My Late Preterm Babies

November is Prematurity Awareness Month. I debated for a while about whether I should write about my premature babies because, even though they were born early, they are far from the tiny babies born at twenty-something weeks who had to spend weeks to months in the NICU and face a lifetime of health, emotional, and behavioral problems.

But if I blog for my children to one day read it and learn a little bit about what they were like as kids, then I want them to know they were born early, but are lucky, and maybe they’ll realize this is why they may have faced challenges at a young age.

Both of my babies are late premature babies. When they were born, they looked like any other newborn, just a little smaller and weighing less than 6lbs. Once they left the hospital, they were treated like any other newborn. No one talked to me about any effects being born early might have on them and none of the pediatricians said anything. It was as though they had been born between 37 and 40 weeks. Fortunately, I have a Master’s in Clinical Psychology and have worked with children with developmental disabilities. I knew there was a chance my children would face challenges and I would just have to keep my eyes open and be cautious about how to interpret their behavior.

My son was born at 34+6. Labor was so unexpected because I had recently been talking to a couple of friends who were due not long after I was. We had all heard first babies tend to be born late, so going into preterm labor wasn’t even on my radar. Even when I went into labor late on 34+3 with painless contractions I thought were Braxton-Hicks (though their regularity of occurring every 2 hours should have told me something), I didn’t think it was going to happen. None of my doctors had mentioned preterm labor to me; my pregnancy was almost flawless. There was no way my baby was coming at 34 weeks. I was sure they would do something to stop labor.

Except they didn’t. I was far enough along that survival was guaranteed, and far enough along that they wouldn’t stop labor. My doctor just mentioned he hoped the baby’s lungs were developed enough, but the NICU was ready to receive him.

I knew about NICUs, had visited one, and even now I’d still like to volunteer in one. But I never thought I’d have a baby in one. While laboring, I was scared of how long he would have to be in the NICU.

After 3 days of labor in and out of the hospital, my son was born. I was told he was born screaming, so his lungs had, thankfully, developed in time. Later, my husband and I would joke that he waited until his lungs were ready and then he wanted out and more space. But he still spent the first 6 hours in the NICU. After getting to hold him for a minute or two, he was taken away and I didn’t see him for 6 hours. They weren’t keeping me from him; I had blood clots they’d missed and spent those 6 hours bleeding heavily, getting the clots out, and trying to recover from a large amount of blood loss.

I dimly remember the couple of days I spent in the hospital. I remember they took him several times for this test or that and a nurse very patiently helped me breastfeed, though it was still four days until he was able to latch. I cried the day I was discharged and he was not because he had jaundice. The last time a nurse handed him to me before I left the hospital, he was wrapped in a special blanket and she called him my glowworm.

I later learned that, even though I was also born with jaundice, the risk of developing it was higher for him because he was five weeks early. His liver was nowhere near ready and he required treatment in the hospital. The next three days were tough as I spent the days going to the hospital to breastfeed every 2 hours, the nights pumping every 2 hours, and the times in between trying to recover from iron deficiency and labor.

I must say that my little preterm baby was quite a trooper as soon as he came home. Six weeks later, we packed him into a car and spent a week and a half driving across the country (permanent move and definitely not for fun). He gained weight quickly. Though always small, he found his own track and has been a perfect delight for almost 4.5 years. I kept my eyes out for any signs that he might have any developmental delays. The only apparent one has been a speech delay, but a year of therapy remedied that and he now talks almost non-stop. My ears sometimes long for those silent days, but he makes me smile and laugh at the things he says sometimes. As he heads into Kindergarten next year, I’ll be keeping my eyes out for any other challenges he might be facing.

My husband and I knew we were going to have 2 kids. I’d done a lot of reading about the timing. Originally, I was going to be finishing graduate school, so the kids would be about 5 years apart. Moving changed my plans, so I needed to figure out when would be the best time to have number 2. I read that getting pregnant within 2 years of giving birth would increase my odds of having a preterm baby. Having already given birth to one preterm baby already increased my odds of a second. So, we waited until our son turned 2.

My first appointment was with a nurse. She told me that, since my son was born early, I already had a high risk pregnancy and would be getting weekly progesterone shots and ultrasounds every two weeks or more frequently. I left that appointment freaking out about the shots (I’m terrified of hypodermic needles) and hoping she was wrong.

Unfortunately, my doctor confirmed it was true. They were going to try to keep this baby in as long as possible. Well, I was all for that, so I sucked it up and got my shots. Every week starting at 17 weeks, my son and I would take a fun little trip so he could watch me get poked. The nurses loved him. At first, everything went swimmingly. Because the ultrasounds started at 16 weeks, we were able to find out we were having a girl at 16 weeks. Everything looked normal, my cervix was long and closed, and the baby was doing well despite a little stubbornness.

I felt confident that everything was fine. Everything said it was fine. So, I started doing a bit of walking. Well, pacing, really. Across the living room while my son napped. I was about 7 months along and everything said the pregnancy was going well. I was so busy with school while I was pregnant with my son that exercising was sporadic at best. This time, I was determined to keep myself as healthy as possible. Anything to try to ensure a term birth.

And then it wasn’t going well. At all. Every time I was active, my cervix seemed to shrink. I started being put on and off bed rest. I had ultrasounds sometimes twice in one week. My doctor mentioned a cerclage and I freaked out, planted myself on the couch, and prayed my cervix would lengthen. It didn’t, but at least it didn’t shrink at an alarming rate.

By 8 months, it was getting hard to tell if the shots were doing their job. The day before I was due for my next shot, I would get twinges all day. By the time my daughter was born, I’d already been sent to Labor and Delivery 3 times. I really didn’t want to keep going. Every visit was hours long and incredibly boring and incredibly frustrating as I also had a 2.5 year old toddler in tow.

Fortunately, I made it to 36 weeks without going into labor, though I’m pretty sure I was having contractions during my baby shower at 34 weeks, which would explain why I was already dilated 3cm at my 36 week appointment. My doctor said there was no point to getting the last shot. So, if she was fine with my giving birth at any time, then so was I. Two days before my daughter was born, my mom and I took my son to the mall and we walked the whole thing as it was potentially his last outing as an only child.

Save for our weekly trip to the market, it was his last outing. This time, labor was so fast that I was holding my daughter 8 hours after walking around the market, determined to keep her in for at least another day. But this girl is stubborn just like me. She wanted out at 36+6. She made it to a day before term and then she’d had enough. Though she ended up having to endure being pricked throughout her first 24 hours to have her glucose level checked (routine for any baby born before 37 weeks) and was monitored for jaundice as she was at high risk. Thankfully, she never developed jaundice, but was at high risk and still needed at-home treatment.

Sometimes I shrug off her being born at 36+6. She was so close to 37 weeks that it’s easy to think of her as just any other term baby. Except every week, every day, counts. 37 weeks is still 3 weeks before 40 weeks. Those 3 weeks matter. She didn’t get those 3 weeks and I have to wonder if it’ll have an effect on her. So, far, at 18 months, she’s small, but thriving. She’s smart and silly and already has an interesting vocabulary full of oh no, no (and shaking her finger at her brother when he upsets her), cracker, cheese, three, and thank you. She’s overly attached to me, but I don’t mind. I’ll be on the lookout for any challenges she might face, but hoping she was cooking long enough that she’ll be just fine.

When most people think of preemies, they think of the tiny babies born way too soon who had to spend time in the NICU. My kids are far from that, but they are still premature babies. I’ve learned there are early preterm and late preterm babies. It’s a large range. I don’t know what effect being late preterm will have on them, but I will be ready.