Prematurity: An Unscripted Beginning

Our nurses encouraged us to “perambulate” up and down the corridors of the maternity floor as soon as we got our legs back. During the day, new mothers shuffled by my room, back and forth, pushing rolling bassinets with their newborns inside.

One of my favorite mothers on the ward pushed the bassinet with one hand and held a steaming mug of coffee with the other. When I finally caught up with her, I told her the coffee smelled fantastic. “You better believe it was the first thing I asked for after this guy was born. I earned this.” She beamed down at the little fellow in his bassinet. He was wonderfully big and fat and favored his mother around his eyes.

“So where’s your baby?” she asked. It was an innocent question. I was pushing an empty wheelchair instead of a bassinet in order to keep my balance.

I hesitated before answering her. “Third floor, in the NICU. She was a little early.”

I knew she hadn’t meant any offense by asking, but still, she was incredibly embarrassed, and that pretty much ended the conversation with an “I’m so sorry” and “but she’s doing okay?” and “we’ll be praying for you.”

I mean, what do you say, right? Despite the fact that prematurity occurs in one out of every 10 live births, the experience of prematurity can feel entirely unscripted. It is a total departure from the usual what-to-expect narrative. And many times, it can feel surreal, because however you imagined your first experiences of motherhood, you probably didn’t imagine what it would be like to not hold your baby before you were discharged from the hospital.

It was 10 days before we were allowed to hold our little girl. Born at 29 gestational weeks, she weighed two pounds, four ounces. Birth drama aside, the moment prematurity became real to us was when my husband and I tried to compose a group text announcing her birth. At the time, we had no idea if her lungs were fully developed or if the medical team would find a brain hemorrhage. “Welcome, Susie Sunshine!” just seemed grossly inappropriate, but coming across as less than enthusiastic about the birth of our daughter just seemed kind of sad.

Early on, our nurses warned us to take one day at a time. I remember thinking their advice was a well-meant cliché, but “taking one day at a time” was exactly how our family navigated the unfamiliar terrain of bili-lit nurseries and honking alarms. A good growing day could easily be followed by a bad brady day (referring to bradycardia); a MRSA (methicillin resistant staph aureus) diagnosis one day could turn out to be a false-positive the next. So instead of focusing on “when are we going home?” we threw ourselves into the day-to-day care of our daughter. I can honestly say, I never thought I’d look forward to changing her diapers, but I did, and the first time I did, it nearly broke my heart.

After about two weeks, we became accustomed to the nursery. We celebrated the big moments as they came, whether it was graduating to a nasal cannula or wearing big-girl clothes for the first time. And through it all, our daughter was a rock-star, with a special rock-star scream for the visiting ophthalmologist.

The hospital staff was kind and supportive, and I enjoyed listening to their stories about their experiences in the NICU. I learned two different swaddling techniques, two different nursing techniques, and received a lot of great advice on how to manage the symptoms of acid reflux. My husband and I learned infant CPR. We kept so busy, we were nearly caught off guard when it was finally time to go home.

Two and half years later, Daphne is a highly verbal little girl and ruled by curiosity. It hasn’t always been easy, but I can honestly say that every day with her has been an adventure. She always finds new ways to surprise us. This past summer, she climbed up the backside of a mountain feature at an indoor playground. This was not her first summit to scale, nor will it be her last. She stood on top of the mountain and yelled, “I’m tall! I’m strong!” and I felt my heart leap: Yes, baby girl, you certainly are.

Prematurity then…

Sir Isaac Newton is one of the most famous preemies in history. Incidentally, he is also one of the most important scientific luminaries of all time.

In 1903, incubators were introduced to the United States as an exhibit on the Coney Island boardwalk with actual preemies from local hospitals inside. Although incubators were widely used in Europe, American hospitals were reluctant to adopt the new technology because it wasn’t deemed cost-effective.

The youngest son of President Kennedy was three weeks premature. Patrick Bouvier Kennedy succumbed to respiratory distress syndrome (RSV) three days later. His death in 1963 put a spotlight on prematurity and is thought to have inspired the modern field of neonatology.

And now

An infant is considered “premature” if he or she is delivered before 37 gestational weeks.
The earlier an infant is born, the greater the challenges they and their families will face, from speech and developmental delays to chronic health conditions ranging from asthma to cerebral palsy.
In 2014, the national birthrate of premature births was 9.6%. In Texas, the rate was slightly higher at 10.3%.

There is no single cause of prematurity. Risk factors include (but are not limited to) teenage pregnancy; lack of proper, affordable prenatal care; smoking; and alcohol consumption during pregnancy. Sometimes it’s caused by an underlying health condition; sometimes it’s just plain old bad luck.

When preemies leave the hospital, they have an “actual age” and an “adjusted age.” Their actual age begins on their birthday. Their adjusted age is usually calculated with their original due date in mind. This adjusted age helps doctors and therapists better gauge their developmental progress.

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