If a woman develops severe pre-eclampsia or HELLP syndrome, her baby may need to be born early if continuing the pregnancy becomes too risky. But delivering early can have serious impacts on the baby, as premature babies can have health problems as they have less time in the womb to fully develop. It is also thought that pre-eclampsia can sometimes cause babies to be smaller compared to their peers at the same gestation.
Some women we spoke to delivered early. Their gestation varied; Kay’s baby was 25 weeks old, Paige’s baby was 32 weeks, and Aileen’s babies were born at 30 and 34 weeks respectively. It wasn’t always clear whether the baby was going to live after birth. This was a fear for Kay who found it reassuring when doctors described her baby girl as a “fighter”. Munirah developed severe pre-eclampsia which caused her baby to have brain haemorrhages (bleeds inside the brain) and he was stillborn at 25 weeks.
But not all of the babies of women we spoke to were born early, nor did all have health problems. Angela’s baby was born at full term (40 weeks). Mairi’s baby had no health problems and her doctors “were very clear that the problem was not with the baby; the problem the whole way through was with me”. Helen X’s baby had some problems establishing feeding but otherwise no major health concerns.Preparation and anticipation
Some women talked about trying to prepare themselves for the arrival of a premature and potentially ill baby. Women spoke about being frightened and worried. Sarah remembered “sobbing my heart out while they were trying to put this epidural in my back”. It could be hard to know what to expect and doctors could only talk about likelihoods until the baby was born.
Premature and unwell babies were looked after in neonatal units: a NICU (Neonatal Intensive Care Unit), a LNU (Local Neonatal Unit) or a SCBU (Special Care Baby Unit). Some women who had the chance to talk to a paediatrician or neonatal specialist found this very helpful. Kay also had a tour of her NICU beforehand. However, Josie said that nothing could have prepared her for the reality. Aileen is a neonatal nurse and so was aware that her baby had good chances of survival at 34 weeks but also knew the risks.Immediately after birth
Hearing a baby’s first cry was very emotional. Claire’s baby was born at 34 weeks and she had been advised by the paediatrician that she might not cry right away: “if I hadn’t been aware of that I think that would have freaked me out even more. She did cry, it was very weak, but at least it was a cry”. Josie remembered hearing her baby scream and then go quiet, which was frightening. Several women said their baby needed to be resuscitated after birth. Julie saw her baby being resuscitated which she found “horrific”.
Premature and poorly babies were quickly taken away to SCBU or NICU, so women did not always find out immediately after giving birth whether their baby was okay or get a chance to see and touch them. Kay didn’t know what sex baby she was having and her baby was taken away so quickly for medical checks; she had to ask a midwife if her baby was a boy or girl. Samantha X saw a “glimpse” of her baby on the way to SCBU, but was sad to have missed out on getting to hold her daughter.
There were sometimes delays before mothers could see their babies again. These delays could be upsetting and affect how they felt about early bonding
. Kate remembered being “worried about when I’d see him again, would he know me? Would he like me? Because I felt like I’d let him down”. You can read more about some of the emotional experiences here
.Medical concerns and treatments
Not all the babies of the women we spoke to had health problems or needed treatments. But for those who did, the main medical ones were:
Several babies had needed help breathing and were given CPAP (Continuous Positive Airway Pressure). This involves a mask or nasal prongs (small tubes) being fitted over the nose, which keeps blowing air and oxygen into the baby’s airways to help them breathe more easily. Aileen explained: “if you think about a balloon-, that when you first inflate a balloon it's very difficult to inflate. So, my baby's lung was like that; it's very difficult to inflate, so with the help of that pressure it stays open, his lungs stay open basically”. Sometimes oxygen was added to help the baby’s breathing a bit more. Paige’s baby had CPAP initially but only as a precaution. Sometimes babies needed help with breathing for longer and a few stayed on oxygen for a while after being discharged home.
Babies born early often have not yet developed the ability to suck milk from the breast or a bottle. Because of this, some babies were fed with a feeding tube. Some women were able to express breast milk which was given to their baby through a tube. Babies were usually able to move on to being breastfed or bottle-fed after a while, although not all women were able to establish breastfeeding or use their own milk because of their medications (see also the section on breastfeeding
). Sarah’s son had problems with his digestive system, as well as feeding, and this meant he needed a gastrostomy tube into his stomach until he was nearly aged five. Nicola’s baby would stop breathing when feeding, which meant she needed to be tube-feeding for a while. Betty’s baby had reflux and vomited a lot.
- Body temperature regulation
To help keep premature babies warm, they were often placed in an incubator and/or had a heated mattress. This meant it was hard for parents to touch or hold their baby. Helen X and Kate’s sons were born a few weeks early and just needed to be kept warm for a few days. Sometimes parents were able to do ‘kangaroo care’ (which involves holding the baby inside their shirt or top with a lot of ‘skin-to-skin’ contact) if their baby was more stable and well enough.
A common condition for babies is jaundice, which makes the skin and eyes yellow. It is caused by a build-up in the blood of bilirubin (a substance produced by the liver which is found in bile). In healthy newborns, jaundice often corrects by itself, especially as the baby gets older and their liver works better at processing the bilirubin. For premature or poorly babies, treatments are available. Betty, Ruth X and Lyndsey all remember their babies having light treatments to help.
Premature babies have less developed immune systems and some medical interventions (like intravenous lines) increase their risks of picking up an infection. Sometimes antibiotics were given because the baby had symptoms of an infection, other times as a precaution. Paige’s baby had a thrush infection which became serious. Kay’s baby had a suspected MRSA infection when she was 10 days old. Olivia’s baby was monitored for 48 hours because she had tested positive for a bacteria called Group B streptococcus during her pregnancy.
Some babies had other medical problems – some related to their pre-eclampsia, others unrelated. Sarah’s baby had septicaemia (a bacterial infection of the bloodstream) and scans showed he had had a bleed inside the brain at some point. In addition, her unborn baby had been diagnosed with a heart problem 21 weeks into the pregnancy and which would require surgery once born; although the heart condition was unrelated to pre-eclampsia, Sarah had worried the condition and being born prematurely might exacerbate health problems. Betty’s baby had high levels of insulin after birth, which eventually he outgrew.