Cover image for Preemies : the essential guide for parents of premature babies
Title:
Preemies : the essential guide for parents of premature babies
Author:
Linden, Dana Wechsler.
Personal Author:
Publication Information:
New York : Pocket Books, [2000]

©2000
Physical Description:
xiv, 578 pages : illustrations ; 24 cm
General Note:
Includes index.
Language:
English
ISBN:
9780671034917
Format :
Book

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Anna M. Reinstein Library RJ250 .L56 2000 Adult Non-Fiction Open Shelf
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Audubon Library RJ250 .L56 2000 Adult Non-Fiction Open Shelf
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Summary

Summary

Preemies is the only resource of its kind -- a comprehensive Dr. Spock-like reference that is both reassuring and realistic, delivering up-to-the-minute information on medical care in a warm, caring, and engaging voice. Authors Dana Wechsler Linden and Emma Trenti Paroli are parents who have been there. Together with neonatologist Mia Wechsler Doron, they answer the dozens of questions that parents will have at every stage -- from high-risk pregnancy through preemie's hospitalization, to homecoming and the preschool years -- imparting a vast, detailed store of knowledge in clear language that all readers can understand.Preemies covers topics related to premature birth, including: What are your risk factors for having a premature baby? Can you do something to delay early labor? What do doctors know about you baby's outlook during her first minutes and days of life? How will your preemie's progress be monitored? Can you breastfeed your preemie? How do you cope with a long hospitalization? What should you know if your baby needs surgery? Are there special preparations for you baby's homecoming? What kind of stimulation during the first year gives your baby the best chance? Will your preemie grow up healthy? Normal?


Reviews 2

Publisher's Weekly Review

Linden and Paroli, mothers who met in the hospital when their preemies were born, and neonatologist Doron present a comprehensive guidebook for parents whose babies are born prematurely. One out of 10 babies in the U.S. is born early, but in half of these cases the mothers have no known risk of giving birth prematurely, so they can't prepare for the whirlwind of unexpected events and emotions they will experience in the neonatal unit. The authors fulfill the need for information with remarkable clarity, offering answers to a multitude of questions. Divided into four sections (Before Birth, In the Hospital, A Life Together and Other Considerations), the book covers risk factors, the first day, the first week, surgery, taking the baby home and many other topics. Each section contains personal observations from parents of preemies, insightful comments from "the doctor's perspective" and information on procedures, equipment, common problems and other issues. While medical information is presented in detail, the book maintains a personal, reassuring tone, explaining that, though their organs and body functions are immature, most preemies are basically healthy. Since parents can't always plan ahead for the possibility of a preemie, this book provides a valuable crash course and serves as a useful tool for communicating with medical staff. Includes a helpful resource guide and glossary. (Aug.) (c) Copyright PWxyz, LLC. All rights reserved


Library Journal Review

Although one out of ten children born in this country is born prematurely, until now there has never been an authoritative, practical, and encouraging reference tool for their parents. This book is just that, a work in the "Dr. Spock" genre that will prove to be a bible for parents of "preemies." Linden and Emma Paroli, who each have children born prematurely, have joined forces with Mia Weschler Doron, a physician whose specialty is neonatology, to produce the book they wish had been available to them when they needed it. The authors cover myriad issues, ranging from a discussion of risk factors for prematurity, through possible and probable problems in the newborn's life and early years, to long-term prognoses. They do this primarily in a question-and-answer format, with lots of accompanying information. Their book should handsomely meet the needs of families dealing with premature infants and in fact is certain to be a blessing to them. Enthusiastically recommended for all public library collections.DLinda M.G. Katz, Florence A. Moore Lib. of Medicine, MCP Hahnemann Univ., Philadelphia (c) Copyright 2010. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.


