A Week-by-Week Guide to Premature Babies

Premature babies are any infants born before the 37th week of pregnancy. However, if you've ever spent time inside a neonatal intensive care unit (NICU), you know that a 30-week preemie, for example, is very different from one born at 24 or 36 weeks.

Almost all premature babies are small and require complex medical care both in the NICU and at home. They will inevitably face far different complications from those born closer to their due date.

23 to 24 weeks

Premature babies born between 23 to 24 weeks gestation are called micro-preemies. They weigh just over a pound and measure about 8 inches long from their head to their bottoms. Here are some other things to note:

• Some 30% of babies born at 22 weeks who receive medical care live to see life outside the NICU. If they are born just two weeks later, at 24 weeks, babies who are medically treated have more than a 50% chance of survival.

• Babies born at this time will be covered by fine hair called lanugo, to keep them warm, as they have not yet developed brown fat.

• Their skin is also very thin and delicate.

• Although their eyes will most likely be fused shut, they'll have fully developed eyelashes and brows. They will even have tiny fingernails.

• Most of the body's systems are underdeveloped at 23 to 24 weeks gestation. The lower airways are only beginning to develop, which is why many 23-weekers and 24-weekers need respiratory support for long periods.

• Babies at this age have fully formed hearing systems. While that means they can hear your voice, loud noises can overwhelm their underdeveloped nervous system.

25 to 26 Weeks

By 25 to 26 weeks, premature babies weigh about 1 1/2 to 2 pounds and are about 9 inches long when measured from head to bottom. By 26 weeks gestation:

• Premature babies' lungs are starting to develop alveoli, the air sacs that allow gas exchange. While they are still too young to breathe without help, this is a major milestone.

• The startle reflex is developing. A baby born at this time will startle at loud noises—a normal reaction of their nervous system.

• Their footprints and fingerprints are also developing.

• 50%-60% survival rate

27 to 28 Weeks

By 27 weeks, premature babies are no longer considered micro-preemies. Now called "very premature babies," these infants have a greater than 95% rate of survival past birth and NICU discharge. However, at 27 and 28 weeks, babies still require a lot of medical care and can be expected to stay in the NICU for several weeks.

• By 28 weeks, premature babies weigh about 2 1/2 pounds and are about 16 inches long from head to toe. Other developmental milestones to know are:

• Premature babies born after 27 weeks can blink and no longer have fused eyelids.

  The retinas are still developing, which puts babies at risk for retinopathy of prematurity (ROP). Their eyes can form images at this stage.

• Premature babies are also starting to develop more coordinated sleep/wake cycles and will have periods of REM sleep.

29 to 30 Weeks

By 29 to 30 weeks, a growing baby has matured a great deal. A premature baby born between 29 and 30 weeks will still require a NICU stay, but their vital organs are much more developed than those of babies born earlier. At 29 to 30 weeks, premature babies weigh about 3 pounds and are about 17 inches long. You may also notice:

• While they're still very small, 29-weekers and 30-weekers have more fat stored under their skin, making them look more like full-term babies.

• They're also starting to shed their lanugo (the fine hair that covers a preemie's body).

• Their eyes can now blink, but bright lights and loud noises might still make them uncomfortable.

• The brain is starting to look grooved and wrinkled.

• They are also mature enough to begin controlling body temperature.

• They feel secure and cozy with swaddling and nesting.

• The baby's stomach and intestines are maturing and getting ready to digest milk.

• They still cannot nipple feed, so will be fed through a tube. But they can begin sucking on a pacifier to help develop these muscles.

• Kangaroo care becomes appropriate for babies starting around 28 weeks. Holding your baby skin-to-skin will not only help you bond, it has been shown to lower babies' pain response.

31 to 32 Weeks

By 31 to 32 weeks, premature babies weigh between 3 1/2 and 4 pounds and are between 18 and 19 inches long. That's almost as long as a baby born at term, but there are a few differences to note.

• Between 31 and 32 weeks, babies gain a lot of body fat. Premature babies born at this age are starting to look plump and may be able to maintain good body temperature without the help of an incubator.

• They use all five senses to learn about their environments but still may get overstimulated by bright lights and loud noises. That being said, at this age, your baby will likely enjoy seeing your face up close.

• Preemies must be several milestones before most NICUs will discharge them. They must be able to:

  • Take milk by breast or bottle without needing tube feedings

  • Maintain a healthy body temperature without the need for warming devices

  • Gain weight steadily

33 to 34 Weeks

Premature babies born between 33 and 34 weeks are called "moderately pre-term babies." Weighing between 4 and 5 pounds at birth and measuring almost 20 inches long, these babies are getting much closer to the size of a baby born at term.

• Premature babies are almost fully developed by 33 and 34 weeks. Their bones are fully formed, their fingernails come to the ends of their fingertips, and in biological boys, the testicles are descending into the scrotum.

• Although they are getting bigger, 33- and 34-weekers are still immature and may need a stay in the NICU.

