breastfeed, but they may start learning to suck. 9

28 to 30 weeks

Premature babies at 28 to 30 weeks might start moving and stretching more, which can help improve their muscle tone. 9 They won’t be quite as large and strong as they would in the womb, but at this age, they’ll start to be a little bit more responsive to your voice.

They also may start to settle into their sleep routine 9 but keep in mind that their skin is still sensitive, so gentle, still hands only if you’re having a sleepy cuddle.

30 to 33 weeks

At 30 to 32 weeks, preemie babies’ organs are stronger and more developed. If your baby is born at this stage, they may not need as much medical support. But keep in mind that every baby is different.

Now, they might be able to bend their arms and legs by themselves, respond to your voice, and show interest in breastfeeding.

33 to 36 weeks

Premature babies at 33 to 36 weeks are approaching the time they were originally due. However, even as they reach what would have been full term, they may still be a little bit behind.9

Preemie babies at this age can move more smoothly, and they’ll be able to let you know what they need a little better9. You should be able to work out when they’re sleeping, drowsy, alert, or fussy much easier.

At this stage, you can spend more time socialising with them, but now they’ll be able to close their eyes or turn away when they’ve had enough social time. 9 They’ll still be sensitive to handling, but gently talking to them about what you’re doing can help them start to relax.

37 weeks and more

Home time can vary for premature babies at 37 weeks. It can depend on how they’re doing, especially if they’ve had surgery or an illness.9

Your medical practitioners will have development goals for them to meet before they’re ready to be taken home. Steady weight gain, exclusive breast or bottle feeding, and stable breathing are just a few things they might look for. 9

Do I need to treat my preemie baby differently to a typical baby?

Every baby is unique, and the same goes for premature babies. Your medical practitioners will be able to advise what you need to do to care for your little one, regardless of how many weeks early they were born. Usually, though, premature babies will need extra nourishment to help them catch up in growth.10 So, your doctors may give you a personalised feeding plan to help provide those extra calories.

When you’re caring for a preemie baby, it’s best not to compare with typical baby milestones. Your baby is running their own special race and may need some time to adjust. That’s why it’s so important to keep up with your preemie medical check-ups, so your doctor can keep tabs on their progress and wellbeing.

Do premature babies have problems later in life?

It’s hard to predict how your preemie baby will develop later in life. Some premature babies may struggle with health conditions early on, while other issues may appear later. Late preterm babies usually have a lower risk of medical and developmental complications than extremely preterm babies.11 However, many preterm babies also develop completely ‘normally’.3,11

Premature development can vary, but some children may experience issues3 such as:

  • Language delays

  • Growth and movement problems

  • Vision or hearing impairments

  • Learning disabilities

  • Social and emotional problems

There’s no denying that navigating preemie parenthood can be complicated. It’s normal to worry about how they’ll cope when they grow up. The most important thing is caring for their needs as they progress and nurturing their development – whatever that may look like.

If you’re at all worried about your baby’s development, reach out to your doctor or nurse for support.

Parents with premature children in Australia are entitled to free visits to a child and family health nurse to keep an eye on how they’re doing.4 You’ll have check-ups at all key stages of development until they head for school, so there are various opportunities to touch base with an expert.

Letting go of the journey you’d imagined

Julie’s twins were born at 23+6 weeks, “It was a surreal experience. I was initially a little naive about NICU, thinking that they’ll be fine and will be discharged when they reach their due date. Of course, as the days went on, I knew our journey as parents would be so, so different.”

Premature babies might need to stay in hospital for weeks or even months. Part of the NICU experience is learning to let go – your baby is fighting a brave fight with an incredible team around them, but so much is out of your control.

It’s normal to grieve for the birth and beginning you thought you were going to have, Julie shared, “I learnt to accept and let go of the picture of what I thought life would be like.”

Riding the preemie parent rollercoaster

Every minute of every day in the NICU is an emotional ride you never wanted to be on. Your premature baby is unique and will follow their own development path. Comparing them to the other preemies around you is only natural, but it’s a shortcut to heartbreak.

One mum told us “Things can change in a moment – they might have had a difficult night then by the morning things are looking positive again. You can go through every emotion in the space of a day: fear, guilt, jealousy, anger, pride, happiness. It’s exhausting, but all totally normal.”

Befriending the other NICU parents around you can be a great support. You’re going through the same thing – they get it. That sense of shared experience is vital, as it means you have someone to listen to when things get tough, and to celebrate with when you have moments of joy.