Excerpts

Excerpts

Chapter One: In the Womb: Why Premature Birth Happens and What Can Be Done to Prevent It For parents trying to grasp the extent of their risk, and what they can do to minimize it. Also for parents looking back, trying to make sense of what happened. Introduction Questions and Answers Bed Rest Bed Rest Survival Tips High Blood Pressure and Preeclampsia Predicting the Birth Date Diagnosing and Treating Preterm Labor Are You in Preterm Labor? Drugs for Preterm Labor Cerclage Diagnosing an Incompetent Cervix Hidden Infections and Preterm Birth If Your Water Breaks If Your Water Breaks before Your Baby Has Reached Viability When Baby Needs to Be Delivered Early Checking on a Baby's Well-Being before He Is Born Baby's Fighting Spirit Steroids Are There Medications other than Steroids You Can Take to Help Your Baby? Multiples Likelihood of Prematurity A Note If You Considered Multifetal Pregnancy Reduction Twin to Twin Transfusion Syndrome One Twin Needs Early Delivery In Depth Risk Factors for Prematurity: Are You at Risk? Introduction: In the Womb A normal pregnancy that leads, nine months later, to the birth of a healthy baby is a natural life experience in which doctors are mostly watchful bystanders, until the time of delivery comes. But if you're at risk for a premature birth, your experience is going to be different. Some women will be aware of their risk before they conceive. For many others, suddenly becoming a patient comes as a shocking surprise. If you're likely to have a preterm birth, you'll probably get assistance from an obstetrician who specializes in high-risk pregnancies (called a perinatologist). Your doctor's efforts will be directed at preventing a premature birth, or postponing it as much as is possible and advisable. Why prematurity happens is still a puzzle. In fact, experts believe most preterm births result not from a single cause, but from several risk factors interacting throughout pregnancy. Doctors know many reasons for preterm birth (as you'll see from the list on page 33), and can identify many pregnancies at risk. But about half of the expectant mothers who go into preterm labor have no known risks for it. If you've already given birth to a preemie, and you never suspected that it might happen to you, you're certainly not alone. Perhaps even more frustrating is that in many cases, premature birth cannot be prevented, even when mothers are known to be at risk. Still, even if a premature delivery cannot be avoided, a lot can be done to delay it for at least a few days (and sometimes much longer) -- enough time to take some precautions that can greatly reduce the health risks for both you and your baby. For example, you may be admitted to a hospital, where you and your baby can be monitored twenty-four hours a day, or transferred to a facility with more expertise in perinatology and newborn intensive care. If you have an infection, you'll be started on antibiotics, to help prevent your baby from getting it, too. And you may be given steroids to help your baby's organs mature faster before birth. Sometimes, your doctor may decide to purposely deliver your baby before term, because he is not growing or doing well in the womb, or because it has become too dangerous for your own health to continue the pregnancy. About 20 percent of all preterm births are such so-called "elective," or medically indicated preterm births. The rest occur spontaneously -- about 30 percent after a woman's water breaks too early, and about half after preterm labor. As you read through the information below, remember that only an experienced obstetrician can evaluate your own individual case. It's important for you to develop a good, trusting relationship with your obstetrician, so that you can count on her for support, as well as for state-of-the-art medical care, as you travel the demanding road of a high-risk pregnancy. Questions and Answers Bed Rest My doctor told me to go on bed rest, but I have so many things in my life I need to do. Will bed rest really help prevent an early birth? Nobody knows for sure. Bed rest is probably the oldest prescription for a high-risk pregnancy. Yet despite its widespread use -- one out of every five pregnant women in the United States is put on bed rest -- it has not been studied extensively. Although more research is needed before anyone can answer your question for sure, so far, the few studies that have been done have produced no convincing evidence that bed rest helps reduce preterm births. So, why do almost all obstetricians prescribe it to women with preterm labor, premature rupture of membranes, preeclampsia, bleeding, or other pregnancy problems, and sometimes even as a preventive measure to women who are expecting multiples? Because even without proof, there are situations where bed rest makes sense to doctors, for some solid, scientific reasons. For example, say your baby isn't growing as well as she should in the womb. Fetuses depend entirely on blood flowing through the placenta for their supply of nutrients and oxygen, and a mother's blood flow to the placenta is greatest when she is lying down. So, it makes sense that your baby will have the best chance of growing better if you spend a few extra hours in bed each day. Or say your water has broken early. It makes sense that you could maximize the amount of fluid remaining around your baby by spending more time off your feet, since increased blood flow to the baby leads to greater production of amniotic fluid. Also, the fluid is less likely to drip out when you're lying down. Bed rest also makes sense when gravity may be dangerous for a pregnancy. For example, once a woman's membranes have ruptured, there is a risk that the umbilical cord could slip down through her cervix -- an absolute emergency, because the cord could get caught there and squeezed, cutting off blood flow to the baby. Gravity also can be risky when a woman has a weak, or "incompetent," cervix, which could open if the fetus presses down on it too hard. There is also good evidence that blood pressure is higher in women who are walking around. So, it is assumed that bed rest is helpful to pregnant women with preeclampsia, a condition involving high blood pressure which, when