Looking back- preterm birth and special care
Going into labour early (preterm or premature labour) is worrying and stressful. Mothers who had preterm births were shocked and understandably anxious about the baby's health, especially if the baby was very early.
She was shocked to go into labour at 22 weeks and afraid the baby would not survive. He spent 5...
And how many weeks pregnant were you?
I was twenty-two plus about five days. I just couldn't believe what, what I was hearing. And because there was no physical sign, no pain, I thought, 'Oh well, they've got it, they've got it wrong.' So I was told not to move off the, the couch. They got a wheelchair and said, 'You're going to have to go into the labour ward.' So I said 'Well, could you call my husband?' Anyway, they said that because it was so early, you know, that the child's survival is very, very low. And that, that it, to help the baby survive they would have to give me a course of steroid injections to mature the baby's lungs, but the injections - there would have to be two injections and they have to be twelve hours apart - but they weren't sure whether I would hang on for the twelve hours. So they had me on a bed with my legs elevated to act against gravity. Luckily I managed to hold out for the twelve hours and got the two steroid injections to mature the baby's lungs.
They needed to transfer me to a, another local hospital that had a special care baby unit for very, very premature babies, but they weren't, they weren't sure whether the undulating of the ambulance would set off the, the labour. Anyway, eventually they did take the chance and I got to the other hospital and within, within a few hours I went into spontaneous labour. And my son just popped out, a vaginal birth. If you blink, if you'd blinked you'd have missed the birth. He just popped out and they scooped him up and took him up, took him away. And funny - I remember sort of seeing his arms just waving in the air and sort of frantically working on him in the corner but he was, he was fine in terms of physically.
Then it was sort of, it was five months of up and down, roller-coaster of emotions in the special care baby unit. After four weeks, after four weeks he developed a blood clot in the hand and lost, lost the hand. Well, the hand, the hand - most people think it was amputated, but it wasn't. It just died and that, and that came off. And then there were trips up and down Great Ormond Street because of the lungs. Feeding. Eventually he stabilised and we spent as I say five months in the special care baby unit at this local hospital. And my son came out of hospital in, two days - no, sorry, three days after the date, the expected date of delivery. Off oxygen, so he didn't have to come, he didn't have to come home with any oxygen, which is very unusual for such a premature baby. But to date he is doing very well.
A threatened early labour could also be frightening - one mother who had a bleed at thirty weeks was worried about the baby but also worried about the effect of the steroids she took to help the baby's lungs develop and felt she had not really made an informed choice.
Bleeding in late pregnancy suggested she might be in preterm labour. She was worried about taking...
But we had, I really don't feel we had any choice about having those injections. I mean we, the doctor left us to talk about it, and we talked about it and we really weren't happy with it. And she came back and she said it was our choice but, you know, by the morning baby could be on its way and if it came at any point during the next few weeks then it would need to have had this injection, and the earlier it had it the better. And that they couldn't predict whether I was going into labour or not, which I'm not sure was entirely true because I think they're, they would've known at a slightly later date. And so I really feel like that's something happened to me quite against my will really. But you get into this horrible position where you're thinking, trying to think for the first - well, not the first time, because you're eating well and not drinking and things - but, you know, they very much couch it in terms of, 'You're doing something for the baby', and you're worried that your response to it is about you and what you want, and you should be trying to think about the baby and what's good for the baby. And that's really hard, because they obviously know much more about what's right for the baby than you do. So we did have these injections. And everyone I asked about it in the hospital seemed to think it was entirely routine and fine, and my great book seems to think that it's okay, but still to me it felt like a very extreme reaction to
What were you worried about?
Well, being given two injections of steroids, twelve hours apart, what else they would be doing. I mean, her essential response was that they wouldn't harm the baby but they might not be great for me which I, is fair enough. I mean, you stop thinking about yourself in the same way. But I suppose I just don't trust them that it might not do something else to the baby'
I still think about the steroids thing because I still feel fairly unhappy about having, having had the injection because I don't really feel like I made a, that we made a choice. I feel we were made to have a choice. I mean the doctor said to us at one point, "You're not taking this seriously enough," and and, you know this, and actually of course you're taking it seriously [laughs] but sometimes you just, you know, you don't, your gut reaction is not to trust something, you know, not to feel something is the right thing to do, and that it's happening very fast. So I still, I don't feel as bad about that as I did at the time, but it still preys on my mind a bit that it was quite a big thing to do.
