Delivering premature babies in the Pikes Peak region
"I did not have a very good experience with being prepared for his stay or what was expected of me as the parent,” says Jackson. “I eventually worked as a NICU nurse in that same unit where my son spent his time, and it was my mission to make sure no parent felt as lost as I did during my son’s NICU stay.”
It’s safe to say Jackson has achieved her goal. An RN, Cindy is currently a staff, transport and relief charge nurse with the NICU at St. Francis Medical Center, where she’s worked for the past four years. She is part of a uniquely qualified group of nurses who devote their professional lives to helping ensure the best possible outcome for babies who arrive too early or with serious medical problems.
Colorado Springs is home to two major hospital systems that are capable of caring for premature babies and those with serious conditions. Memorial Hospital is a Level IIIB NICU and St. Francis Medical Center is a IIIA. About 270 premature babies are born at St. Francis every year, and in 2012, 92 preterm babies were delivered at Memorial–39 of those weighing less than 1.8 pounds and 53 weighing between 1.8 and 2.7 pounds. Both the Memorial and Penrose systems also care for babies transported from other hospitals.
Deborah Bopp, RN and Perinatal Clinical Nurse Specialist with the Memorial Obstetrical Department, says, “I specialize in safety, risk management and quality outcomes.” Bopp, who’s been with the Memorial system for 20 years, works with the labor and delivery nurses. “I teach the nurses that the preterm baby is a more fragile infant and can have more of a response to stress than a full-term baby. We have to be careful not to expect too much of them. They can deliver with less labor and can respond to infection more severely and rapidly.”
Though the labor and delivery room for a premature delivery is prepped in much the same way as for full-term deliveries, there are a few important distinctions. “When called to attend the delivery of a premature infant,” says Jackson, “the baby’s gestational age is of great importance. A nurse practitioner, an RN from the NICU, a respiratory therapist and at times a neonatologist attends the delivery of what we term a ‘micro preemie.’ This is a baby born weighing less than one pound, 12 ounces, or before 26 weeks gestation.”
The delivery room staff is prepared to move very quickly, knowing there is not a moment to waste once a preemie arrives. Jackson says immediately following birth, a high priority is keeping the baby warm. “The warmer is on and warm blankets are ready,” she says. “This is to prevent a drop in temperature and to keep the premature infant from using what little glucose stores s/he has available. The infant is dried, and there is one staff member listening to breath sounds, one evaluating heart rate and another placing a preductal pulse oximeter (measures oxygen saturation noninvasively). Suctioning of the mouth and nose may be occurring, and evaluating color. No more than 30 seconds is allowed between an assessment, evaluation and treatment.”
Deborah Bopp says if there’s time before delivery, the NICU staff is often asked to talk with the parents and family to go over what to expect with the birth of a premature baby. “It depends on how premature the baby is,” says Bopp, “but the small ones especially can have a roller coaster ride of ups and downs in the NICU.”
One might assume that all premature babies are born by C-section, and certain situations certainly warrant C-section delivery, but many preemies are delivered vaginally. “So much depends on the mother and the baby, and any high-risk issues they may have,” says Bopp. “Right now there is not a clear advantage of one over the other, but that is still being studied around the world.”
C-sections are likely if the mother is in distress due to conditions such as eclampsia or pre-eclampsia, pregnancy-induced hypertension, or abruption, says Jackson. “If the infant is in distress—decreased fetal movement, stress, low fetal heart tones, pre-determined in utero issues—or if there are any deformities that may make a vaginal delivery difficult or dangerous for mother or infant, a C-section will be warranted.”
Trying to determine why some babies are born prematurely is a challenge. “In my experience,” says Bopp, “we find out the cause in 30-40% of pregnancies, and the rest seem to be related to unknown or subclinical issues. The key to everything is good prenatal care, good health before you get pregnant, and keeping your appointments for follow-up.”
“For the most part, having a baby is the most joyous event in human existence, in my opinion,” says Bopp. “The joy greatly outweighs the tragedy. My job is to try to keep us on the joy side as much as possible, and away from the tragedy. It can be difficult but it is totally worth it. It is the most amazing place to work!”
Did You Know?
As reported by CNN Health, as of 2011
Vermont had the lowest preterm birth rate (8.8%) and Mississippi had the highest (16.9%)
Colorado’s preterm birth rate was 10.3%
According to the March of Dimes in 2013, the preterm birth rate in the U.S. fell for the sixth consecutive year in 2012 to 11.54 percent of all births, the lowest it’s been in 15 years
Colorado is one of five states to be recognized in 2013 for lowering preterm birth rates by more than 8 percent since 2009
The U.S. infant mortality rate fell in 2011 to 6.05 infant deaths for every 1,000 live births, an all-time low