it's severe, can necessitate a premature delivery. Although research hasn't demonstrated so far whether bed rest itself makes the difference, we know there has been a dramatic improvement in the outcomes of pregnancies with pre-eclampsia. It may well have to do with the increasing use of hospitalization, which allows for both intensive monitoring and more bed rest than most women can get at home. But if sometimes there is sound reasoning behind the prescription of bed rest, other times there is simply a mixture of observation and wishful thinking. Take preterm labor. Many doctors believe that women who remain active in the third trimester of pregnancy have more Braxton-Hicks contractions -- the normal, "false" labor contractions that don't lead to cervical change and delivery, and are of no concern. It's natural for obstetricians to extrapolate from that and assume that bed rest might reduce the risk of real labor, too. Nobody knows whether the initial observation itself, about Braxton-Hicks contractions, or the extension of it to real labor, is valid. So far, studies on pregnant women haven't found that bed rest decreases preterm labor. (Monitoring contractions with a home monitor -- another intervention that seems like it should work -- doesn't appear to make a difference, either. Research suggests that home monitors don't improve pregnancy outcomes, although they do increase the number of doctor visits -- probably meaning they cause a lot of preterm labor scares.) But well-meaning obstetricians want to do something for women with preterm labor, so as long as there is a possibility that bed rest might help, many suggest it. Some obstetricians also have observed that a prescription of bed rest can bring a helpful focus to a pregnancy. The thinking is that your pregnancy may have the best chance of succeeding if you, your family, and even your doctor focus more attention on your needs, concerns, and symptoms. Some women say this worked for them: that after trying to juggle a lot of things during the early part of their pregnancies, bed rest actually reduced their stress by allowing them to shift their emphasis away from their many other daily obligations. Undoubtedly, obstetricians also prescribe bed rest partly as a holdover from past medical practice. As recently as a decade ago, nearly every woman with a pregnancy risk or problem was put immediately to bed, and told to stay there twenty-four hours a day. Today, however, on top of a lack of proof of bed rest's effectiveness, there's a growing awareness of its potential costs. Total bed rest quickly causes bone and muscle loss (much of which is regained after a woman becomes active again). And for plenty of women it causes more stress, rather than less. In fact, it can be really hard on an entire family, especially when there are older children, or job and financial concerns. So, more and more doctors are recommending reduced activity -- lying down for a few hours each morning and a few hours each afternoon -- rather than complete bed rest, except in a few situations like an already open cervix, ruptured membranes, or severe preeclampsia. Thankfully, you'll rarely see the once-common Trendelenburg position, in which a woman lies with her feet raised higher than her head. There's no evidence that it makes a difference, and a general consensus that no one can tolerate that position for long! While you nestle in bed, try to stay as optimistic as possible (remember that medical treatments often work best when patients believe they will), and take a look at the practical tips below to make that experience more tolerable. Bed Rest Survival Tips OK. You've been put on bed rest, and you're feeling understandably miserable. How are you going to make it through the long weeks ahead? These survival tips may help: Recognize that you are performing a job, one of the hardest you'll ever do . If you are an active person with a tendency to ask "What have I gotten done?" each day, it's easy to feel frustrated and inadequate while on bed rest -- unless you give yourself credit for a daily achievement: an investment in your child's and family's future. Whenever you feel like you can't take it anymore, or are about to give in to the many temptations to get up, remind yourself of the job you have to do, and focus on your goal! Make your physical comfort a priority. Lying down for long stretches at a time can be very uncomfortable, and aches and pains are going to make your job far more difficult. You may have heard that you should lie on your left side, because blood flow to the placenta will be greatest -- but your right side is good for your baby, too. What's most important is simply to avoid lying flat on your back, because blood flow is reduced that way. Rest a pillow under one side of your tummy or back, so you're on a slight tilt. That's fine! Do light exercises in bed. To avoid muscle and bone loss, some obstetricians now arrange for a physical therapist to visit their patients on complete bed rest. If your doctor doesn't mention this, don't hesitate to ask. The therapist can teach you light, isometric exercises you can do while lying down. Or you can try to make up your own, very light exercise regime: point and flex your toes, do head rolls, rotate your hands, tense and relax the muscles of your arms and legs. Stay clean and attractive. It's amazing how this can affect your mood. Many hospitals have arrangements with hairdressers who will come to your room and expertly wash your hair without ever asking you to sit up. If you're at home, ask friends or the staff of your hair salon if they know of a hairdresser who makes house calls. Put on makeup every morning. Some women find that when they're feeling down, it lifts their mood to pamper themselves with manicures, pedicures, or facials. Make your environment attractive, too. It will just take a couple of minutes for a friend or your partner to tape up some family photos or art works by your children. When you're feeling imprisoned, warm touches go a long way! Don't expect the household to run as smoothly, or cleanly, as usual. It's a fact of life: women on bed rest don't have clean houses! If your family eats pizza for the seventh time in a week, you're not