Miriam's casebook - Premature baby
At 28 weeks of pregnancy, Carol noticed that her fingers, hands, and feet were swollen. Two weeks later she had raised blood pressure, so her blood pressure, blood, and urine were monitored. Her baby was checked too, with electronic fetal monitoring and ultrasound scans. There was albumin in Carol's urine, which is a symptom of pre-eclampsia, along with high blood pressure and swelling.
Monitoring Carol's baby
© DK
After a week of careful monitoring, Carol's blood pressure hadn't gone back to normal and there was still albumin in her urine. At the beginning of the 32nd week of pregnancy, the baby was showing signs of fetal distress. Her obstetrician decided that labour would have to be induced. After a straightforward induced labour, Carol delivered her baby, Alice, who weighed in at 1.4kg (3lb).
Carol's obstetrician thought that her placenta had begun to fail at the beginning of the third trimester and so her baby's nutrition had been inadequate for some time. When this happens late in pregnancy, the baby's head is disproportionally large because of the relatively normal growth of the brain at the expense of the rest of the body.
He explained that low-birthweight premature babies like Alice are born with insufficient energy stores and don't have enough fat to maintain their body temperature. Premature babies are more likely to suffer from hypothermia, hypoxia (lack of oxygen to the tissues), and hypoglycaemia (abnormally low blood sugar), so it's crucial that they are kept warm. Alice was put straight into an incubator and her immature lungs were helped by a ventilator. Carol was given a room next door so she could be with Alice as much as possible. Carol and Mark were quite taken aback by the first sight of Alice even though they'd had time to get used to the idea that she would be premature. When they looked at Alice inside the incubator, attached to a ventilator and taped with wires and tubes for monitoring and feeding, she seemed very tiny, and very far away and isolated.
Appearance of Carol's baby
Alice didn't look like they had expected her to. Born eight weeks early, she had none of the fat that a baby normally puts on in the last few weeks and her movements tended to be jerky because of her immature nervous system. She looked too small for her skin, which was red, wrinkled, loose-fitting, and dry, and her head looked large in comparison to her body. She had lanugo (fine downy hair) on her back and the sides of her face.
Her bottom looked bony and pointed due to lack of fat, and her chest, which looked small with prominent ribs, rose and fell dramatically as she breathed. She seemed to have to make a huge effort to take every breath and sometimes her breathing would stop for a few seconds, but this is not abnormal in a preterm baby.
Seeking reassurance incase your baby is prematured
Understandably, Carol found herself bursting into tears at the sight of her tiny daughter, so alone and shut away. At the same time, she realized she was having considerable difficulty relating to her baby in the incubator even though she knew this was her longed-for child. Mark encouraged Carol to explain her difficulties to the counsellor on the ward, who comforted Carol and said that her feelings were common and normal. The staff of the special care unit were understanding; they encouraged Carol and Mark to touch and stroke Alice through the portholes of the incubator. Research shows that this helps a premature baby to establish breathing more readily. The staff explained to Carol that her love was more important for the baby's survival than all the technology they could offer.
Getting to know their baby
As Carol became involved in caring for Alice, she realized that she loved her and desperately wanted her to survive. The nurses showed her how to express her colostrum so that it could be fed to Alice via the tube. The colostrum of the mothers of premature babies is extra rich in trace minerals - those minerals the baby would be getting if she were still in the uterus - and their milk contains extra protein to help their babies grow.
Meanwhile, Mark became interested in the machines in the unit and what each one was doing for his daughter. Busy as they were, the staff found time to answer his questions.
Miriam's casebook - Premature baby - (next) ►
Posted 30.06.2010
Get more on this subject…
