Premature birth: finding life

"How are you doing? And how is the baby?" If you are pregnant, you will hear questions like this very often. The whole family, friends, work colleagues and neighbours - most of the people around you show a keen interest in the progress of your pregnancy. And of course, the midwife who accompanies you during these months, as well as your gynaecologist, will be interested in your condition and the well-being of your baby. 

Facts and figures on premature births

But even if a pregnant woman is socially well embedded and medically well cared for, it is possible that an unborn child will be born before its time. Around 64,500 babies are now born prematurely in Germany every year. That is around one in 10 children. The term "premature" is clearly defined. It means that the birth takes place before the 37th week of pregnancy - or the baby has a birth weight of less than 2,500 grams. And this is not so rare: More than 10,000 of the so-called Premature babies are even born with a birth weight of less than 1,500 grams.

- One Extremely premature birth is present before the 28th week of pregnancy. A birth weight of less than 1,000 grams is then not uncommon. 

- From a early premature birth is when the child is born between the 28th and 32nd week of pregnancy. These children usually weigh less than 1,500 grams.

- As late or moderately premature birth are births after the 32nd and before the 37th week of pregnancy. These babies are usually born weighing less than 2,500 grams.  

But these are all just figures and statistics. Behind every single case that is included in the premature baby statistics, however, there is a family caught between hope and fear. There are the parents who may have to make decisions, and there is a tiny human being who has to find its way in this world. Thanks to modern intensive care medicine for newborns (in technical jargon: Neonatology), premature babies today have better chances of survival than ever before. In fact, even extremely immature babies born from the 22nd week of pregnancy can now be given intensive medical treatment. The medical team always weighs up carefully with the parents concerned whether this makes sense in each individual case. 

Unfortunately, this is also a reality: children who are born before the 22nd week of pregnancy generally have no chance of survival. After all, the baby's lungs must be at least sufficiently developed to ensure oxygen saturation for the small body with technical assistance. Intrauterine, this task is performed by the placenta. As soon as the baby has left mum's womb, it must be able to breathe on its own. The development and maturity of the lungs marks the limit of viability in premature babies.

Basically, the earlier a child is born, the higher its risk of physical and mental impairments (including severe ones). Conversely, this means that every day, every week that the baby grows longer in the womb improves its chances of survival and the best possible health. 

A kind of "milestone" on this path is the completed 24th week of pregnancy . The unborn child is now around 29 centimetres tall and weighs approx. 550 grams. Children born at this time already have a 60 to 80 per cent chance of survival. And there is something else: the doctors are now also legal The company is obliged to do everything in its power to save the little life if possible. 

Most premature babies are born between the 32nd and 37th week of pregnancy. If the baby weighs between 1,000 and 1,500 grams at birth, its probability of survival is already at 91 per cent.

Possible reasons for a premature birth

There are various factors that can increase the risk of a premature birth or trigger a premature birth. The causes lie partly with the mother and partly with the child. Sometimes different circumstances can interact on both sides. However, there are always cases in which the cause simply cannot be clearly determined. 

The risk of a premature birth is often increased if a High-risk pregnancy was diagnosed. In the following, I would like to briefly introduce you to the main reasons that can have an influence on a premature birth:

(Pre-)diseases of the mother: Certain diseases of the mother that have already before The risk of premature birth can be higher if a woman has a medical condition that existed during pregnancy, such as diabetes mellitus or high blood pressure. However, pregnancy-related illnesses such as Pre-eclampsia or the HELLP syndrome can be dangerous. 

Infections in pregnant women: In many cases, acute infections are the trigger for premature labour. This applies in particular to bladder or vaginal infections in the mother, which can spread to the uterus. However, if recognised in good time, the problem can be treated with medication and the risk averted. But infections in the mouth can also lead to premature births. This is another reason why it is important to visit the dentist during pregnancy.

Placenta problems: When the Placenta for example, is in the wrong place in front of the cervix (placenta praevia), this can lead to premature birth. The same applies if the placenta no longer supplies the child sufficiently Placental insufficiency) or begins to detach prematurely from the uterine wall.

Irregularities in the uterus: A malformation of the Uterus impairs the regular development of the child. Benign growths (fibroids) on the uterus can also lead to premature birth. This is because there is then too little space for the child. A premature birth can also be triggered by weakness of the cervix (cervical insufficiency), as the cervix then begins to open prematurely. Bleeding can also trigger premature births. 

Lifestyle of the mother: If a pregnant woman consumes a lot of alcohol and nicotine, this can increase the risk of the child being born prematurely. Heavy, physically demanding labour is also considered a risk factor. In addition to these causes, life circumstances that place a heavy psychological burden on the woman can also play a role. These include, for example, persistent severe stress (e.g. due to chronic money worries or partnership conflicts), intense feelings of anxiety (e.g. about childbirth or the future), traumatic events (e.g. the death of a loved one), violence at work (e.g. due to bullying) or domestic violence.  

Paediatric malformations: Premature birth can also be caused by genetic defects or pathological malformations in the child. Examples of this include so-called open spine (spina bifida) or heart defects.

Other factors: In addition, there is a higher risk of premature birth in the case of multiple pregnancies, after artificial insemination or if the mother is severely overweight or underweight. Her age also has a certain influence if the woman is under 18 or over. over 35 years is old. The same applies to previous premature births.

