Premature: What to expect and what to do if your baby is born too early?
A normal pregnancy lasts an average of 40 weeks. But if your baby is born before the 37th week, this is called a preterm birth. This is also known as being premature. The consequences of a preterm birth depend on several factors. For example, you can imagine that a baby born at 26 weeks generally needs more care and support than a baby born at 36 weeks. Read on to learn more about prematurely born babies and what you as a parent can do to optimally support your baby if they are unexpectedly born too early.
When is a baby premature?
If your baby is born before the 37th week of pregnancy, they are considered a premature baby. A preemie. When the birth occurs between 24 and 26 weeks, the care that will be initiated is discussed in consultation with the parents. From 26 weeks, a specially trained doctor will do everything possible to optimally support and guide a baby in the Neonatal Intensive Care Unit (NICU). Children born before 32 weeks are always admitted to the NICU. For children who arrive after 32 weeks but before 36 weeks, customized care will always be provided. This can be in the NICU, the neonatal ward, or the pediatric ward.
Physical development
A prematurely born baby was actually not yet ready for arrival. You could say that your baby was not yet mature enough to be born. Naturally, there is a difference between a baby born at 26 weeks and one born at 36 weeks. In terms of weight and length, of course, but especially in the development of the organs. Every prematurely born baby is different, but below you can read more about common problems.
Lungs
The lungs of a prematurely born baby are often not yet sufficiently mature. The lungs cannot yet expand adequately and are also not yet able to absorb enough oxygen. Breathing is often shallow and rapid. Many prematurely born babies need support in the form of medication, oxygen, and mechanical ventilation.
Heart
The functioning of the heart is often good. However, it may be that the connection between the aorta and the pulmonary artery has not yet closed. This is discovered by hearing a heart murmur. Sometimes this closes on its own, and sometimes it needs to be treated.
Intestines
The intestines are also not yet fully mature. Mother's milk is always the best recipe for this. Easily digestible and always tailored to the nutrients needed. If the mother cannot express milk, donor milk or formula is sometimes used. It is important that the intestines start working, which you will notice when your baby starts having bowel movements.
Immune system
The defense against infections is also not yet optimal. Although a prematurely born baby has received some antibodies from the mother, the risk of infection is much higher. This is also why (hand) hygiene is so important in the NICU and why no visitors are allowed who are ill or carrying contagious (childhood) diseases.
Temperature
A prematurely born baby cannot yet maintain their body temperature well. In the NICU or incubator, the temperature is therefore measured, and extra warmth is added if necessary.
Other problems
- Jaundice: the liver is not yet mature and cannot process the amount of bilirubin in the blood. By placing the prematurely born baby under a blue light if necessary, the bilirubin is reduced and the yellow color disappears.
- Growth retardation: babies born too early are naturally small. You often see that growth lags, especially in the first year.
- Muscle tone is lower: the muscle tone of a premature baby is often lower than that of a baby born on time.
- The sexual organs are not yet fully formed in very prematurely born babies. For example, boys' testicles have often not yet descended.
- The skin is thin, almost transparent, and your baby often has not yet built up fat.
Monitor
A prematurely born baby is often connected to many tubes and a monitor. The monitor continuously tracks breathing, heart rate, blood pressure, and temperature and sounds an alarm if necessary. In the NICU and the neonatal ward, your baby receives the best available care. Although all those wires and tubes look very impressive on such a small child, it is comforting to know that your baby is being closely monitored.
Premature attachment
While you would normally start the bonding process immediately after birth by laying your baby on you and letting them drink, this is often not possible with a prematurely born baby. Usually, the priority is the right care for your baby, and the focus is first on ensuring they are as stable as possible before moving to the correct ward. But as soon as it is possible, skin-to-skin contact ("kangaroo care") with the father and/or mother begins. If the situation is stable enough, your baby is placed on your bare chest in just a diaper. Then, you are covered with a blanket.
Kangaroo care is incredibly important for the bonding process and for your baby's growth. In addition, your baby can often maintain their body temperature better, and it benefits the production of mother's milk. Kangaroo care is good for both the baby and the parent. During this time, oxytocin is released—a hormone that provides bonding and positive feelings.
In addition, kangaroo care is often very pleasant because, at this moment, it is actually the only (and best) thing you can give your baby.