• The respiratory system doesn't finish developing until the last weeks of pregnancy. Antibodies are only starting to pass from parent to baby—so preemies' immune health is still a bit compromised.

35 to 36 Weeks

Premature babies born at 35 to 36 weeks are called "late pre-term infants." These babies are about 20 inches long and usually weigh between 5 1/2 and 6 pounds.

• These babies have reached their full height, are gaining weight rapidly, and have fingernails that come to their fingertips and fully formed footprints. They often look just like full-term babies.

• Their lungs won't be completely developed for another couple of weeks, and they may need a bit more time to learn how to breastfeed or bottle-feed. Continuing to protect their sleep and time in the NICU until they are ready to go home is important.

Read full article here:

https://www.parents.com/premature-babies-week-by-week-2748606

https://pmc.ncbi.nlm.nih.gov/articles/PMC1117667/

Signs labor is 24 to 48 hours away

When looking for signs that labor is coming in the next day or two, keep in mind that, because every pregnancy is different, the signs of approaching labor don’t really come with a timetable. These signs, however, are common early signs that labor just might start very soon.

1. Nesting

   • When labor approaches, you may find yourself feeling energized and focused on readying your home for your new baby.

   
   

2. Lightening, or dropping

   • You may notice you’re carrying your baby lower in your belly than before. That’s because baby is facing down and baby’s head is moving toward the birth canal in preparation for delivery.

   • as you approach delivery, your baby descends lower into the birth canal, a process called "engagement." With this move, the weight of your baby is no longer pressing on your diaphragm, and you may be able to breathe more freely as a result. The tradeoff? The potential for more pelvic pressure, which could mean even more frequent urination.

   
   

3. Cervix dilates and effaces

   • As you approach delivery, the cervix will also soften, thin, and dilate—and this process actually begins before labor officially starts. As the cervix begins to open, you may also notice an increase in vaginal discharge that may appear brownish or pinkish in color.

   • If you have an internal vaginal exam by a doctor or midwife, they may also inform you of any softening, thinning, or dilation of your cervix, which is another sign that your body is preparing for labor and delivery.

   
   

4. Increased discharge

   • Many people experience an increase in vaginal discharge (leukorrhea) throughout pregnancy, and sometimes the amount of this discharge increases in the weeks and days leading up to labor as the vagina prepares for the baby to pass through the birth canal. Leukorrhea plays a vital role in the vagina's ability to self-clean.

   
   

5. Weight gain slows

   • Near the very end of your pregnancy, your weight gain may slow. This may be due to the baby reaching their full-term size. Not everyone will experience a decrease in weight gain, however, and some pregnant people may experience more swelling near the end of pregnancy.

   
   

6. Bloody show

   • Your cervix dilates to make room for delivering your baby. As the walls of the cervix begin to thin out in preparation for labor, the mucus plug that blocks the passage will break free and be discharged. Bloody show in pregnancy isn’t entirely uncommon. Sometimes you’ll see faint streaks of blood.

   
   

   How do you know the difference between your mucus plug vs. discharge?

   • Your mucus plug, also called bloody show, is a pink-tinged discharge. It’s more stringy and gelatinous than your typical vaginal discharge.

   • “When you lose your mucus plug, it doesn’t necessarily mean that you’re going into labor,” said Gina Demas, a supervisor for nursing and patient care at OSF HealthCare.“It could be within a few hours. It could be within a few days. It could not necessarily be related to labor at all. So, when you notify your provider, let them know that you lost your mucus plug.”

   
   

7. Is nausea a sign of labor?

   • Nausea can be a sign of approaching labor. But it can also be caused by several other things, making it a poor predictor of labor by itself.

   
   

8. Loose and frequent bowel movements

   • If you're finding yourself taking a few more trips to the bathroom with loose and frequent bowel movements, there may be a perfectly good explanation. "That's the body's way of emptying the bowels so the uterus will contract well," explains Rochel Lieberman, a certified midwife in Brooklyn, New York. "Indigestion and vomiting prior to labor are also possible."

   
   

9. Mild cramping or contractions

   • You may notice an increase in mild cramps or Braxton Hicks contractions ("practice" contractions) that feel like a tightening or hardening of the uterus as you approach delivery. Additionally, you may notice a sensation of building pressure or cramping in your pelvic and rectal area.

When to go to the hospital for labor

• Your last cervical exam may have shown signs that your body is gearing up for labor. You will start to experience regular contractions when the early stage of labor begins. But you may experience contractions for hours before you need medical monitoring.

• For first-time mothers, health care providers typically want you to go to the hospital once your contractions are three to four minutes apart for two hours.

• If you’ve given birth before, your labor is likely to move more quickly. That’s why providers suggest going to the hospital once your contractions occur every five minutes for one hour.

• Your water breaking is another sign that your pregnancy has hit the labor stage. It’s time to call your provider and go to the hospital.

How do you know if your water bag – the sac of fluid that surrounds your baby inside the womb – has broken?