alone, either. The best thing is to lower your expectations, recognize that these things aren't a priority right now, and plan to fix them later, when you're up and about. Organize your space. It's terrible to have to ask for every little thing you need. Instead, ask your partner to put a table next to your bed, with the following items within easy reach: a telephone, books and magazines, grooming items, tissues, and disposable cleansing wipes (to wash your hands), the television remote control, paper and pencil, things you need for your hobby, a water pitcher, and a lunch that your partner sets out for you each morning. No matter how much your partner wants to help, it will minimize tension between you if he doesn't have to act as your constant gofer. Be understanding that bed rest is hard on your partner and children, too. Your partner's life is also disrupted. He may be as worried and distressed as you are, and he's probably picking up lots of extra tasks while holding down his usual responsibilities. Try not to be resentful of him for still being able to move around, or for not being able to meet your every need. And give him as much time off as you can. It's important to keep supporting each other. It's normal for your children to show some reaction, either behaving badly toward others or toward you. It's also normal for you to worry about them, and to think how long this period feels to them. But believe us, they will forget about it soon afterward. In the meantime, encourage them to spend time with you by making your bedside into a play area with their toys, and putting up a little table where they can eat some meals. Try to arrange special time for them with grandparents. Some mothers say it helped a lot for their child to be present when the doctor explained the need for bed rest; hearing it from an outside authority made the child understand better, and even eager to cooperate. If you were working, make sure to discuss financial arrangements with your employer. Find out if you are eligible for disability payments, and whether this time is being counted as part of your maternity leave or sick leave. Remember that the Family and Medical Leave Act requires employers with 50 or more employees to give up to 12 weeks of unpaid leave related to pregnancy problems or childbirth. You are eligible if you have been working for your employer for 12 months, and have worked at least 1,250 hours during the last year. Get some easy things done from bed. You haven't bought furniture or linens for the nursery yet? There are childcare books you wanted to read and don't have? Shop by catalog or computer. Or give your mother-in-law a list of all of the layette items you need -- she'll probably be thrilled to help, and it's like having a personal shopper! Don't be surprised if you get depressed, or have ups and downs. Many women say that some days their spirits are up, and then suddenly they find themselves in tears. Irritability, lots of anxiety, anger, and inability to concentrate are all normal reactions. You can expect a few naive comments from friends, like "I'd love to be on bed rest and catch up on my reading." But most people who have been on bed rest themselves will tell you that it's hard. When you think what you're doing it for, though, it's worth it. High Blood Pressure and Preeclampsia I've always eaten right and exercised. But now, in my pregnancy, I suddenly have high blood pressure. I'm stunned. Because high blood pressure is often associated with an "unhealthy" lifestyle, it can be a real shock for a health-conscious pregnant woman to find out that she has it. But there is a kind of high blood pressure that occurs only during pregnancy, and can strike out of the blue. When it is accompanied by other signs and symptoms, like protein in the urine and fluid retention (which shows up as very rapid weight gain, or a puffy face and hands -- not the normal leg swelling that many pregnant women have), doctors call it preeclampsia. Luckily, the prognosis is usually very good. Upward of 90% of all women who develop high blood pressure during pregnancy will deliver a healthy baby at term. And because preeclampsia always goes away after delivery, the vast majority of mothers are back to their previous state of health within a few days of their baby's birth. Despite the fact that most people haven't heard of it, preeclampsia is actually quite common, affecting nearly 10% of pregnant women. Some women are more at risk for it: those who are pregnant with multiples, are overweight, already have high blood pressure, or have kidney disease or diabetes. Preeclampsia also runs in families, so if your mother or sister had it, the likelihood that you'll get it is increased. But an enormous 70% of women with preeclampsia don't have any risk factor for it at all. Most of the time, preeclampsia is an easy diagnosis for your obstetrician to make. He'll measure your blood pressure, check your weight, and possibly do some simple urine and blood tests. But sometimes, it isn't clear whether preeclampsia or some other medical condition is causing the problem. It is important for your doctor to figure that out, because the cure for preeclampsia is delivery. If you have a severe case of it, a time may come when it's best to deliver your baby prematurely. The reason preeclampsia is dangerous is that it causes changes in the body that are the opposite of what should happen during pregnancy. Normally during pregnancy, the amount of circulating blood in a woman's body increases, to provide for both her and her fetus, and her blood vessels open wider to accommodate it. But in preeclampsia, a mother's blood vessels tighten, and not as much blood can flow through them. Her blood pressure rises, and all of her organs, including her uterus, receive less blood. When preeclampsia is mild, the amount of blood flow is slightly decreased but still adequate. But when preeclampsia is severe, a mother's vital organs may not get enough blood, and serious complications can result. Your doctor will watch you closely for kidney, liver, or intestinal problems (be sure to tell him if you have pain in your belly), and symptoms like blurry vision and headaches, which could indicate that your eyes or brain are