I don't have kids, but I'm an aunt of two nieces and four nephews (so that makes me an authority on the subject). And nine months? Can sometimes not be long enough to prepare yourself to be a parent. So put yourself in Callie's shoes. She didn't even get nine months, and when she saw her baby for the first time? Sofia was covered in tubes, electrical leads, and hooked up to machinery and oxygen. Yikes. At the end of Episode 719, "It's a Long Way Back," Callie is scared to death of taking Baby Sofia out of the hospital—and how can we blame her? There were reasons (and good ones) that her little baby had so many tubes...

What qualifies as 'premature birth'?

Babies are considered premature (or preterm) when they are born at least three weeks before their due date. Doctors consider forty weeks as full term, so premature birth would start at thirty-seven weeks. However, Baby Sofia was born at twenty-three and a half weeks, so she actually fits the category of "micro-preemie"—babies born at less than twenty-six weeks and weighing less than one and three-fourths pounds.

According to the National Institutes of Health, 8-10% of all pregnancies are premature in the United States, and the CDC reports premature birth as the leading cause of death among newborns. Premature babies often stay in the neonatal intensive care unit for long periods of time because they can have serious health risks and require extensive monitoring.

Why are babies born prematurely?

Many factors may contribute to a mother going into labor early such as health problems, lifestyle choices, and previous medical events. These may include:

- Having a previous preterm pregnancy.
- Carrying more than one baby (Such as twins or triplets).
- Cigarette smoking, alcohol use, or illicit drug use during pregnancy.
- Certain infections during pregnancy.
- Problems with the mother's uterus or cervix.
- Chronic illnesses (Diabetes, high blood pressure, clotting disorders).
- Heart or kidney problems with the mother.
- Bleeding due to abnormal positioning of the placenta.
- Trauma.

And sometimes, the pregnancy proceeds problem-free, yet the baby still wants to come out before the due date for unknown reasons.

Are there any warning signs of premature labor?

Some doctors plan to deliver babies earlier than the due date depending on the health of both baby and mother, but most premature births are unexpected. Signs of premature labor may be:

- Abdominal cramps, with or without diarrhea.
- Cramps that may feel like your period.
- Low, dull backache.
- Pelvic pressure (the feeling the baby is pushing down).
- Contractions (Your abdomen tightens like a fist every ten minutes).
- Change in vaginal discharge (Leaking fluid or bleeding).

If born prematurely, babies can experience both long term and short term medical problems.

- Respiratory and breathing difficulties.
- Vision and hearing loss.
- Cognitive and developmental problems.
- Cerebral palsy.
- Feeding and digestive problems.
- Jaundice.
- Bleeding in the brain.
- Problems controlling body temperature.
- Trouble communicating and making sounds.
- Various infections.

While in the NICU, preemies need extensive monitoring and care to give them basic needs to ensure their survival and growth.

Due to decreased birth weight, preemies do not have the necessary body fat to maintain a stable temperature, even when swaddled with blankets. And a stable temperature helps these preemies grow. Therefore, NICU teams strive to keep these babies warm with incubators and radiant warmers. Incubators will be placed around the preemie to provide warmth, stave off infection, and reduce water loss. Radiant warmers are a type of electrically-warmed bed with an opening that lets NICU personnel easily access the baby. They can keep track of the baby's temperature by taping a tiny thermometer to his or her skin.

Since they do grow at a faster rate than full term infants, preemie babies have special nutritional needs that need to be addressed in the NICU. Their digestive systems are not quite mature enough to take breast milk directly from the breast or even bottle until they reach 32 to 34 weeks gestational age. The mother can pump her breast milk, which can then be fed to the baby through a tube from the baby's nose or mouth to the stomach. They must be fed slowly in order to prevent them from getting necrotizing enterocolitis (NEC), an intestinal infection common to preemies. Along with the vitamins and proteins already in breast milk, preemies also need additional phosphorous and calcium.

How can one lower their risk for premature labor?

Even though some babies are born premature for unknown reasons, mothers can still be proactive in taking care of their health before and during pregnancy. For example, doctors advise that women receive a medical check-up before trying to get pregnant. And then as soon as they learn they are pregnant? They should seek prenatal care as soon as they can. Women should make sure they receive treatment to control chronic problems such as diabetes or a high blood pressure. They should try to quit smoking and avoid substances such as alcohol or drugs while pregnant. And if a woman detects any warning signs or symptoms of preterm labor, she should seek medical attention.

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