Q1: Why has my baby arrived early?
The following are some of the more common causes of preterm birth:
Uterine abnormalities
Cervical incompetence
A previous preterm birth
Pre-eclampsia
Infection
Smoking
Underweight or overweight
Diabetes and gestational diabetes
Placenta abnormalities
Vaginal bleeding
Multiple births
Conceiving through in vitro fertilisation
Short time between pregnancies
However, sometimes, no specific cause can be identified.
Q2: How can I parent in the NICU?
Preterm birth flips the paradigm of parenthood on its axis. It robs families of their hopes, dreams and expectations. Parents often find themselves as passive bystanders watching others do what they had planned in terms of caring for their child in the NICU.
Most modern NICUs deliver care within a family-centred and developmentally supportive care framework. This type of care recognises the parents as the primary caregivers supported by the medical team. The family has 24-hour unrestricted access to their baby, participates in ward rounds, is a co-decision maker about all aspects of the care provided and is supported in their parenting role from day 1 in the NICU.
Kangaroo care (KC), - often referred to as skin-to-skin contact between a mother, father, carer and the newborn infant - frequent and exclusive breastfeeding and early discharge from the hospital have been effective in reducing the risk of mortality among preterm and low birthweight babies. Kangaroo Care reduces the risk of hypothermia, severe illness and nosocomial infection, it also reduces the length of hospital stay and improves growth, breastfeeding, and maternal-infant attachment. Tell your baby’s medical team that you wish to do Kangaroo Care with your baby and they will facilitate the transfer of your baby from the incubator to your chest. They will closely monitor your baby’s vital signs before, during and after the transfer. The minimum time that you should do Kangaroo Care with your baby is 60 minutes because frequent handling may be stressful for your baby and 60 minutes allows your baby to go through a complete sleep cycle (Touching and holding your premature baby.
If your baby’s medical condition is not stable enough to permit Kangaroo Care, ask the medical team to teach you how to do containment holding, which involves a parent placing your hands firmly on the baby’s head and under the feet and holding them still. A positive touch from a parent provides comfort and stability for your baby.
Your baby recognises your voice and parents are encouraged to read to their babies. Reading calms your baby, reduces stress, and promotes bonding and brain development.
Q3: What can I do to support my baby’s development?
At 33/34 weeks of gestation, only 53% of the brain’s cortical volume is present. Much of a preterm baby’s development takes place outside of the protective environment of the womb.
Babies in the NICU are exposed to many external stimuli that their immature neurological, sensory and motor systems are not capable of processing.
To protect your baby's development, it is crucial that all care is delivered through the lens of brain care.
Babies developing motor systems need to be protected by caring for them in nests in their incubators. The nests provide boundaries that enable babies to exercise their developing motor system and contain flailing limbs.
Incubators should be covered with incubator covers to protect the babies from bright lights. Sound in the NICU should also be carefully monitored, as sound above 45 decibels can negatively impact your baby’s development.
Preterm babies undergo many painful procedures during their time in the NICU. Pain not only drains your baby's energy but can also adversely impact the developing brain. Ask your baby's medical team if they have a pain management protocol and ascertain if there are areas where you can participate to reduce the pain your baby experiences. The following are ways that you can support your baby during procedures:
Skin-to-skin contact
Offering breast milk
Offering glucose
Comforting your baby after a procedure
Babies communicate with gestures, physiological signs and behaviours and these cues will help you understand and meet your baby’s needs. It's important that you are supported by your baby's medical team to learn your baby’s language and interpret your baby's cues to help you respond appropriately.
Your baby's development does not stop at the point of discharge and there are several developmental interventions that you can do in the home setting to support your baby's physical, neurological, motor, and sensory development. For example, tummy time, play activities, painting, messy time and sound games.
Prior to discharge discuss your baby’s specific developmental needs with the medical team and develop a home intervention programme that will support your baby's development.
Now that you have learned more about how you can support your premature baby and help them to thrive in the NICU, it’s time to turn your attention to preparing yourself for a NICU stay, self-care and family involvement.