Most preterm babies will need at least some time in a special care baby unit or neonatal intensive care, and this may mean the woman has to transfer to another hospital during early labour. Being moved to a hospital with less specialised intensive care facilities upset one couple - but no places were available locally. The two hospitals seemed to have different policies about the drugs prescribed to try to stop the labour, which worried them.
When she went into preterm labour, the local special care baby unit had no spaces. They were...
So it was simply a precaution?
...the treatment didn't work and you were... How, how soon afterwards did you in fact give birth?
Father' Next day, wasn't it?
Mother' It was
Mother' it was, well, yes, I suppose you...
Father' So this was --
Mother' It was 36 hours from...
Father' this was about eight o'clock in the morning when we were finally told we were going to have to be moved. And then they started ringing round and they must have rung ten hospitals, they said, before they finally found somewhere
Father'...that could take us. And when they said that, I thought, 'Oh my God, we're going to be in Scotland, or something stupid like that.'
Father' And so then it took them a little bit longer to arrange for an ambulance to take us across and make sure they had a midwife to go with us. And then we must have travelled over at about half eleven, twelve o'clock to the hospital, the other hospital. The stupid thing is we were going from the referral centre, where a baby should be transferred to, to the hospital but, so it was back to front, completely ridiculous.
To a less specialized place?
Mother' Yes, exactly.
So you knew that at the time, that, that you were going from a sort of more specialist to a less...?
Father' No, they only told us when we got there, that normally they would refer children or babies back to where we'd come from.
How did you feel when you discovered that?
Father' I just thought it was ridiculous, really, that we were in such a state and that this was going on. Because we were there, there was another couple who were, lived quite far away, and then on the news they were talking about a couple who had to travel 200 miles to visit their child because it had been, that was the only hospital they could find. So it seemed all of a sudden it was all over the place, this thing was happening. And then what made it worse was that the, the procedures that were put in pla
As with any birth, empathy and support from staff made a big difference. A French woman who was very anxious about labour had planned to go home to France for the birth, but went into labour at 34 weeks. The midwives and doctors helped her feel relaxed and confident.
She planned to go home to France for the birth but went into labour early. The midwives and...
When the contractions, when I was free from contractions I was just happy lying there, and they were having this lovely chit chat with me and trying to make me laugh, And the obstetrician was, he had quite a, a very English humour, I must say, and he told me, 'Oh, you see, well you didn't need to go to France to have a baby. It's happening well in here.' I thought, 'Yes, just shut up - I'm hurting.' I was thinking, 'Why is he trying to laugh with me? I'm not in a state to laugh.' And he said, 'Oh, next time please, do it in France, but take me with you because I would love to go again to Paris.' And I was thinking, 'Oh, is that the time to have humour?' [laugh] But I think actually, you know, that was quite refreshing. And the midwife who was monitoring the heartbeat of the baby, just before he was born she told me, 'Oh, my God.' And she called everybody, 'Look, just his heartbeat is just like really going for it. He's going for it, it's not fading or anything.' Because as I understood, sometimes during the baby, when the baby goes through the, the heartbeat slows down. Well apparently mine didn't. He wanted to go there. He wanted that to happen. So, yeah, there was all the monitoring.
So had you expected or planned to be moving around more, or do you think that's what you would have done?
I wanted to be moving around more. Well, I did, waiting for the contractions to come. Yeah, I did move around. But I would have liked probably to, to have a different position. Next time I will request it, but when it's the first baby I think you just, you don't know what to expect and I was just going with the flow. I was just, they were telling me to do something and I was just doing it because it was simpler. But next time, yes, I will have a different position to give birth.