Feeding
Often it is not yet possible to have the baby drink mother's milk directly from the breast. But in the hospital, everything will be done to support you in this. Initially, you will start by expressing milk, and with the help of a lactation consultant, your baby will be placed at the breast once they are physically ready. For this, your baby must have developed a good suck-and-swallow reflex. If breastfeeding does not work, donor milk or a substitute can sometimes be used.
Premature clothing
In the beginning, your baby will not yet wear clothes. Everything is too big, and it is often too taxing to dress and undress your baby. But as soon as your baby is a bit bigger, the nurse will often indicate that you can bring clothes. Clothes without irritating seams, which still allow the monitor to remain connected, are the most comfortable. There is an increasing range of premature clothing.
To a nearby hospital
Only a few hospitals have a NICU. Often, you and your baby have been away from home for a while. But as soon as your baby is stable enough and meets the right conditions, you will be transferred to a hospital in the vicinity. It is exciting, but also very nice to be near family again. A transfer is always done by ambulance.
And then home?
Of course, going home is wonderful. But also very exciting. Because suddenly you have your little baby at home who was previously being watched 24 hours a day. Sometimes you are still entitled to a little bit of care. That is nice to feel more confident with your baby at home. Discharge usually takes place when your baby is completely stable and around the due date. Sometimes a little earlier, sometimes a little later.
Working further on the bonding process
At home, you naturally continue the bonding process. When your baby is born prematurely, your start has been different than you imagined. Although kangaroo care has already contributed to the bonding, this naturally continues at home. You can do a number of things yourself to ensure this progresses positively:
- Continue with kangaroo care at home as you were used to in the hospital.
- You can start carrying your baby, so your baby can enjoy the benefits of close contact even more. Preferably use a well-fitting baby carrier or, ideally, a woven wrap.
- Listen and watch your baby's signals closely; this way you get to know your baby better and can offer safety when needed.
Carrying a premature baby in a wrap or carrier
A prematurely born baby can be carried in a wrap as soon as they are stable enough. Some hospitals are experienced in this and can help. But it is often something you start with at home. For a prematurely born baby, a thinner, soft woven wrap is actually always recommended. A stretchy wrap often provides too little support, and carriers are often still too big. A woven wrap will provide your baby with the correct support if you tie it properly.
Carrying a baby born prematurely is very good for bonding, but also for your baby's further maturation. You continue the kangaroo care in the home situation, and this literally helps your baby grow. The need to be with you is often even greater than with a baby born on time. And the need is high even then.
Our advice is to always ask for help from an experienced babywearing consultant. They can teach you how to tie and ensure that you carry your baby safely and with the right support. You can also contact our babywearing consultant if you have questions or need advice. She is available via the WhatsApp button at the bottom of this page.
If your baby is size 38/44 when you start carrying, then you can choose a regular woven wrap. The Pure Baby Love wraps are super soft and perfectly suitable for prematurely born babies. They are not too thick (225gr/m2) and very flexible.
Do you prefer to use a carrier? Then the Wrap & Go+ and the Click & Go+ can be used from approximately 3300 grams.
Keeping a prematurely born baby at temperature
A baby born too early or who is still very light in weight has a little more trouble staying at the right temperature. Wool is truly a must-have here! A wool onesie, wool hat, and a wool blanket can make the difference.
A big favorite is the merino wool swaddle blanket. In this, you can tuck your baby in extra snugly and keep them warm. But the regular cradle and crib blankets from Pure Baby Love are also suitable for this. Wonderfully soft, but above all, just right for proper temperature regulation.
Is dysmature the same as premature?
You don't hear much about dysmature babies. Sometimes people think it is the same as premature. But that is not correct. Premature means that a baby is born earlier than expected. Dysmature means that a baby is born with a lower weight than you would expect for the duration of the pregnancy. This simply means that a baby is too light.
It may be that a dysmature baby is also not yet fully mature, and you encounter some of the same problems as with a prematurely born baby. For example, the head is relatively large and heavy, the belly is often thin, the baby has little body fat so temperature is harder to maintain, and your baby may be more restless or hungry. For dysmature babies, it can also be very helpful to do kangaroo care, carry them, and respond to the signals your baby gives. For dysmature babies, we also recommend using a woven wrap for the best support.
It also happens that a prematurely born baby is also dysmature.
Do you still have questions about your individual situation? Feel free to ask your question via WhatsApp. Our babywearing consultant specializes in carrying prematurely born babies and is also a nurse, so she can always advise you.