Prevention

Basically, it has to be said: 

- The better a pregnant woman is informed about the processes in her body and the risk factors for a premature birth, the sooner she can adapt her lifestyle accordingly. This is the best prevention!

- And the better a pregnant woman knows her way around, the easier it is for her to recognise any abnormalities and inform her doctor or midwife. If there are any indications, such as a conspicuous smelling discharge (indicates infection) or premature labour, they can then react accordingly. 

If there are signs of an imminent premature birth, the medical staff will try to maintain the pregnancy for as long as possible. Depending on the cause, it is sometimes enough for the mother to be given absolute rest and bed rest, sometimes even in hospital. In other cases, she is given additional medication to inhibit contractions or relax the uterus, for example. Or other medical measures are taken, such as closing the cervix. Rest and protection are nevertheless required in all cases! Depending on the week of pregnancy and the degree of maturity of the unborn child, the mother may also be given medication (glucocorticoids) to accelerate the baby's lung maturation if there is a risk of premature birth. 

Nevertheless, despite all the measures taken, it can sometimes be unavoidable to deliver the baby prematurely - or to bring it home in order to avert greater danger to the mother and/or child. 

Delivering premature babies

There is a controversial debate as to whether premature babies can be born vaginally or have to be delivered by caesarean section. Studies do not show that all premature babies must always be born surgically, i.e. by caesarean section. Rather, it makes sense to carry out an individual risk assessment. In addition to the week of pregnancy, the position of the baby in the womb also plays an important role in the decision. Consideration is also given to whether there are additional risks for the mum or the baby that can be reduced by a caesarean section.

While in the case of a premature birth from gestational week 30+0, a normal birth is aimed for if the baby is in the cephalic position, spontaneous labour is only recommended from gestational week 36+0 in the case of a birth from a breech presentation.

As a rule, a paediatric team specialising in premature babies is also present at premature births and can take immediate care of the little one. Depending on the maturity and condition of the child, it may need oxygen, ventilation and intensive medical treatment. The incubator serves as a warm, safe and protective nest for very immature children.    

Strengthen premature babies

Children born before the 37th week of pregnancy or with less than 2,500 grams urgently need two things above all: breast milk and skin contact! Of course, this applies to all babies after birth - but especially to premature babies!

"Kangaroo method": The current recommendation of the World Health Organisation (WHO) after evaluating over 200 studies is to allow skin-to-skin contact with the mother or alternatively the other parent before the premature baby is transferred to an incubator. This not only strengthens the emotional Parent-child bondingbut also increases the child's chances of survival. In more and more clinics, parents are involved in the care of their premature baby anyway. This also includes regular cuddling with the baby skin-to-skin. This has become known as the "kangaroo method" and is practised by both parents both in the maternity clinic and at home. 

Breast milk: Breast milk is by far the best food for tiny babies. This allows them to develop in the best possible way. However, many premature babies are often not yet able to suckle at mum's breast. In these cases, expressed breast milk helps, which is administered to the child - sometimes via a feeding tube. If the mother is unable to express her milk, the supply in breast milk banks should be used. Extremely premature babies are often initially given nutrients intravenously. Once the intestines have matured and there is enough strength for digestion, they can and should also be given breast milk.  

Finding help in everyday life

For mothers who have experienced a premature birth, it is now particularly important to have support. This includes talking to other affected people, which can be extremely helpful. Parents of premature babies can find contact details for self-help groups, a telephone hotline for parents and lots of other valuable information and brochures at the Federal Association for the Premature Infant.

After a premature birth, the mother is also entitled to a longer Maternity protection periodnamely 12 weeks. This means that the woman may not be employed by the employer during this period. 

If the parents are at home with the premature baby, the follow-up care and support provided by a Midwife plays a very important role. If necessary, my colleagues can accompany the family for up to a year. If prescribed by a doctor, the statutory health insurance will cover the costs. As part of the Socio-medical aftercare Various specialists, such as a paediatric nurse, can also support the family in everyday life. A doctor's prescription, which is issued at the maternity clinic, is also a prerequisite for the statutory health insurance fund to cover the costs. Parents can find further information on this and more on the network of nationwide aftercare centres and support services on this Website.

And last but not least, the network's contact points also offer Early help 

Development opportunities for premature babies

I don't want to withhold this information from you either: According to current knowledge, the critical threshold for a premature baby to survive without impairment is the 25th week of pregnancy. If a baby is born before this and survives, the probability of oxygen deprivation and haemorrhaging is very high. And yet there are always examples that show that even extremely premature babies develop really well. 

Even if the number of premature births has not fallen significantly in recent years, the number of premature babies who survive and develop well has risen steadily in recent years. The vast majority of premature babies grow up to be healthy children! Late preterm babies in particular (born between the 32nd and 37th week of pregnancy) hardly have any developmental delays. They usually catch up quickly. Very soon, they can no longer be distinguished from children born at term. 

For earlier "early starters", the following generally applies: the earlier a child is born, the more time it may need to catch up with its development. 

Earlier in life means a later start to complementary feeding

However, premature babies still need a longer period to be born. This is due to the fact that in the time up to the due date, the missing development of the pregnancy must first be made up for. Therefore, the age of 6 months after the due date is used as a guideline for introducing complementary foods to premature babies. But even for these children, parents can and must take their baby's individual rate of development into account when starting complementary foods. After all, even premature babies develop at different rates.

The development of premature babies can be well supported by an intimate bond and appropriate support. Premature babies benefit in particular from the caring attention of Baby massage.