In contrast, another couple whose first baby was born at 33 weeks felt unsupported at one stage. As they pointed out, women who have a preterm birth have often not had time to attend any antenatal classes or think about birth choices, so they very much need advice and continuous support.
She felt unsupported and lonely in labour, and did not know what to do. It helped when one doctor...
So she had to go off and she said, 'Oh, this midwife here will look after you.' And she was actually, the midwife that was going to look after me was a senior midwife. So my, the midwife that was going to help me went off, to do this tour. And the senior midwife was in the room, and she said, 'Oh, right, here's the table. Get on the table. Here's the gas and air. If you need me ring the bell' and she went out. And that was it, really. And I was just sort of left on my own in this room. And all I could hear through these contractions, and I just took this great big gulp of gas and air thinking, 'Oh, I'll have a go, have a go at this and see how it feels' was all this laughing outside the room. And I was thinking, 'Oh, it just looks, sounds like they're having a coffee morning out there or something', you know. And I couldn't believe that I was just lying on this delivery bed and I'd just been given this gas and air and this button nearby to press if I needed her, and she'd just gone swanning out. And I just thought, 'Well, what do I do? Do I press the bell and say, 'Well, can you come and wait in here with me? It's my first baby, I don't know this hospital, I don't know what the procedures are, I don't even know what the breathing is I'm meant to be doing'. Well, you know, do I do that? Or do I just stay here by myself and play it by ear?' So I just stayed in there by myself and waited for [husband]. And I think it's when you came that the other midwife came into the room with you.
Father' Which one?
Mother' The older one that was just looking after me.
Father' Oh, yeah - matron. She was a bit...
Mother' And she was so...
Father' -old school, wasn't she?
Mother' -awful, she was awful.
This is the one that was covering while the other one was doing the tour?
Mother' Yes, that's right. And she, I think because I hadn't got, had a birth plan written down, or I hadn't really, really thought about what was going to happen during birth, I think I said something like, 'Oh, well, when..' - I didn't realize how quickly it would happen or how slowly it would happen - I said, 'Well, when the baby's born, could we discover the sex for ourselves?' Because that's one of the things I'd read about. You should mention things like that just in case they say, 'Oh, it's a boy, it's a girl.' And she said, 'We don't do things like that at this hospital' and just had such an attitude, didn't she, when she spoke to me? And I said, 'I've never been here before. How am I sup-' you know. And then I was thinking, 'Well, how am I supposed to know what they do at this hospital and what they don't? And it's so obvious that this midwife obviously has no interest in finding out about, well, where have I come from? You know, what's happened to me? Why am I..?' You know, she had no interest at all in what was happening to me, and while I was, you know, having these contractions and I was
After birth, parents knew their baby had to be taken to special care, but it was still upsetting to be parted. Some women found it difficult to feel close to the baby at first, although others bonded straight away. The caring attitude and technical expertise of staff in special care units was greatly valued.
It took a long time to feel attached to the baby when he was in special care. She found it hard...
It took a long, it, I remember it took a long, it took a long time for me to feel attached, attached to the child, because when he was in a special care baby unit in the incubator you, I could put my fingers in in the side and touch him, but it still didn't seem real. It just, it, I felt as if I was having an out-of-body experience, so I was sort of looking down, looking sort of this situation and I was in the frame, but I wasn't. And at the back of my mind with all the machines going, I kept thinking maybe, maybe we will lose him, but I just kept praying for him to survive. And it didn't matter what happened. I just wanted him to survive. And I remember vividly one of the senior nurses coming over to me because at first I wouldn't touch. I remember I wouldn't touch him. I wouldn't touch him and she said, 'Oh come on, Mummy, you've got to', you know, and she took my, she took my finger and pushed it into, into the incubator, and I remember stroking him and he felt really hairy, just very, very hairy. And he didn't look, he didn't look, he didn't look like a human being. He looked like a little, a little rat, or a little chicken. So I remember that very vividly.
So at what point, I mean, you said that there was then a five month roller-coaster ride. Tell me about that. What were the ups and downs that you lived through?
