What To Expect

Something has gone terribly wrong! You made it through your pregnancy, your due date is 2 weeks or less away, and you thought everything would be fine! If you had a scheduled c-section, your doctor assured you that your baby was “mature” even though you’re not quite at your due date. You may have even undergone an amniocentesis for “lung maturity” that came back as “mature.” But a bunch of nurses and other people you don’t know are taking your baby away from you, and you don’t really know why and nobody is telling you anything. WHAT IS HAPPENING ???

You don’t understand what has happened! Your baby was due in about a month – or maybe even less – and everything was supposed to be fine. You know lots of women who have delivered their babies a couple weeks early, and they went to the normal nursery. But your baby is in the NICU and can’t be with you. A couple of weeks doesn’t make any difference, does it?

CONGRATULATIONS!!! You made it to 32 weeks!!! Maybe your membranes have been ruptured for several weeks and you’ve been sitting in the hospital hoping and praying you don’t get an infection. Or maybe you’ve got identical twins that are sharing a placenta, or your doctors have told you there is something else wrong with the way your baby was formed that will require a surgeries and other treatments after birth. You’ve gotten the steroid shots to help your baby’s lungs develop (that’s not all they do!), and you’ve put your entire life on hold to follow doctor’s orders for strict bedrest in the hospital.

CONGRATULATIONS!!! You made it to 28 weeks!!! While you’re probably thinking, “how can my baby possibly be okay when s/he was born 3 months early?” your neonatologist is rejoicing that you made it past the critical threshold of 28 weeks EGA. If you have been threatening preterm delivery for several weeks, your neonatologists may have mentioned the greatly improved outcomes experienced by babies born after, as compared with prior to, 28 weeks. The benefit to your baby of delivering after 28 weeks cannot be overstated!

If your baby was born between 25 and 28 weeks’ gestation, you’re probably thinking “how can my baby possibly be okay when s/he was born 4 months early?” While, obviously, this is not an ideal situation, the truth is that many babies born at this degree of extreme prematurity do survive and can have very good outcomes. You may have been threatening preterm delivery for several weeks, and the benefit to your baby of delivering after 25 weeks compared with before cannot be overstated! A recent study of outcomes in Canadian NICUs cites a survival rate of 82% for infants born at 26 weeks, compared with 54% if born at 24 weeks. The sacrifices you made to make it past 25 weeks were well worth it and you deserve to be commended!! Somehow, though, you don’t feel lucky. Your baby is hooked up to all these machines, and you can’t hold him/her, and your doctors are being noncommital. They tell you to expect a 3-4 month NICU stay with lots of ups and downs. What is going to happen?

Your baby born at this degree of prematurity is the very youngest that an infant can survive outside the womb. You may have spoken with a neonatologist before delivery and heard scary predictions about your baby – who maybe even suggested that heroic and life-saving measures in the delivery room be avoided instead for keeping your baby warm and comfortable for the short time s/he had with you. But your baby is in the NICU now, and things are happening so fast. Nobody’s talking much to you, other than giving you papers to sign and using unfamiliar terms. Every baby is different, and no one can tell you exactly the events for YOUR son or daughter. Miracles DO happen – they just are not predictable! What follows is a guideline of events and expectations for a baby born at this most extreme limit of prematurity.