suffering. In a very small minority of women with preeclampsia (only about 5%), the symptoms progress to seizures (called eclampsia) or dangerous abnormalities of blood clotting with liver damage (called HELLP syndrome, for hemolysis -- destruction of red blood cells -- elevated liver enzymes, low platelets). Women with these most severe forms of preeclampsia occasionally have strokes, or even die -- that's why your obstetrician takes it so seriously. For a fetus, the main consequence of preeclampsia is receiving less blood flow through the placenta and, therefore, getting less oxygen and nutrients. For that reason, babies of mothers with preeclampsia are often small for their gestational age. (See page 70 for what that can mean for a child.) If the restriction of blood flow becomes extreme, or if the placenta separates from the wall of the uterus (a complication called placental abruption, which is more common in pregnant women with high blood pressure), there's a risk of fetal death. But thanks to alert doctors and good fetal monitoring, this is an uncommon tragedy today. The earlier that preeclampsia occurs during pregnancy, and the more severe its symptoms, the more it can affect a mother's and fetus's well- being. Most women with mild preeclampsia continue their pregnancies until term, but women with severe preeclampsia usually deliver within a couple of weeks of being hospitalized for it. Some, however, are luckier, and are able to continue their pregnancies for much longer. Your doctor will tell you what you should expect in your own particular case. The simplest and most commonly prescribed treatment for preeclampsia is rest, which can lower an expectant mother's blood pressure, and help her baby to get more blood flow. Your doctor may recommend bed rest at home, or admit you to the hospital. You may also get medications to lower your blood pressure, and to prevent seizures. The usual drug to prevent seizures is magnesium sulfate, which is generally safe for both mother and fetus, although it can have bothersome side effects (like making some mothers feel sick, and sometimes, temporarily depressing a newborn baby's breathing. Don't worry about that, though -- if necessary, a ventilator can help your baby breathe until the magnesium wears off). If it looks like your pregnancy is becoming too risky to continue, your obstetrician will decide to deliver your baby prematurely. In fact, preeclampsia is the most common cause of elective preterm deliveries, done most often to protect the mother's health. When you hear that, you may think, "I don't care about myself, if it would help my baby to stay longer in my womb." It's heroic to be willing to take such risks for your child. But your family, including your baby, needs you. And when preeclampsia gets so severe in a mother, her fetus usually begins to suffer severely too, and is in real danger of dying soon in the womb. Women who have had early, severe preeclampsia in a previous pregnancy have about a 40% chance of getting severe preeclampsia again. Unfortunately, efforts to prevent preeclampsia by using medications such as aspirin or calcium, on which researchers once pinned their hopes, have not been very successful. Although these drugs have not proved helpful when prescribed to a wide range of pregnant women, your obstetrician may still use them. They are safe, and there is some evidence to suggest that they may possibly be of benefit to women who are at the highest risk. Predicting the Birth Date My doctor says I'm at risk for having a premature baby. Is there any way of telling how long my pregnancy will last? If pregnancy researchers had a Holy Grail, it would be the ability to predict whether an expectant mother would deliver her baby early, and if so, when. That crucial information would allow doctors to intervene early, when therapies are most effective, and only treat women who really need them. Tests of fetal well-being (see page 23) can help determine how long a pregnancy might last when there's a known medical complication. But those screenings can't predict whether preterm labor, or preterm rupture of the membranes, might cut short a pregnancy that is otherwise proceeding well. Most methods adopted so far to help forecast the likelihood of a preterm birth -- such as adding up and scoring a mother's risk factors, or closely monitoring the opening of her cervix or her uterine contractions -- have had disappointing results. In recent years, though, researchers have been looking at a whole new set of tests that seem to be more useful and effective. Many obstetricians have started using ultrasound, in addition to their traditional exam, of the cervix. Doctors traditionally examine a pregnant woman's cervix with their fingertips, to see if it is starting to open (or "dilate"). But this technique evaluates only the outer part of the cervix. Ultrasound can be used to look at the inner part of the cervix, where the earliest sign of dilation -- a shortening of its length -- can be detected. An early answer as to whether the cervix is opening can provide a doctor with useful information. For example, if your cervix is shorter than it should be, your doctor may decide to give you a cerclage (a simple surgical procedure in which your cervix is sewn shut) to try to keep it from opening further. On the other hand, if you're having contractions, but your cervix looks normal on ultrasound, your doctor may decide that you're not in true labor, and instead of prescribing medication to stop contractions, may simply observe you for a while. Ultrasound measurement of cervical length is a quick and painless test that can be done at the same time as a routine vaginal exam. One of the most exciting new tests for prematurity measures a pregnant woman's saliva for the presence of the hormone estriol: a kind of estrogen that has an important role in preparing the uterus for labor and delivery. One version, called SalEst (Sal for saliva, Est for estriol), has already been approved by the Food and Drug Administration. In the studies done so far, this test was used weekly to measure levels of salivary estriol in pregnant women at risk for premature birth. When a steep surge was detected, it indicated that labor was likely