The ups and downs there I remember not wanting to go to the hospital on my own. So always waiting until my husband, my husband came home from work so that we could go up together, because at the back of my mind I used, I would think, I don't want, I don't want to hear bad news on my own. And I remember walking onto the ward and if one of the consultants or the nurses were walking towards me I'd be convinced that they had something horrible to say. You know, something had happened - when in fact they probably were thinking about what they were going to have for lunch, or what they were going to do when they got home. So the, I went through a phase of not wanting to go to the hospital on my own. And then after a while I got over that and I would go up and tend, tend to my son because they, they encouraged you to take part, to take part in the care and the nursing, nursing of the baby. There was also the sense of when you went up the hospital and having to leave, to leave him there, because up until the sort of twenty-two weeks he was inside me and was part of us at home, being involved, and then all of a sudden we always kept having to leave him there. We, our first, yeah, his first Christmas was spent in the special care baby unit and I remember, remember decorating his crib and having lights, and celebrating him making it to Christmas.
Staff in the special care baby unit were wonderfully supportive and there was a family atmosphere...
But it was just so strange atmosphere. You were feeling like in a cocoon, really protected. And I saw, I mean, all the different shifts because my baby stayed twenty days there, so I saw all different people working there. And some of them when I was arriving they were holding either my baby or another baby, and they were cuddling and kissing the babies and talking, you know, little words like, like a mum does. And I thought, 'Wow. It's not just a job. It's more than a job, it's actually really caring for the babies, whoever they are.' And that was surprising. I never realised that people could be so committed. Well, it's lovely to have a baby, even if the baby's not yours, it's just lovely, but they were just so committed. And they talked me through everything, how to bath him, how to breast-feed, everything. They were just there every step - without me even asking sometimes, they were there. They knew probably, you know, what the next step was going to be, so they were telling me first before I was asking. And the day that we left the hospital was heart-breaking, because I wanted to go every day again to see them. I couldn't [laugh], I had no reasons, but it was like leaving, yeah, a part of the family or friends, and it was nearly tears. And they were like, 'Oh, so our big boy is leaving now.' And one of them actually asked me, she was one of the newest ones. She said, 'Well, I've looked after him for the last two days and a half, can I please go with you to the car park to the car?' I said, 'Of course you can.' So she, she came downstairs with us. She escorted us to the car, just to say, you know, to stay a bit more with my son and to say goodbye. And so yeah, it was like really family. We went a few times after that to say hello. And each time it was the same atmosphere. You know, it's like, outside world, and you go through these doors and it's like oh, a different world completely.
Mothers who lived close enough to the hospital could go home at night, although it was always difficult to leave the baby behind. The woman who had been transferred to a hospital some miles from home decided to stay with the baby, but she felt in limbo waiting for normal life to start again. After five weeks they discovered the only reason the baby was being kept in special care was to establish breastfeeding, which preterm babies may find difficult. They decided to change to bottle feeding and go home.
She stayed in hospital for five weeks while the baby was in special care. The nurses were very...
Did you feel you got much emotional support from the, the staff on the neonatal unit?
Mother' Yeah, there were a few of the nurses that I really connected with, that gave that kind of support. And I think that's, I think that was with everybody. There was always a certain nurse that you could really talk to. I mean I'd get up in the middle of the night and I'd go down to look at him or change his nappy or feed him. And I'd be the only one, only mother there on many occasions, because quite a lot of them were going home because they lived closer to the hospital. So I would be there and I'd just chat to the nurses. And that just, even if I was chatting about nothing in particular or it was nothing to do with babies, it just really helped, you know, having somebody to talk to.
Gemma cried when she couldn’t hold her baby who stayed in special care until he was 35 weeks old.
So, so you gave birth at 7 and you didn’t see him till, till 5 in the afternoon?
5 in the afternoon.
And did anybody tell you what was happening in that time?
