Do you like November?? It’s the month I was married, so I look forward to the grays and lavenders outside, and the sense that we are winding down the stress on the inside. Foliage just always seems so busy – as if I’m trying to get everything done that I meant to do during the summer. I need a little sit-around-and-snuggle time!

I’ve been finishing up sewing projects, putting away the porch rockers. And of course now I’m starting to think about the holidays. So my few days of inner peace and calm may disappear pretty quickly.

Where is this all leading? November is also Prematurity Awareness Month, so I want to talk about staying pregnant for a good long while! The Association of Women’s Health, Obstetric and Neonatal Nurses (called AWHONN, thank heavens) just rolled out a new campaign called 40 Reasons to Go the Full 40 Weeks.

We are used to thinking about a pregnancy as nine months – but it’s actually ten lunar months (yes, 280 days) from the date your last menstrual period started. Forty weeks of seven days each – and remember, some people go overdue – so it could be up to forty two weeks.

Oh, but – I need to have this baby before (fill in the blank). Before Thanksgiving? Before Christmas? Why? So you and the baby can drive around to all the relatives, and you can learn how to breastfeed in front of family? Really? Or you just want to bring a premie out in the cold. Really??

It sounds like I’m being sarcastic, and of course I am. But the bottom line here is – there’s big trouble with having a baby early. If the baby decides it must come – or your body decides that baby must come – well, okay. But if you are bugging your doctor or midwife to get your baby here earlier – especially if you aren’t 38 weeks pregnant – let me tell you some of the risks.

Risks at Birth

  • Breathing Problems: Babies born between 34 – 38 weeks are more likely to have respiratory distress. This may mean they end up out of your arms – in the nursery, with oxygen to help keep them in good shape. That’s stressful for both mom and baby.
  • Temperature Regulation: Babies put on a good bit of “good fat” the last weeks they are in the womb. That means they can keep their temperatures regulated. A baby born too soon who gets “cold-stressed” starts to grunt – there’s those breathing problems again – and sometimes even has problems with….
  • Hypoglycemia (low blood sugar). If you ever get low blood sugar you know it makes you feel bad. But in a baby it can lead to brain damage. At the very least your baby will be getting his or her heel pricked for blood tests until the blood sugar stabilizes. No fun! And even if you are breastfeeding, these babies sometimes need IV’s or formula to keep them on an even track.

In the Hospital

Once you’re past those first hours, it would only seem fair that things would get easier. But since late preterms are still premies, they often have other problems. This includes

  • Sleepiness: In the womb, babies sleep a lot. That’s fine, since they are keeping warm and getting fed twenty four hours a day! But out here the sleepiness can be a problem. That’s because if can lead to
  • Feeding Problems: Feeding is a collaborative activity for babies. We provide the food – they need to eat it. Late pretermers are not yet on a full-term-baby sleep/wake rhythm, and sometimes the work of waking up and eating just seems like too much to them! You’ll probably learn how to use a hospital-grade breastpump and to hand-express your milk – and may need to pump after feeds when you get home too.
  • Jaundice (Hyperbilirubinemia): Later pretermers are more likely to get jaundiced for two reason: Their livers are immature, and they are poor feeders. This makes it likely that you will stay extra days in the hospital as your baby’s system clear the extra bilirubin in his or her system.

At Home

Once you are ready for discharge from the hospital (typically 3-6 days after the birth, depending on how well your baby is making the change to life out here) you’re likely to continue to have challenges with sleepiness and eating.

  • Immature Immune System: Your baby’s doctor may suggest you keep your baby away from friends, family and crowds for the first month. That’s because your baby missed getting many of the antibodies that it would have received via the placenta in the last weeks of pregnancy.
  • Developmental Delays: Last but certainly not least, your baby is at higher risk for developmental delays and learning challenges like ADD.

Years ago, we called babies born between 34 and 38 weeks “nearly term”. You can see that calling them late pretermers is really a better description – they are premies, not ready for prime time, and deserve the time to grow and mature!

Next week we’ll discuss ways to keep yourself and your baby together a little longer.

Reading: The AWHONN Late Preterm Infant Initiative