to occur in two to three weeks. When salivary estriol was low, labor in the following three weeks almost certainly would not occur. Unfortunately, what seems like the perfect predictive test for prematurity has some limitations. One of them is that SalEst is more accurate in predicting when premature labor won't occur than when it will. This means that if your salivary estriol level is low, you almost certainly won't deliver soon -- valuable information that may save some women from being treated with bed rest or anti-labor drugs unnecessarily. But if your salivary estriol level is high, although you have an increased chance of delivering in the next several weeks, your pregnancy could well go on for much longer. Also, to date, SalEst has been approved only for singleton pregnancies, because hormone levels in multiple pregnancies follow different, more complex patterns. Moreover, some medications that may be given in a high-risk pregnancy (such as steroids) can affect a woman's estriol levels and limit the validity of the test. Another marker for a possible early delivery is a protein called fetal fibronectin. Fibronectin helps to keep the placenta and the membranes well attached to the uterine lining. If free levels of this protein inside the uterus rise, it may indicate that the placenta and the membranes are getting loose. Many obstetricians now use fetal fibronectin testing to help predict a preterm delivery. If on a simple swab of the vagina or cervix, the level of fibronectin is low, it's very unlikely that you'll deliver within the next two weeks. Other tests look for inflammatory substances in a pregnant woman's body to signal that a premature birth may be approaching. That's because some of the substances the body naturally produces to help combat infection or repair damaged tissues can also cause uterine contractions, loosening of the cervix, and weakening of the membranes, making them more prone to rupture. (Up to 25% of women who deliver prematurely have low-grade vaginal infections, and any damage to the placenta or umbilical cord, even if minor, can lead to inflammation.) One sign of infection or inflammation in the uterus is a protein called interleukin 6: if it is found in high levels in a mother's blood and in her amniotic fluid (which would require an amniocentesis to detect), it indicates that she may have a uterine infection, which could lead to preterm labor and delivery. But more studies are needed before doctors know exactly how to use "IL-6" as a routine test. Your obstetrician will decide what tests to use to monitor your pregnancy, and when. None of the new tests is a panacea, and experts warn that they are more effective in predicting which women won't deliver prematurely than they are at picking out all of the women who will. But awareness of new risk factors and more effective ways to detect them, combined with more traditional tools, such as your obstetrician's knowledge of your medical history, physical examina- tions, and tests of your baby's well-being, can give your doctor a better perspective into your future. Diagnosing and Treating Preterm Labor I've been feeling some tightening in my stomach. Should my doctor treat me for preterm labor? There's always a mixture of science and art in the practice of medicine, but when it comes to treating preterm labor, the balance tilts solidly to art. Your obstetrician has to make a judgment call as to whether you are having "true" labor or "false" labor. Some women just have unusually active uteruses, well before real labor starts. It's not always easy to tell whether your contractions are the real McCoy -- ones that will lead to cervical change and birth -- or just harmless ones whose only consequence is to give you and your doctor a dose of anxiety. That means that if you're having contractions, but your cervix hasn't begun to change yet, you may not need anti-labor drugs at all. On the other hand, you may be in the very early stages of real labor, when treatment has the very best chance of succeeding. If real preterm labor is suspected, a mother is generally sent to the hospital, the safest place to be in case she is about to deliver. There, her contractions are monitored, along with her baby's heartbeat, to make sure the baby is not sick or in distress. She is put on bed rest and given intravenous fluids while her doctor tries to determine whether there's a treatable problem, like dehydration or infection, that is causing the contractions. About half the time, if preterm labor is not accompanied by bleeding or ruptured membranes (if your water hasn't broken yet), fluids and bed rest alone are enough to stop it. If bed rest and fluids are not enough, and you and baby are doing well otherwise, the doctor will probably prescribe anti-labor drugs (which in medical parlance are called tocolytics) to relax your uterus and halt the contractions. Most of the time, these drugs put a quick stop to preterm labor in women who don't have bleeding, infection, or whose labor isn't already far along (whose water hasn't broken, and whose cervix is open less than four centimeters). Whether or not labor will return (even if you continue taking medications), and what will happen during the rest of your pregnancy, is unpredictable. Having an episode of preterm labor doesn't necessarily mean you'll end up having a premature birth. Very often, the labor passes, the medication is stopped, and your uterus is quiet and calm again. Sometimes, the doctors never know why the preterm labor came and went -- whether it was an infection that flared up fleetingly, dehydration, or some other cause. In other cases, preterm labor returns in a few days or at some later point in the pregnancy, and can result in a premature birth. If your preterm labor recurs while you are being weaned off the anti-labor medication, the first thing your doctor will do is reassess whether it is safe for you and your baby for the pregnancy to continue. If he thinks it is, he will restart anti-labor drugs, possibly switching you to one that Excerpted from Preemies: The Essential Guide for Parents of Premature Babies by Dana Wechsler Linden, Emma Trenti Parolii, Mia Wechsler Doron All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.

