The leading cause of neonatal mortality is preterm birth and nearly 85% of preterm births occur after 32 weeks of gestation. – PLOS Global Public Health
The prevalence of preterm birth at the Kenyatta National Hospital was found to be 18.3% in 2015. Previous preterm birth, multiple gestations, pregnancy-induced hypertension (PIH), antepartum hemorrhage (APH), prolonged preterm pre-labor rupture of membranes (PPROM), and urinary tract infection (UTI) in pregnancy were all significantly associated with preterm birth. – UoN University of Nairobi
Dr. Lango, a consultant Pediatrician says, “Viability medically starts after 24 weeks gestation. This means that babies born after 24 weeks given the right care with the right equipment and manpower are able to survive. That said, there are many other factors that will affect survival, most importantly the underlying conditions that led to the preterm birth.”
The levels of pre-term vary and each stage is termed differently. Under 28 weeks is extreme pre-term, 28 weeks to 32 weeks is very preterm, 32 to 34 is moderate pre-term, 34 – 36 weeks and 6 days is late pre-term. The closer you are to term the higher the chances of survival. – WHO (World Health Organization)
Rebecca from Nairobi, a mum of four, gave birth to her last-born twins pre-term, at about 8 months, they are now 5 years old. She shares her experience of raising pre-term babies saying, “The fears I had were that my babies will not survive, that they will always be in and out of the hospital and that they will never be normal babies.”
In Rebecca’s case, she had to stay indoors for 2 weeks after her babies were born. She was under strict instructions to be the only one to handle them for that specified duration. They were to stay warm in a room where windows stayed closed.
She says, “I feared health issues, risk of infections, and sleepless nights. What was a surprise was my babies gaining weight and how fast they grew without being admitted to a hospital not even once and thank God for that.”
When looking at some of the causes of preterm births, there are factors that may cut across the board, however, each case is unique, as each situation, baby, mother, and antenatal care facility are unique.
Dr. Lango states “Any delivery before 38 weeks is considered a preterm delivery. Those older than 34 weeks are considered “late” pre-terms, and these usually have the best chance of survival. Those born at 28 weeks and below are considered “extremely premature.” These tend to have more complications.
He explains that “Some of the common causes of premature birth include; Hypertension in pregnancy, Incompetent cervix, Infections – of all sorts, Diabetes in mum, Autoimmune diseases in the mum.” He adds, “Having any of the above will dispose you to preterm birth. Mothers with autoimmune disorders and diabetics would require close follow-up with the obstetrician.”
Mothers who have had pre-term babies worry a lot about their well-being and survival in this world, and understandably so, however in Dr. Lango’s view, it isn’t necessary or helpful to be overly protective, especially after discharge and being declared good to go by your doctor. He says “The bulk of the work is done in the hospital before discharge. To optimize survival and good outcomes with minimal morbidity in the future, we urge mothers with anticipated preterm deliveries to deliver in institutions capable of handling pre-term birth and babies. What we do in the first few minutes matters a lot.”
He continues to explain, “After discharge, follow up with a Neonatologist is paramount. We need to keep track of the child’s development, and key milestones and mitigate the known complications of premature birth. Parents of babies born prematurely tend to be over-protective of these small ones. This is not necessarily a good thing. Lack of adequate sun exposure worsens their existing predisposition to rickets. Shielding the children from interacting with the world is not necessarily good either. It worsens their existing high predisposition to allergy. In summary, treat the children like the rest of the kids in the house and let your Neonatologist worry about the medical bit.”
Conception, pregnancy, and motherhood are all a mystery and a God-given gift. It’s still a phenomenon that we all seek to understand more. Life is valuable, even when it seems premature.
