Reading my birth story back, I think it’s clear that we weren’t expecting what happened to happen. The whole experience was disorientating, worrying and on an accelerated timeline. When we were in hospital, it felt like we were there for AGES, but looking back, everything happened very quickly. I was admitted on a Sunday and had given birth in less than a week. I didn’t really have chance to get my head around the fact that we were having a premature baby and what that would mean.
How is a premature baby defined?
The whole gestation period of a human pregnancy is super confusing. Everyone thinks a pregnancy lasts 9 months, but actually it’s 40 weeks from the date of your last period. Once you reach 24 weeks, your pregnancy is deemed “viable”, which means your baby is likely to survive if born at this point, and (in the UK) this is the very latest you could have an abortion (and for medical reasons only). Everything from 37 – 42 weeks is classed as “term”. So if you have a baby before 37 weeks, your baby is premature, but between the range of 24 and 37 weeks, there are different levels of prematurity.
- Extreme prem – less than 28 weeks
- Very prem – 28-32 weeks
- Moderate to late prem – 32-37 weeks
Sebastian was born at 35+6 (35 weeks and 6 days) so he is classed as moderate to late prem.
What does being premature mean for a baby?
As ever, I’m no medical professional, but from what I can tell, it’s different for every baby and depends on lots of factors, not just how long your little one has been cooking in your belly. Babies born before Sebastian have been healthier and babies born after have had more health problems.
Our pregnancy was induced because of my health, not because of our baby’s; so we knew that (as far as we could tell) there was nothing wrong with our baby. But we were told that babies do a lot of growing in that last few weeks, piling the weight on ready to come into the world, and that our baby would miss out on that. The medical professionals said that there was no way of knowing whether our baby would be well or unwell. We didn’t know whether our baby would need to go into the Special Care Baby Unit (SCBU) or not.
We were given a tour of SCBU once it started to become apparent I wasn’t going to make it to 37 weeks. I remember thinking that our baby would be fine, that s/he wouldn’t be very premature so they would be OK. And then we had the tour and it hit home. A quiet environment, babies in incubators, a high ratio of nurses to patients – it was very different to the labour ward, that’s for sure. I couldn’t help but cry.
Sebastian’s time in SCBU
When Sebastian was born, he was floppy, a blueish colour and didn’t have a strong cry. The doctors inflated his lungs for him before he could start breathing on his own. He was taken straight to Special Care from the delivery room. The first time I saw him after his initial birth was hours later, he was in an incubator and attached to various monitors, wearing just a nappy. He was wheezing with every breath. I felt strangely detached from him and I was so out of it after labour I don’t really remember seeing him for this first time. I just wanted to sleep, I was probably a little bit in shock.
We didn’t know how long to expect Sebastian to be in SCBU, so it’s easy to divide his stay into weeks now, but at the time it was all about taking it a day at a time.
For the first day or so, Sebastian was in the high dependency room. He was hooked up to an IV drip feeding him sugar water like a bumble bee who needs energy to fly. He was too small to feed from me or from a bottle. He was in an incubator, which was keeping him warm because he couldn’t regulate his own body temperature. He was given IV antibiotics as well to treat him for suspected sepsis.
After the antibiotics were finished and it was clear he was out of immediate danger, he was moved into one of the ‘normal’ rooms. Here, he was in with a couple of other babies, but that would change over the week as some came and went. Some babies just need to be in for a short period of time after birth, others for longer.
In this week Sebastian had a small plastic tube inserted into his nose and down into his tummy because he needed more sustenance than the sugar water allowed. He was tube fed my colostrum and the small amounts of milk I could express, as well as formula to top him up. It was crucial to get his energy levels up to get stronger.
Sebastian also developed jaundice, a common condition in newborn babies, that turns their skin yellow. It’s caused by too much bilirubin in the body, a substance that is created when red blood cells are broken down. If the bilirubin levels get too high they can cause brain damage, so Sebastian was treated using phototherapy. Strong lights were shone onto his skin for two days at a time, which broke the bilirubin down to make it easier for his liver to process.
Unfortunately, he didn’t seem to be able to shake the jaundice off and “re-bounded” three times. This means that his levels spiked higher than they wanted after the phototherapy had been completed. So he would have to start the treatment again. Sadly this meant we couldn’t hold him much, as time on us meant time away from the lights.
Taking part in Sebastian’s care
The staff encouraged us to get involved with looking after Sebastian and having as much contact as possible. We changed his nappies in the incubator (no mean feat) and we learnt how to feed him through the tube.
Every time you want to put something into the baby’s NG tube, you have to check that it’s in the right place. To do that, you attach a syringe and draw back a small amount of stomach contents, then test that against a pH indicator strip. You’re looking for a pH of 5.5 or below, showing that the fluid you have drawn is acidic and therefore likely to be from the stomach. If the pH was higher, we would ask the staff to check the tube was in the right place.
Once the levels were confirmed, we would measure out the amount of milk required, warm it gently in a bowl of water and pour it into a syringe attached to the end of the tube. It would gradually pour down into Sebastian’s stomach. Most of the time he was asleep while we did it.
At the start of the second week, I was beginning to wonder whether we were going to make it out before his due date. I kept setting myself deadlines of when I hoped to be home, torturing myself I suppose.
We were able to dress Sebastian for the first time, as he finally emerged from the phototherapy lights. This only lasted a day and a bit though, before he was back under them again.
It took nine days for him to be well enough to be moved out of the incubator. I was so happy and overwhelmed to see him in a cot and be able to be so much closer to him. Despite it being 28°C in the room, he was dressed in two layers, a hat and four blankets to keep him warm. He had an apnoea mat underneath his mattress that monitored his breathing and would alarm if it stopped. He was still connected to the oxygen monitor and had the NG tube but he was off the drip and seemed to be making progress.
Until suddenly he wasn’t again. I came in one morning to be told he had been poorly overnight and had been seen by the doctor. He had been sick and seemed unwell, but no one knew why. We spoke to the consultant and agreed to put him back on antibiotics – not ideal for tiny babies, but better than waiting for test results and seeing our little man get weaker.
Various tests were run but nothing amiss was found. We don’t really know what was wrong with him, but after a few days on the antibiotics again he picked up.
From then, everything seemed to move quite quickly. Once Sebastian had turned a corner, he pulled out his NG tube and we really went for it with the breastfeeding. He was looking stronger and it was time to start thinking about going home.
Making the transition home
Our hospital has a couple of rooms in the delivery ward and SCBU that they keep for getting premature babies ready for home. The idea is that you stay in with your baby and care for them for 24-48 hours by yourself, whilst you’re still in hospital and they can have their obs done regularly. It is a buffer period to make sure that the baby is ready to go, and a chance to ask any questions about their care if you need to.
I’ll always remember this as a special time because it was the first time the husbear and I had been alone with Sebastian. Although we were still in hospital (in the world’s sweatiest room with no windows to open on some of the hottest days of the year) we were in our own little bubble as a family. It was so exciting!
We were discharged after two nights in the room and that’s when the real work began. Life with a newborn baby is hard, so so hard. But that’s a tale for another day.