The issue of premature birth

Premature births are a global issue. Similarly to other developed European countries, approximately 7% of babies in the Czech Republic are born prematurely, i.e. about 7 to 8 thousand infants a year. The Czech Republic is among the most successful countries in terms of caring for premature babies.

Neonatology is the field that deals with the medical care of newborn infants. It developed mostly in the second half of the 20th century when methods of intensive medicine, especially ventilation support, made their way into the care of premature babies.

The age when premature baby care begins differs by country. In most developed countries, intensive premature baby care begins in the 24th week of pregnancy. In the Czech Republic, for many years the threshold to start such care was the 28th week of pregnancy or birth weight of over 1,000 grams. With rapid advances in neonatalogy, the threshold of viability was lowered in 1994 to the 24th week of pregnancy or birth weight of over 500 grams.

Degrees of prematurity

Premature babies are classified by week of pregnancy or by birth weight. The number of weeks of pregnancy, which gives a better indication of how underdeveloped the baby’s organs are and how long it may take them to develop, is more relevant in terms of postnatal adaptation and the likelihood of follow-up care than birth weight.

Classification by week of pregnancy

  1. Slightly pre-term: 36th - 37th week of pregnancy
  2. Moderately pre-term: 32nd - 35th week of pregnancy
  3. Very pre-term: 28th - 31th week of pregnancy
  4. Extremely pre-term: less than 28 weeks of pregnancy

Classification by weight

  1. Normal birth weight: greater than 2,500 g
  2. Low birth weight: 1,500 - 2,500 g
  3. Very low birth weight: 1,000 - 1,500 g
  4. Extremely low birth weight: less than 1,000 g

Caring for premature babies

A premature baby requires special care the extent of which depends on the baby’s birth weight and gestational age.

The care provided in the Czech Republic to premature babies and infants at risk is among the best in the world. This success (truly unique in post-communist countries) is attributable to the adoption of new intensive care methods in the late 1980’s and, most importantly, to the foundation of twelve regional perinatal centres equipped to care for premature babies (i.e. those born from the 24th to the 32nd week of pregnancy). A system has been in place since about the mid-1990’s that makes it compulsory for all hospitals to refer expecting mothers at risk of premature birth or serious complications that may lead to the termination of their pregnancy to one of these specialised centres in order for the mother to give birth there. This gives premature babies immediate and the best possible care. The programme is known as ‘transfer in utero’ (transportation in the womb).

The number of premature babies is increasing year by year. The reasons include the growing number of children born after artificial insemination, i.e. children born in multiple births, the older age of mothers at birth, i.e. the proportion of women giving birth after 35 years of age, who are more likely to give birth prematurely. And last but not least, the survival rate of extremely pre-term babies, i.e. those born in or before the 26th week of pregnancy, is increasing.

What the parents go through

Prematurity affects not only the mother and the child but also the extended family, relatives and society. Coming to terms with having a premature baby is very difficult. It is an experience that differs dramatically from the ideas parents have when planning and expecting a child. Having a premature baby puts a strain on both parents.

Intensive care and resuscitation units for newborn infants are a place where it is very difficult to feel like a parent. The time a premature baby spends there differs case by case, generally ranging from a few weeks to months.

We know the risk factors that may lead to a premature birth and can reduce or eliminate some of them during pregnancy (by treating vaginal and other infections during pregnancy, applying cervical cerclage, removing excessive amniotic fluid, etc.). Yet, the primary cause of as many as 40% of premature births remains unclear. This figure contrasts sharply with the prevailing feelings of mothers of premature babies such as self-blame and guilt for not avoiding the premature birth. But that is not the only stress mothers and the whole families experience. These discomforting feelings are exacerbated by the following:

  • Uncertainty and fear for the baby whose health and life are at risk for many weeks.
  • Unpreparedness for motherhood because the birth comes when nobody is expecting it.
  • Inability to maintain physical contact with the baby who is usually in an incubator approximately for the period that remains until his due date. Naturally, hospitals make efforts to allow parents to have as much contact with the baby as possible, get them involved in the care for and treatment of newborn babies, help them prepare for breastfeeding and support them to practice kangaroo mother care. However, limited capacity often makes it impossible to hospitalise the mother with the baby, so she has to share a room with other mothers or visit the baby in hospital.
  • A feeling that others do not understand what the parents are going through. These reasons make a premature birth difficult for the whole family.

A family where a very premature baby or a baby with a disability is born, finds itself in a difficult situation nobody was expecting and wished to happen. The values, needs and sometimes the roles inside such a family change dramatically.

Biologically, a premature birth is almost identical to a birth at term. A child is born and hormonal changes in the mother trigger lactation and the development of parental nurturing behaviour. This is where a crucial difference occurs. A mother of a premature baby has nobody to look after as the baby is immediately placed into an incubator because his life functions are unstable and must be monitored or even supported by machines.

On top of that, premature babies usually differ from the mental picture women create about their future children. This leaves many parents surprised or perhaps even disappointed or shocked when they first see their baby in an incubator. Specific problems occur in addition to those associated with crisis situations in general. The stark difference between the fantasies parents had about their child and the baby in an incubator is often unbearable.

Many mothers often feel guilty for not carrying the baby and may be afraid of not being a good mother and of how their partners, relatives and friends will respond. The childbirth is not associated with usual joy and celebrations.

The mother spends several months in hospital with her baby, burdened with feelings of isolation, helplessness and anxiety.

Fathers have an extremely difficult role as they work, look after older kids and only get to see their premature baby occasionally and for short time. They are expected to provide support, yet often there is no way or place for them to express their worries and concerns.