by: Renee Bowling RN, CBE
November is Premature Birth Awareness month. In 2006, the Preemie Act was initiated by the Federal Government to improve the treatment and health of premature babies and to create programs to give families additional support. The March of Dimes has implemented an initiative called “Healthy Babies are Worth the Wait.” This initiative focuses on preventing medically unnecessary preterm deliveries and elective inductions and C-sections prior to 39 weeks gestation. On the Premature Birth Report Card just released by the March of Dimes, Texas scored a “D.” Texas’ premature birth rate is 13.1% with the goal being 9.6%.
Between 1981 and 2005, the rate of preterm deliveries increased almost 35%, with the largest increase being babies born between 34-37 weeks. Research and clinical experiences are showing that babies born just one week early, 39 weeks, increases their risk for morbidity and mortality.
Babies are categorized as:
Less then 34 weeks are called preterm
34-36 6/7 are called late preterm
37-38 6/7 weeks are called early term
39-41 6/7 weeks are called term
42+ weeks are called post term
Late preterm to early term infants can experience an increase risk of feeding difficulties, respiratory distress syndrome, large weight loss, dehydration, temperature instability, increased use of formula, unstable blood glucose levels, jaundice, infection and an increased risk of Sudden Infant Death Syndrome. They are physiologically, neurologically and metabolically immature, even if they “look term.” More than 1/3 of brain volume develops during the last 6-8 weeks gestation, with huge growth occurring during the last 4 weeks.
Skin to skin contact with their mother is extremely important for these babies. That means a baby is in a diaper only and mom bare chested. They maintain their body temperature better, cry less, breast feed more and stabilize better. If taken away from mom they in act a “protest-despair” signal that is a survival response raising their stress hormones and will calm back down when given to mom. These babies were supposed to be carried by their mothers until 40 weeks, so they need intense skin to skin contact with them. Put them skin to skin against their mom with the baby’s chest, abdomen and legs closely flexed around mom’s body with unrestricted access to the breast. This is known as the biological nurturing position. They feel very secure and balanced when in this position.
Breastfeeding management needs to be closely monitored. We want to monitor for and decrease any health risks, be sure mom develops and maintains an adequate milk supply and continue observance to be sure the infant is growing adequately. Breastfeeding sessions should be reevaluated periodically so that changes to the feeding plan can be made based on the individual baby’s developmental stage and ability. The infants may lack feeding skills due to low energy stores and inadequate muscle tone. They may become too tired when nursing to obtain adequate milk transfer, have a weaker muscle tone and uncoordinated sucking swallowing and breathing ratio. They need to be able to maintain their airway, maintain a good latch and the vacuum pressure needed to transfer milk at the breast. These babies need a lot of practice opportunities at the breast, monitoring for signs of fatigue and milk transfer. Most of these babies will need additional supplementation until they are at their due date or several weeks beyond. There are various ways you can supplement babies. You can use a cup, syringe, supplemental nursing system, or specific bottles. Each method has its own advantages and disadvantages and is chosen based on that mom and baby. The feeding technique needs to be taught to mom and other care givers.
Moms that deliver prior to term may experience a delay in their milk coming in and problems with building a full milk supply. It is very important for moms to maintain a good pumping program to build their milk supply. This should be kept up until the baby is able to take over this job completely on their own. This generally occurs at term or 2 weeks post term. Proper pumping routine and procedures should be taught to mom. Moms should be observed during a pumping session to assess proper pump use and techniques. If the baby is in the hospital for health reasons, mom should be encouraged to spend time with her baby. As soon as the doctors allow, skin to skin contact and breast exposure and practice should be initiated. Early implementation is shown to improve milk production and breastfeeding skills.
It is a very stressful situation for families when babies are born early. The work caring for and feeding these babies is very time intensive. It may be many weeks before the baby is able to breastfeed efficiently. A lot of support and information needs to be available to these families. I would like to wish all those going through these challenges the best of luck. We at The Motherhood Center are here to help! Give us a call at 713-963-8880.