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Many pregnant and expecting parents will have prepared a birth plan to cover scenarios of vaginal birth and c-section. However few parents include for a premature birth in their birth plan and postpartum supports.
Premature
In Ireland approximately 55,000 babies are born annually, of which approximately 3,500 are born premaurely, a rate of 6.3%.
Not many families consider the possibility of a preterm birth unfortunately. If you are one of the 6.3% of families whose baby is born preterm, lack of preparedness for this outcome can result in additional worry and a scramble to find appropriate supports.
A premature birth is defined as babies born alive before 37 weeks pregnancy. There are sub-categories of preterm birth, based on gestational age:
Extremely preterm (<28 weeks)
Very preterm (28 to <32 weeks)
Moderate to late preterm (32 to <37 weeks).
Survival rates (approx) | ||
Babies born at | Chance of survival | At age 3 |
23 weeks | 29% | 50% have no disability |
24 weeks | 46% | 60% have no disability |
25 weeks | 69% | 70% have no disability |
26 weeks | 78% | 80% have no disability |
27 weeks | 90% | |
28-31 weeks | 90-95% | |
32-33 weeks | 95% | |
34 weeks onwards | same likelihood of survival as full term infant |
Possible developmental issues as a result of preterm birth:
· Developmental delay
· Retinopathy of prematurity
· Physical disability ie cerebral palsy
· Deficiencies in social competence or the inability to integrate
· Internal or external organ disorders (intestines, heart, lungs/BPD/asthma, hearing, visual or speech impairment)
· Intellectual disability
· Learning disability or partial decreased performance (attention deficiency hyperactive syndrome, dyscalculia, dyslexia)
· Bonding and interaction disorder
· Feeding problems and failure to thrive
Tips:
Useful items to pack in case your premature baby requires a NICU stay:
· Notebook and pens
· Camera
· Scarf or muslin square that has been worn by you to leave with your infant
· Blanket to keep your infant warm during kangaroo care
· Loose clothing with front opening is helpful for kangaroo care
· Hand mirror to help you see your baby’s face during kangaroo care
· Pictures of siblings
· Cool Bag for transporting milk to the hospital
· Diary/Journal
· Long phone charging cord
· Headphones or airpods
· Nursing pillow
· Pumping bra
· Books to read to baby
· Slippers
· Hand lotion
· Water bottle
What others can do for families in the NICU:
· Create a Meal Calendar for the family and get volunteers to cook meals.
· Offer to do the household chores e.g laundry, putting the bins out, doing the shopping, care for pets, gardening.
· Offer to drive the mother to the hospital to visit her infant as she may have had a caesarean section and be unable to drive.
· Offer to take care of pets such as dog walks.
· Offer to take care of other siblings, school runs, playdates.
· Put together a hamper of useful items for the NICU for the family.
· Offer to be the family spokesperson to convey updates on the infant’s progress
· Offer your services using an INHA Pledge Card; free to download from this website. https://www.inha.ie/inha-pledge-cards/
Common myths about premature babies:
Myth: All premature babies require NICU support. Only premature babies require NICU stay.Reality: Not all premature babies require NICU stay.While many NICU babies are preemies, full-term babies can also need NICU care due to complications during birth or health issues after delivery, such as infections, breathing difficulties, or congenital conditions.
Myth: Premature babies can't be breastfed.Reality: Breastfeeding (or providing breast milk) is encouraged for premies babies. Maternity hospitals offer lactation support for pumping breast milk and facilitate breastfeeding when the baby is developmentally ready, even if they need alternative feeding methods like tube feeds initially.
Myth: Premature babies are too fragile to be held or touched by parents.Reality: In most cases, midwives encourage skin-to-skin contact (kangaroo care) as soon as possible after delivery and can be facilitated if a baby requires a NICU stay, as it promotes bonding, improves the baby's health, and helps stabilise their vital signs.
Myth: After a premature baby is discharged from the NICU, everything is back to normal.Reality: The transition home can be challenging, and many NICU graduates require ongoing medical follow-ups, therapy, or special care. Families may need additional emotional and physical support as they adjust to life after the NICU. It is estimated that up to 70% of NICU moms experience a perinatal mental health disorder like postpartum depression or anxiety.
Myth: Premature babies will never catch up to their peers.Reality: With the right care and support, many premature babies not only catch up to their peers but thrive in ways that surprise and inspire. While some may face challenges, they can reach developmental milestones and grow up to lead healthy, happy lives, often overcoming incredible odds.
Examples of Birth Plan considerations:
Post-Delivery NICU Plan: If my baby needs to go to the NICU after delivery, who will accompany the baby and who will stay with me?
What are my preferences for immediate newborn care if my premature baby requires NICU support? o Skin-to-skin contact as soon as possible o Delayed cord clamping if possible o Partner to cut the umbilical cord if possible o Me and/or my partner to be the first visitors o Be present for all “firsts” (ie. feeding, dressing, bathing)
If I need to give birth under general anesthesia without a partner present, what initial steps would I like to happen with my baby if possible? o Immediate skin-to-skin with the partner o Baby to be shown to me as soon as I am conscious o Partner to stay with the baby until I am awake
Communication Preferences How would you like to receive updates about your baby’s condition if they are in the NICU? o In-person from medical staff o Via phone call o Via text message o Partner to receive updates
Are there any specific cultural or spiritual practices you would like respected during and after birth?
Any specific personal preferences or rituals to be observed?
Who will carry baby to NICU skin to skin? Dad, after csection
What is my plan/preferences for establishing breastfeeding after delivery if I am separated from my baby or my baby is not able to feed by mouth immediately after birth? o Begin pumping immediately after delivery o Provide colostrum via syringe o Lactation consultant support for milk expression o Use donor milk if available
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For additional information and resources on premature babies see the Irish Neonatal Health Alliance https://www.inha.ie/
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