Prepping for a Preemie: How to Get Ready Before Your Prem Baby Arrives

Preemie day has the air of a national holiday celebration for all the villagers who inhabit the walls of the NICU. We witness the real-time unfolding of the ultimate underdog story. We observe these tiny bodies fight battles of cosmic proportions and win. It’s a victory for all of us. Yet, embedded in the intensity of the indigo ribbon of Preemie awareness is all the hidden human struggle that belongs to every affected family member.

Developments in the field of medicine, where they pertain to neonatal intensive care, continue to push the age of viability. Medicine’s ability to support smaller and less mature babies has resulted in miraculous outcomes. These unprecedented advancements have propelled us into the realm of the experimental. These interventions are life-saving, but the challenges of parenting a preemie can be immense and long-lasting.

Families of preemies live through unspeakable uncertainty with minute-to-minute unpredictability. The days of elation as progress is made, or the throes of disappointment when there is a setback. The confusing blend of grief, guilt and the lack of time to process any of it. Even to doctors, it sometimes seems that the burden placed on that family (relational, financial, physical) is humanly impossible to carry. Their mighty baby grit seems to carry parents from day to day.

The ripple effect of strain is felt by the other children. The effects of the divided attention are interpreted as abandonment or “punishment”. Relational stress manifests as breakdown and divorce. The mental health implications for new mothers are dire, and the effects of isolation on the father explain the consequently increased incidence of paternal PTSD measured in these families.

Even when there is “collapse”, which is heartbreaking to watch, there is no time to process the critical events, because the next feed is in two hours. It’s gruelling. Across the public and private sectors, this is the point at which a therapist or social worker becomes part of the team.

Graciously, antenatal ultrasound has made immense strides, too, and it is becoming more and more common to have forewarning. It does mean that some preparation is possible.

So, how would you prepare if you were on the receiving end of an antenatal ultrasound report that could mean your baby is delivered prematurely? I recently asked a friend who is walking this road and she said something so very unexpected, but something that made so much sense.

Do Mental Health Preparation

This is someone whose sense of self-awareness is Olympian.

She said that she increased the frequency of her appointments. Simple, yet revolutionary. Having been on the receiving end of a life-changing diagnosis and having very little mental bandwidth for the adaptability required to navigate my thoughts out of survival mode, it is profound. How would it feel if all that stress and worry became actual capacity?

Improving maternal mental health

– Improves sensitivity and responsiveness, resulting in better neurodevelopmental outcomes at six months. (1)

– It also resulted in fewer readmissions and better weight gain (2)

– Has been shown to improve bonding and attachment as a result of more positive interactive behaviours in the NICU. (3)

Families who received early psychological support after preterm birth showed better emotional adjustment, marital satisfaction, and family functioning, two years later. (4)

Get to know your Team

If there is suspicion of a birth defect that may require surgery, it is useful to get to know your team in advance. Hearing what to expect from an experienced source and building relationships with your multidisciplinary team may set you at ease. Hearing it more than once, and answering questions may cast some light where there would have been uncertainty.

Abrahams et al. concluded that good outcomes are achieved with early diagnosis and referral to a tertiary centre, which has resulted in more refined frameworks for antenatal counselling internationally. (Goel; Abrahams)

Take your partner with you

Every birth is different, but during the birth of my daughter, I had the privilege of orbiting through Harriet Bloom’s stratosphere. Harriet Bloom is a perinatal yoga teacher in Cape Town and has created an ecosystem to support everything intrapartum. She created a course to empower your partner to become your “birth partner”. It felt like the sweetest date night as we journeyed through birthing positions, options to relieve pain, phases of labour, as well as tips and tricks to advocate for the mother in the hospital setting. All in the romantic glow of candlelight.

It felt like the intimacy created that evening aligned our hearts. Communication felt easier, and trust deepened. I felt safe and held.

Read Children’s Books (for yourself too)

Age-appropriate books for the sibling which mention NICU, preterm birth or why the baby is in the hospital help children have a bit more awareness of what to expect. Books that focus on the siblings’ feelings of jealousy, confusion and pride normalise them.

Read the book first, as books should align with the family’s value system.

This may have the unintended effect of lowering maternal stress, especially if there are pretty illustrations or stickers. NICU jargon can also be intimidating and clinical, and simplified definitions help demystify the routines.

Life is unpredictable and can’t be bubble wrapped, but we can build soft landings and strong legs to bounce forward. I have seen many families perform “ordinary magic”, and I am reminded every 17 November! Happy Preemie Day!

ALSO READ: Too Soon: What You Should Know About Premature Babies

References

1. Field et al., 2010 (Infant Behavior & Development)
2. Vigod et al., 2013 (Pediatrics)
3. Holditch-Davis et al., 2014 (Journal of Perinatal & Neonatal Nursing)
4. Treyvaud et al., 2012 (Journal of Pediatrics)
5. Goel P, Agrawal V, Srinivasan RB. Management, Outcome, Risk, and Expectation Classification for Structural Fetal Anomalies to Aid Antenatal Counseling: A Systematic Review. J Indian Assoc Pediatr Surg. 2024 Jul-Aug;29(4):309-318. doi: 10.4103/jiaps.jiaps_53_24. Epub 2024 Jul 6. PMID: 39149443; PMCID: PMC11324076.
6. Abrahams I, Van Wyk L, De Vos C. The outcomes of specific surgically correctable congenital gastro-intestinal malformations at a tertiary level neonatal intensive care unit in South Africa.  https://doi.org/10.52783/jns.v13.1250
7. Lakshmanan, A., Song, A.Y., Belfort, M.B. et al. The financial burden experienced by families of preterm infants after NICU discharge. J Perinatol 42, 223–230 (2022). https://doi.org/10.1038/s41372-021-01213-4)
8. Kusters CD, van der Pal SM, van Steenbrugge GJ, den Ouden LS, Kollée LA. Impact van vroeggeboorte op het gezin: ook na 19 jaar ondervinden families nog gevolgen [The impact of a premature birth on the family; consequences are experienced even after 19 years]. Ned Tijdschr Geneeskd. 2013;157(25):A5449. Dutch. PMID: 23777961.
9. Nusinovici S, Olliac B, Flamant C, Müller JB, Olivier M, Rouger V, Gascoin G, Basset H, Bouvard C, Rozé JC, Hanf M. Impact of preterm birth on parental separation: a French population-based longitudinal study. BMJ Open. 2017 Nov 16;7(11):e017845. Doi: 10.1136/bmjopen-2017-017845. PMID: 29150469; PMCID: PMC5701975.
10. Louis D, Nykiforuk A, Chiu A, Oberoi S, Ruth C, Flaten L, et al. Parental separation following preterm delivery in Canada: a population-based cohort study. BMJ Paediatrics Open. 2024;8:e002408. https://doi.org/10.1136/bmjpo-2023-002408