This is a guest post by my friend Silke. She had two premature sons:  Max, born at 25 weeks and Felix, born at 28 weeks. She recently has put much effort into the launch of the Hearts Milk Bank, a not-for-profit social enterprise, which will soon operate in Greater London to fill the current shortages of donor milk in the area. Today, it’s World Prematurity Day and Silke wrote this post to educate us on the care of premature babies and the importance of donating milk.

Felix, born at 28 weeks, day 0 of his life

Pregnancy, we all know, for some women is pure bliss and for others a more arduous affair. But no matter how high or low you are feeling during pregnancy, nothing can prepare you for a premature birth.

My name is Silke and I live in London with my family. I am a mum of three, Lia, Max and Felix. My first pregnancy was easy. Lia was born at 37 weeks, which is not unusual. Labour was quick but all went well. Lia grew up and after a few years we tried for a second baby. The pregnancy was fine; I was healthy and happy to be having a second baby soon.
But then things went wrong. From one moment to the other I started having contractions at 25 weeks gestation. Doctors tried to stop labour unsuccessfully and 3 days later Max was born. He was a tiny boy, weighing only 750g (which is an average weight for a 25-weeker). Max was transferred to one of the UK’s best neonatal units, NICU. However, despite the best care, he passed away.
To loose Max was devastating and it took a long time to accept what had happened. Doctors did not know why I went into early labour and it seemed that we had just been unlucky. After a while we felt that our family wasn’t complete yet. We decided we could not possibly be unlucky a second time and tried again for a baby. I fell pregnant with Felix.

Having had a preterm baby, I was under close observation and had scans and blood tests regularly to keep a close eye on my pregnancy. All was fine, but still I stopped working at 24 weeks and took it easy. In the end we made it to 28 weeks with Felix. He too spent time on a NICU but luckily made it and is now a happy and healthy three-year-old boy.
Doctors still do not know why I give birth early.

Felix’ dad holding on to his dad’s thumb

Babies are increasingly born prematurely. In the UK for example, 70,000 babies (nearly 10% of all babies born) are born prematurely each year and the numbers are rising.
There are three gradations in prematurity: babies born between 24-28 weeks gestation, between 28-32 weeks and 32-37 weeks. There is a big leap in babies’ development especially around the 28 and 32 week mark. The care of premature babies depends mainly on three factors: their prematurity, the reason why they are born prematurely and how healthy the babies are the moment when they are born. In general, we can say that the earlier premature babies are born, the more difficult is their care.
When born, prematurely babies will spend time in an incubator, which keeps them warm. The earlier the babies are born the more difficulty they will have breathing, due to their underdeveloped lungs. There are various ways of helping babies to breath: a ventilator, if they are not able to breath by themselves; CPAP, which assists their breathing and blows air with slight pressure into their nose; and lastly oxygen tubes which are put under their noses with light oxygen flow. Both Max and Felix had all three before they were able to breath on their own.
To feed preterm babies is a rather medical procedure. In an ideal world, preterm babies are fed breast milk or donor milk through a tube. The feeding tube goes through their mouth or nose (if they do not need any breathing assistance) straight into their tiny stomachs. Only after 34-weeks gestation babies will have developed the sucking reflex and will be able to feed at the breast or bottle.
NICU nurses and neonatologists perform a lot of the medical care, but no matter how early the babies are born, the parents can still do a lot of the personal care of their little one(s):

• Touching and speaking to them. It is important that parents keep in contact with their babies. Amongst all the noises on a neonatal unit, like beeping monitors and people talking, it is important to hear the voices of mum and dad. Babies recognise them and it makes them feel secure. So sitting by their side, holding their tiny hands and talking to them, reading a children’s book or singing a lullaby can work wonders. Actually, both for the baby and the parent.

• Baby changing and washing. No matter how small, the babies need to be washed and changed. In UK hospitals, this is the task of the parents. At first it can be a bit stressful, for both the baby and the parent, but after a while both baby and parent get used to putting on nappies (a fraction of the size of normal newborn nappies!) on tiny, tiny bottoms.

• Kangaroo care. This is the moment when the babies come out of the incubator or cot and you cuddle up with them. For hours! Skin to skin, baby and parent can feel each other’s heart beat, and the parent can keep the baby warm. The most amazing fact I think is, that the parent’s body temperature adjusts to that required to keep the premature baby exactly at the right temperature! Sitting with my boys for hours and giving kangaroo care was the best time we’ve had in the neonatal unit.

• Expressing breast milk. Kangaroo care also helps the mother’s breast milk to come in. Giving breast milk is maybe the most important way for mothers to care for their premature babies. Research shows that breast milk is ideal for babies in terms of its digestive qualities, the nutrients and the immune-boosting components. It is therefore very important for premature babies, as their intestines are not fully developed yet and their immune system is virtually non-existent. Breast milk reduces the risk of infection in preterm babies. However, when you have a premature baby your body is not ready to produce milk yet. Donor milk can help to bridge the time it takes for the mother to produce breast milk herself, which may days or even weeks. When available donor milk can help to reduce risk of infection and help to save babies’ lives.
  We were very lucky to have been offered donor milk for both Max and Felix. This gave us peace of mind knowing that they both got the best care, as well as a chance to get my own supply which in both cases took a couple of days. Unfortunately not all hospitals have access to donor milk hence it is not always offered to parents of premature babies. The donor milk available has kindly been donated by other mothers and has been tested and heat-treated at a milk bank. One of these milk banks is the Hearts Milk Bank, a not-for-profit social enterprise, which will operate soon in Greater London to fill the current shortages of donor milk in the area. The Hearts Milk Bank is at its beginnings and needs not only milk donations but also financial support. If you want to know more, please visit the website and watch the film.

Silke holding Max, kangaroo care

Felix, age 2, and Silke

Thank you,
Silke