While not being by your baby’s incubator is hard, allowing yourself to leave the NICU and take short breaks is essential. Clear your mind, get some fresh air, or hear the voice of a friend. Yes, it’s tough to see the world carrying on while yours is upside down, but a little space can help you re-centre and come back re-energised – your baby needs you at full strength.

Celebrating every premature baby milestone

Premature baby development is unpredictable. Every little step your baby makes is amazing progress and a huge victory in their journey to home. It’s important to find joy in and celebrate them.

The day their feeding tube is removed, the day they come off oxygen, the day they are ‘promoted’ to special care baby unit (SCBU) and you get one step closer to bringing the car seat in. Celebrate those inchstones, rather than milestones.

Julie remembers, “When Jack was about five months old, I came in one morning and called his name, he instantly smiled as he knew it was his mummy and that it was his name. It was such a special moment.”

It takes a village

It takes a village to raise a child, so imagine the support you need as a preemie parent. Not just during their NICU stay, but well beyond as you rebuild and recuperate from your experience.

Although well-meaning requests for updates from friends and family can feel annoying, always take up offers of help. Or better still, ask.

They will be desperate to support you through this difficult time in whatever way they can, but they won’t know what you need. Ask them to make you some home-cooked meals to heat up when you get home from a day at the hospital.

If you have other children, let your family take them out to have some fun at this difficult time. And if they offer to come and meet you for a coffee, take them up on it.

Recognising your resilience

Preemie parenthood is relentlessly tough. But caring for a premature baby teaches you so much, and you discover reserves of strength and resilience you never dreamt you had.

This will be your parenting super-power which you’ll use endlessly on the rest of your parenting journey.

How WaterWipes is supporting preemie parents

We’re working with Bliss – a leading charity for premature or sick babies. To support preemie parents, WaterWipes and Bliss have launched the About Neonatal Care guide. Designed to inform and support parents during this challenging experience, the guide answers many of the questions you might have if you find yourself in the NICU. Read more about how WaterWipes is supporting and raising awareness of World Prematurity Day, and supporting preemie parents.

For more information on your journey with your newborn be sure to check out our other articles on the Parenting Community:

FAQS

What does prematurity mean?

Prematurity means your baby was born preterm, which is before 37 weeks of pregnancy2. More than nine out of ten premature babies survive early birth, and most grow up to develop normally3 with care and support.

When is a premature baby out of danger?

Every preemie baby is born differently. Some may have more health complications than others, regardless of how many weeks early they were born. Once a premature baby no longer needs the high level of attention of the NICU, they might be moved to a special care nursery.12

Do premature babies sleep more?

Premature babies have a bit of catching up to do, so you’ll often find that preemie babies sleep a lot more than full-term babies.13 Getting lots of good sleep is a key part of their growth and development. However, sleep periods may be shorter.

Do premature babies teethe later?

Some premature babies may teethe later than full-term babies by a few months9, although their teeth will arrive in the usual order. They may also have issues with tooth enamel, so make sure to brush their teeth regularly when they come through to avoid cavities. 9

Do premature babies struggle at school?

Many premature babies grow up with typical thinking and learning development and do just fine at school. Other preterm babies may develop learning disabilities9, which may include struggling with their attention span or reading comprehension. How your child copes with school can vary based on their individual needs and the support they receive.

References

  1. https://www.tommys.org/our-organisation/why-we-exist/premature-birth-statistics

  2. https://www.who.int/news-room/fact-sheets/detail/preterm-birth

  3. https://www.pregnancybirthbaby.org.au/premature-baby

  4. https://www.pregnancybirthbaby.org.au/growth-and-development-for-premature-babies

  5. https://www.pregnancybirthbaby.org.au/corrected-gestational-age-for-premature-babies

  6. https://www.tommys.org/pregnancy-information/premature-birth/causes-of-premature-birth

  7. https://raisingchildren.net.au/pregnancy/premature-birth/premature-labour-birth/premature-birth

  8. https://www.pretermalliance.com.au/About-Preterm-Birth/Preterm-Facts-and-Figures

  9. https://raisingchildren.net.au/newborns/premature-babies-sick-babies/development/premature-baby-26-36-weeks

  10. https://kidshealth.org/en/parents/preemie-care.html

  11. https://raisingchildren.net.au/newborns/premature-babies-sick-babies/development/premature-development-concerns.

  12. https://www.pregnancybirthbaby.org.au/neonatal-intensive-care-unit

  13. https://www.miraclebabies.org.au/content/sleeping/gjnng8

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