No. They, they did, they didn’t even see me until 4 o’clock, when this other midwife come in and said, “Right, come on then, Speedy.” That’s all she said, “Come on, Speedy. Right, we’ll run you a bath, freshen you up.” And I said, “When can I see my son?” She said, “Well, when we freshen you up you can see your son.” So basically I had a bath, got out quickly [laugh]. And she said “Well, that’s not long enough.” I said, “I want to see my son.” And she said, “G, you can see your son in a minute. But we’ve got to take some blood out of you as well.” I said, “Well, you could do that after.” And I said, “I’m gonna freshen myself up and go and get changed and go and see him. Can I see him now?” So I got dressed. And so they showed me where to go. And then me and [husband] went to see him. And he was in this like incubator with like tubes and everything in him and that. And I said, “Can I hold him?” Like, “No, you can’t hold him just yet.” I was like, “Can I just like touch his hand?” “Yeah, you can touch his hand.” And so they sort of like left us. And basically I started crying because you couldn’t hold your baby. D’you know what I mean? So then they told me like to go.
So then I was up in the ward like because you have to stay in there for like five days. But j-, then I stay in long, for a bit longer, like fourteen days. So we were like up and down town to town, like fourteen days, like for two weeks like up and down, you know, from town to town. And then eventually I think the best time was, to get him out of there was when he was 35 weeks.
A mother of twins was upset to discover her babies were in special care only because the wards were short-staffed and could not manage a mother with twins. Seeing other mothers with their babies while hers were in special care brought back painful memories of having a termination for a genetic condition (see 'When something is wrong with the baby').
Seeing other mothers with their babies while her twins were in special care was very upsetting...
When they were born did they not hand them to you and say, 'You have two healthy babies'?
They showed them to me, they didn't hand them to me, they showed them to me and then took them away to special care, which was scary. And then I was left in a room, the recovery room place, and my husband was there as well, and the clock was wrong in the recovery room and my husband was moving chairs and standing on it to move the clock, which was by the by. But, and then I was taken up to see them, and then I was taken to the main ward. And then I was incredibly upset because everybody else had a baby and I didn't have a baby and it was just all, all came back, all over again. And then I cried so much they moved me off the main room and, and put me in my own little room by myself. This is the thing, you have to be really upset and you get your own little room. And I look back and I think, they had my notes, they could have read them, I should have been flagged up as 'major likelihood of post natal depression', 'major likelihood to be upset'. But then nobody had read the notes and that has been a recurring theme throughout everything, is nobody reads the notes. And it takes five minutes probably to get a quick overview of a patient, and sometimes they'll keep you waiting for half an hour but they still won't actually have read the notes, so. I found a, a midwife who was sympathetic, who made sure that I could get to the ward, but the thing was I'd had a section. I couldn't, it was a long way to the special care unit and I couldn't walk that far. I had to get somebody to push me in a wheelchair and I wanted to breastfeed and they were being tube-fed. And it, it just was, it was not a good experience to have them on special care. I wanted to breastfeed. Theoretically they were supportive of that, in practice they weren't, because it's not very convenient to have a mum who wants to breastfeed on the special care baby unit. It, it just, I was in the way.
Some women are at risk of having another preterm birth in future pregnancies. One mother was monitored closely in her next pregnancy and had a stitch put in her cervix to reduce the chances that it would start to open too early. After a car accident at 23 weeks, she was advised to spend several weeks in hospital, although towards the end she was allowed home for a few nights. The pregnancy lasted successfully till 37 weeks and the baby was fine.
In her most recent pregnancy she was afraid of going into labour early again. After an accident...
And when they scanned the cervix had started to open above the suture and at that point they said, 'Right you're going to be in hospital for thirty, for the ten weeks - a month - yeah, ten weeks. And I remember thinking, 'Oh my God, ten weeks in the hospital just laying on the bed, what am I going to do?' And then I thought, 'If that's the way it's got to be, that's the way it's got to be'. So they had me in hospital, permanent bed rest, monitoring, everything, blood pressure, blood analysis scanning, everything. And after ten, eleven weeks and everything was going well they said, you know, you can come out and do a few nights at home.
For further links see our pregnancy resources.
Last reviewed May 2017.
Last updated August 2012.