• Your discharge will be more watery than your usual pregnancy discharge. It could be clear, pink, yellow or brown, depending on what’s happening with the baby inside your womb.

• Also, your underwear will continue to be damp because you won’t be able to stop the leaking.

How to time contractions

• A true labor contraction is felt in your back and all the way around your stomach.

• Labor contractions feel different, and are more painful, than Braxton Hicks contractions, also known as false labor. Braxton Hicks feels like an uncomfortable cramp isolated to one part of your stomach or back.

• True contractions consistently occur every few minutes, becoming more painful and at shorter intervals. Braxton Hicks contractions happen irregularly and may even stop when you change positions.

• If your contractions aren’t close enough to go to the hospital or you’re having Braxton Hicks and the pain is uncomfortable, you can try to relieve some of the pain at home. Tennis balls can be used to roll across your back for temporary relief. Your provider will be able to offer other suggestions to alleviate back labor pain.

• Time your contractions by writing down when they start. Also, note the length of the contraction and the time that passes between the start of one contraction and the next.

• A contraction tracker can help you keep it organized.

Read full articles here:

https://www.osfhealthcare.org/blog/when-to-go-to-the-hospital-for-labor/

https://www.parents.com/pregnancy/giving-birth/signs-of-labor/signs-of-approaching-labor/

6 natural ways to induce labor

How can I induce labor myself?

1. Exercise

   • Exercise can be anything that gets the heart rate up, such as a long walk. Even if this method doesn’t work, it’s a great way to relieve stress and keep your body strong for the task ahead.

   • According to a 2022 study, walking for 30 minutes three times a week at 4 kilometers (km) or 2.5 miles (m) per hour starting from week 38 of pregnancy can help induce labor. It may also help reduce interventions during vaginal delivery.

2. Sex

   • Though research hasn’t found evidence that having sex actually results in the start of labor, theoretically, there are multiple reasons why having sex could induce labor.

   • For example, sexual activity, especially having an orgasm, can release oxytocin, which may help jumpstart uterine contractions.

   • Also, for pregnant people who have sex with men, there are prostaglandin hormones in semen that might help ripen the cervix.

   • Having sex is safe during the final weeks of pregnancy, but you shouldn’t have sex after your water has broken. Doing so can increase your risk of infection.

   
   

3. Nipple stimulation

   • Stimulating your nipples can cause your uterus to contract and may bring about labor.

   • Nipple stimulations stimulate oxytocin production. Oxytocin is the hormone that causes the uterus to contract and the breast to eject milk.

   • In fact, if you choose to breastfeed or chestfeed your baby right after delivery, this same stimulation is what will help your uterus shrink back to its original size.

   • You or your partner may manually stimulate your nipples, or you can try using a breast pump.

   • Research shows that breast stimulation can be an effective way to:

     • induce and augment labor

     • avoid a medical induction

     • reduce rates of postpartum hemorrhage

     • That said, the efficacy appears to be highest after performing breast stimulation for at least three days.

4. Acupuncture

   • Acupuncture has been used for thousands of years. The exact way that acupuncture works is unclear.

   • In Chinese Medicine, it’s believed to balance the chi or vital energy within the body. It might also stimulate changes in hormones or in the nervous system.

   • That said, acupuncture should be administered only by a licensed acupuncturist.

   • According to research, the main benefit of acupuncture is increased cervical ripening.

5. Acupressure

   • Some practitioners believe that acupressure can help start labor. Before applying acupressure to yourself, make sure you get proper instruction from a trained acupressure professional.

   • That said, there isn’t much evidence that acupressure is actually effective in inducing labor. But if acupressure doesn’t get your labor going, it can still be an excellent way to alleviate pain and discomfort during labor.

6. Eating dates

   • Research shows that eating dates in the final weeks of pregnancy:

     • increases cervical ripening and cervical dilation at the start of labor

     • decreases the need for Pitocin use during labor

Perks of waiting for labor to start on its own

• Most pregnant people at 40 weeks are likely ready to have their babies out of their bellies as soon as possible and in their arms.

• However, there are plenty of perks to waiting until your body naturally decides to go into labor — including recovery.

• Pregnant people who weren’t induced typically recover more quickly than those who were. More time in the womb can mean both you and your new baby get to go home from the hospital sooner.

• Infants who are born after a full-term pregnancy also experience other benefits. More time in the womb typically means:

  • more time to build muscle and strength

  • reduced risk of low blood sugar, infection, and jaundice

  • improved breathing as infants born even as little as two weeks early can experience twice the number of complications

  • better feeding once born

  • increased brain development, with the brain growing a third of its size between weeks 35 and 40

Let your body do the work for a few more days, and take the time to get as much rest as you possibly can.

We know that’s easier said than done when you’re 9 months pregnant. You and your baby will need all your energy soon enough!

Read full article here:

https://www.healthline.com/health/pregnancy/natural-ways-to-induce-labor#why-wait-for-labor