Table of Contents

Introduction
A Note to the Reader: How to Use This Book
Part I Before Birth
1 In the Womb: Why Premature Birth Happens and What Can Be Done to Prevent It
For parents trying to grasp the extent of their risk, and what they can do to minimize it
Also for parents looking back, trying to make sense of what happened
Part II In the Hospital
2 Welcome to the World: Your Baby's DeliveryYour baby's transition from the womb to the world
Preparing for, and understanding, a premature birth
3 The First DayEntering the foreign world of the neonatal intensive care unit
Why it's the best place for you baby to be
4 The First WeekA time of crucial test results and waiting
Understanding that things sometimes get worse before they get better
5 Settling Down in the HospitalMaking the NICU the best possible home-away-from-home for you and your baby
6 If Your Baby Needs SurgeryGuiding parents through an event that is usually scarier than it needs to be
Part III A Life Together
7 Finally Taking Your Baby HomeDecisions and preparations for the moment you've been waiting for
8 From Preemie to Preschool (and Beyond)A time to watch you baby's health and development -- and gradually begin to relax and enjoy!
9 When Parents Have Something Special to Worry AboutLearning more about some possible consequences of prematurity
Part IV Other Considerations
10 Losing a BabyHelping you deal with a profound grief, and guiding you through the necessary arrangements
Appendices
Appendix 1 Conversion Charts
Appendix 2 Growth Charts
Appendix 3 A Schedule for Months
Appendix 4 Cardio-Pulmonary Resucitation -- Birth to One Year
Appendix 5 Resources for Parents of Premature Babies
Glossary
Index

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