When starting to think about planning for the birth of a baby, few soon-to-be-mums would set out an ideal of dashing to hospital in an ambulance in premature labour, having an early elective casarean section or having their newborn baby rushed away from them to intensive care. But currently as many as 7% of births in the UK are premature to some degree, and 2-4% are very premature (under 32 weeks). Premature birth is considered high-risk and – whether delivery is vaginal or by caesarean – it will limit your birthing options. So how can you prepare yourself for the possibility of a premature birth and if your baby does come early, how can you still make your delivery personal and special?
Ahead of labour
Not all premature births are sudden. In some cases there will be medical reasons for an early delivery and you may have spent days, weeks or even months on bedrest and/or in hospital under observation with the aim of prolonging the pregnancy as long as possible. Even if you are rushed to hospital in premature labour, you may have a while to go before you meet your baby: If you go into labour before week 35 you will be given drugs to delay labour. If given early enough the drugs may be able to stop labour, and they often delay it for up to 48 hours, giving you valuable time to prepare yourself for the next steps.
- Prepare mentally – Regardless of whether or not you have a premature delivery, it can help enormously to prepare yourself for the possibility that labour might not go the way you would like it to, and that you may have to be flexible for the sake of your health and that of your baby.
- Read up – Reading this is a good start, but it might also be useful to find out what is usually involved in a premature birth and read up on topics such as epidurals and caesarean sections, just in case.
- Stay positive While reading up is a good idea to prepare yourself for what might happen during and immediately after the birth, try to stay positive and don’t make yourself anxious by focusing on any health problems that may result from a premature delivery.
- Talk to the midwives – If you’re likely to need to deliver early you should have special attention from doctors and midwives; some midwives specialise in high-risk pregnancies. Make sure you take the opportunity to ask them plenty of questions about what your particular circumstances may mean for delivery and how you can best prepare.
- Adjust your birth plan – Once you’ve talked to your consultant, the midwives and done some reading you’ll have a better idea of the kind of labour you may be in store for – of course you won’t know until the time comes exactly what will happen – and can make changes to your birth plan accordingly, if you already have one. For example, if it looks like you’re likely to have an elective caesarean then you can specify whether you’d like your partner to be present for the birth and consider whether you’d like to record the birth with photos.
Visiting the neonatal unit was the single most important thing for us. Seeing other parents and babies – especially the older babies who are close to coming out – was hugely reassuring…says TB member Jeremy, dad to Finn born at 28 weeks
- Get to know the neonatal unit if possible – If your premature baby needs special care then it can lessen the shock if you’re already familiar with the neonatal unit, or Special Care Baby Unit (SCBU). If you’re being treated at a hospital with an SCBU, or know where your baby is likely to be sent, then try to arrange to visit at least once to see the equipment, meet some of the staff, and ask any questions you may have. In addition to seeing the set-up, staff and equipment in the unit, a visit should give you a chance to see other premature babies and gain some inspiration from the older babies nearly ready to leave the unit, as well as the parents who’ve been through it all ahead of you. If you can’t visit the unit yourself then consider sending your partner or another family member to have a look and ask questions for you.
- Be prepared for conflicting attitudes from the different departments – If you do go and see the neonatal unit then be prepared that they may have quite a different take on your situation than the doctors on the labour ward. This can be a bit confusing, but bear in mind that the staff on the labour ward will be focused on trying to do everything they can to avoid or delay a premature delivery, while the staff in the neo-natal unit deal successfully with the reality of premature babies every day.
- Talk to people in similar situations – If you’re hospitalised then there may be people around you who are in similar situations to yours, and who maybe even have been through it before, whom you can be mutually supportive of. If you’re home on bed rest then look into support groups or use online support forums where you can ask questions and get support from people who’ve had similar experiences.
- Get someone to pick up stuff for a hospital bag for you – If you haven’t reached the stage of your pregnancy where you’ve got a hospital bag sitting ready to go, which most premmie mums won’t have, then you’ll need to delegate the packing to someone else. Get your partner or friend to print out this list of items for your hospital bag.If you go into labour before week 32 then forget about the items for baby for now (see very early babies, below).
- Prepare your families –
Call key family members and let them know what’s happening to give them a chance to rally round and support you both and take care of any other children or pets etc.
Very early babies
If you have a very premature baby, under 32 weeks, then you may not have attended ante-natal classes and thought about a birth plan yet, if you’re even aware of what one is. In this case it can be very hard to take on board what is happening, as you probably haven’t spent all that much time thinking about the birth and about being parents, as opposed to simply being pregnant.
Your partner or birth partner takes on an even more important role in these circumstances, and will have an awful lot of running around to do for you both in however many hours you have before labour begins in earnest.
Here’s what your partner can usefully do:
- The hospital bag – Pick up and pack everything you need for your hospital bag, particularly some supplies for the delivery room. Forget anything specifically for after the birth for now: Your baby’s immediate needs will be taken care of by the hospital and, as it’s pretty unlikely you’ll all be leaving hospital in a hurry, you’ll have plenty of time to get the other stuff later. There’s also no need to worry about a feeding bra yet.
- Crib up on how to support you through labour and delivery – Not having been to ante-natal classes and prepared for a supporting role in the delivery room he’ll need a crash course on what to expect and how to handle it all. Some basic reading on the three stages of labour is advisable, as is knowing what is often involved in a premature birth and how to best support you during delivery (skip down to the last two sections!). If your partner’s already practised at giving massages then it might be useful to read how massage can help during labour.
- Talk to people who’ve been through it – You may not know anyone else who’s had a premature delivery, but chances are you have one or two friends who’ve had babies. Get your partner to give them a call and chat about their labour room experiences, particularly the women’s experiences. You may have a very different experience and want your partner to support you in different ways, but getting input from others can be really important for boosting his confidence in his ability to help and for feeling more prepared.
- Ask questions – Apart from the health risks for your baby that are associated with premature labour, many mums find one of the most distressing aspects of premature delivery is feeling a lack of control over the course of labour. This feeling of lack of control is likely to be heightened if you’re not familiar with the terminology your medical team are using, or things are happening very quickly. Don’t be afraid to ask plenty of questions about what’s happening, and why, and to ask your midwife or doctor to explain anything that you don’t understand: The better you understand why things are happening, the less worried you will be about them.
- Make your preferences clear – If you have strong preferences on subjects like pain relief, you won’t necessarily have to give them up because your labour is premature. If you wanted a labour without medical pain relief this may still be an option if a caesarean is avoidable. If you do want pain relief, however, and your baby is quite premature then you won’t be able to use pethidine and may be advised to have an epidural.
- Rely on your birth partner – You will probably be putting all your energy into getting through the next hours and coming away with a healthy baby, but your birth partner may be able to ‘rescue’ one or two aspects of your birth plan, if you have one. This could be as simple as organising a camera so you can take photos of, or immediately after, the birth.
- See your baby as soon as you can – Once your baby is born she’ll need a health check before you can hold her. In some cases she’ll need to go straight to the neonatal intensive care unit, but you may be able to hold her for a short time very soon after birth, even if she’s very premature.Many neo-natal units will make sure that the parents get a photo of their baby very quickly after the birth so they have at least something to help them take in the reality of what’s happened.
Above all else, if you do find yourself faced with the possibility or reality of a premature delivery, then try not to worry about what may or may not happen after the birth; you need all your energy and focus directed towards however long of the pregnancy you have left and to a the birth itself.