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[Adapted from The Preemie Parents' Companion, by Susan L. Madden. Copyright © 2000, used by permission of The Harvard Common Press.]

Your baby might require extra care if he is born premature (before 37 weeks or 8 1/2 months), or if he is born full-term but with special needs. You may or may not have known before labor and birth that your baby would have special needs. After hoping for and dreaming of a healthy baby, having a sick baby may feel like a shattered dream. You may be angry at yourself, your partner, your health care provider, or the hospital staff. You may even feel angry at your baby. You may be afraid that your baby will not live or will never be healthy. All of these feelings are completely normal. Your baby may be in a special care nursery or at a neonatal intensive care unit at your hospital, or may have been transferred to a neonatal intensive care unit at a different hospital. Your baby may receive care in one nursery, and then move to another, depending on changes in his condition. His health care provider will explain his needs to you and the level of care that is required.

In a special care nursery or newborn intensive care unit, a highly trained team of doctors, nurse practitioners, nurses and support staff provides care, monitoring and observation of your baby.

Symptoms of Preterm Labor

Remember, preterm labor is any labor that occurs between 20 weeks and 37 weeks of pregnancy. Here are the symptoms:

• Contractions (your abdomen tightens like a fist) every 10 minutes or more often
• Change in vaginal discharge (leaking fluid or bleeding from your vagina)
• Pelvic pressure - the feeling that your baby is pushing down
• Low, dull backache
• Cramps that feel like your period
• Abdominal cramps with or without diarrhea

If you start to have any of these symptoms between 20 weeks and 37 weeks of pregnancy, follow the instructions in the section below "What to do if you have symptoms of preterm labor."

Don't let anyone tell you that these symptoms are "normal discomforts of pregnancy"! If any of them (you don't need to have all of them) happen before your 37th week of pregnancy, you need to do something about it.

What to Do if You Have Symptoms of Preterm Labor

Call your health care provider or go to the hospital right away if you think you are having preterm labor. Your provider may tell you to:

• Come to the office or go to the hospital for evaluation.
• Stop what you are doing and rest on your left side for one hour.
• Drink 2-3 glasses of water or juice (not coffee or soda).

If the symptoms get worse, or don't go away after one hour, call your health care provider again or go to the hospital. If the symptoms go away, take it easy for the rest of the day. If the symptoms stop but come back, call your health care provider again or go to the hospital.

When you call your provider, be sure to tell the person on the phone that you are concerned about the possibility of preterm labor. The only way your provider can know if preterm labor is starting is by doing an internal examination of your cervix (the bottom of your uterus). If your cervix is opening up (dilating), preterm labor could be beginning.

You and your health care provider are a team, working together to have a healthy pregnancy and healthy baby. Your team works best when both of you participate fully, so your knowledge about preterm labor can be essential in helping to prevent a preterm birth. Talk to your health care provider about all of this, and be sure to keep all of your prenatal care appointments. Preterm birth is one of the complications of pregnancy that health care providers are working hard to eliminate. Your participation in this effort is just as important as theirs!

Your Baby's Doctor

Your baby's doctor may be a neonatologist (a doctor who specializes in the care of sick newborns and premature infants) or a neonatal fellow (a fully trained pediatrician who is learning the specialty of neonatology).

Residents

Residents (doctors who are training in the specialty of pediatrics or family practice) may help to care for your baby. Neonatal nurse practitioners (registered nurses with special training and additional education in newborn care) may assist the doctors. Your baby's nurses will provide close monitoring and specialized care. To provide continuity for both you and your baby, the same nurses may be able to care for your baby whenever they are scheduled to work.

Other Health Care Professionals

Other health care professionals, such as respiratory therapists, may help care for your baby. Hospital social workers can offer more resources and support. Care management specialists are also helpful in planning for bringing your baby home, especially if special equipment or help at home is needed. If you wish to breast feed, the nurses will offer encouragement, support and information about pumping and storing breast milk until your baby can nurse. Ask your heath care provider if a special nurse, called a lactation consultant, educator or counselor, is available to you as special needs arise. The nurses are experts in helping babies and their mothers with nursing.

When you first enter the neonatal intensive care nursery or a special care nursery, you may be surprised or frightened. You'll be surrounded by many lights, beeping and buzzing sounds, and complicated-looking equipment. The equipment is highly sophisticated and designed to monitor your baby's heartbeat, blood pressure and breathing. There may be tubes inserted into a vein in your baby's scalp, belly button, hand, or foot to provide fluids or medicine.

Intravenous (IV) Pump

An intravenous (IV) pump next to your baby will regulate these fluids. A pulse oximeter will measure your baby's oxygen level. Ventilators and respirators may be helping your baby breathe. Your baby will be cared for in either an open warmer bed or an enclosed heated bed, called an isolette. The time your baby spends in a special care nursery can be difficult for you and your family. It can also be a time of preparation for bringing your baby home.

If necessary ask your health care provider what you need to know if your baby is in the newborn intensive care or special care nursery.

Here are a Few Suggestions:

• Spend as much time with your baby as you like.
• It is helpful to be with your baby day or night.
• Touch, hold, talk to, and sing to your baby.
• Participate in caring for your baby and to share your plans/ideas with team members in the nursery.
• Your baby will not forget you. Your baby has been hearing your voices since the early weeks of pregnancy. Your baby knows you and needs you.

If you have chosen to breast feed your baby, begin pumping your breasts, preferably using a hospital-grade electric pump. Pump every few hours, simulating a baby's typical feeding pattern of nursing eight to 12 times in 24 hours. This will ensure an adequate milk supply for your baby.

Learn About Your Baby's Capabilities

Write down your questions as you think of them and ask your nurse or health care provider to find answers for you. Talk to the hospital staff. Ask frequently about how your baby is doing. Learn what you can do to participate in your baby's care.

Your partner, family and friends will each handle their emotions about this situation differently. Some may temporarily pull away. Seek out those who can give you the support you need.

If you have other children, you may feel pulled in many directions at once. Your children may act out their feelings in troublesome ways. Ask the hospital social worker, chaplain and nursing staff for help.

Some hospitals have child life specialists who can offer support for your other children.