It’s the moment every mother imagines during pregnancy – having her newborn baby placed on her chest after delivery. But sadly, many women don’t get to experience this if their baby is born premature.
While pregnancy and childbirth are usually regarded as a time for happiness and celebration, the birth of a premature baby is often associated with feelings of loss, guilt and anxiety.
Giving birth to a premature baby is a different experience to delivering a baby at full-term, says Dr Beate Harrison, Perinatal and Infant Psychiatrist at St John of God Hospital Murdoch.
"It has often been a traumatic birth under emergency circumstances that for many represents a crisis,” Dr Harrison says, adding that some women feel a great sense of failure and guilt at having delivered a premature baby. “They’re happy to have a healthy baby but they’re somewhat aggrieved that their birth plans haven’t completely gone as they wanted them to.”
“A lot of women arrive at the SCN following a premature birth with lots of anxiety and this continues into early parenting.”
And it’s something that affects so many women: in Australia, just over 8 per cent of all babies are born prematurely each year, and approximately 15 per cent require the help of a neonatal intensive care unit (NICU) or special care nursery (SCN).
The importance of bonds
Parents of premature babies are at significant risk of early parenting stress, Dr Harrison says – and the new Care and Connect program at SJGH Murdoch is aimed at preventing an anxious style of parenting, to help parents develop a repertoire of useful coping skills. "Our aim is for parents to go home with an optimal bond and attachment," she says.
It can be a more challenging prospect, but establishing an early, healthy bond is vital for the long-term emotional wellbeing of premature infants and their parents, Dr Harrison explains. “There are many difficulties that can get in the way of adequate bonding, such as the separation from baby and medical interventions,” she says. For example, mothers of extremely premature babies have significant levels of depression in the postnatal period; Dr Harrison says that some studies have found rates of postnatal depression are up to eight times higher for that group of mums.
But it’s vital to set up the relationship between mother and baby from the start, emphasises Dr Harrison. “Babies generally rely on the attachment relationship with their mother or primary caregiver for various things such as safety, security and optimal emotional development. With prematurity it’s very important to have that early bond for the enjoyment of the parents, but also for the development of the baby.”
Studies have shown that Kangaroo - or Kanga - care (where baby and mother or father share skin-to-skin contact) helps regulate heart rate and temperature in the premature infant. It also helps with growth and development. “Breastfeeding can also be really important so mothers feel they have a designated role in the care of their baby,” Dr Harrison says.
Bianca* understands the emotional rollercoaster that accompanies a premature birth. Her spontaneous labour, seven weeks early, was stressful and emotional. “I was in total shock. It was so unexpected and out of my control,” she says.
While she felt a huge sense of relief when she heard her son Charlie’s cry after delivery, there was no time for bonding: he was quickly taken to special care, where the process was very medicalised. “Everything I had been looking forward to went out the window. You take it for granted that you’ll be able to hold them and look at their tiny little feet, and I missed out on that,” Bianca says.
Bianca didn’t see Charlie again for over 24 hours, and describes seeing him in an isolette as very emotional. “It’s a very artificial environment. It was very confronting to see him like that, so untouchable,” she remembers.
Many parents find it hard to bond with their baby in such restrictive and difficult circumstances, and Bianca says that she sometimes even felt like she needed to ask permission to be involved with her son’s care.
“Everything becomes very medical and statistical,” she explains. “The hard thing is that premature birth isn’t just premature labour; there are so many other factors to it. There’s concern, a sense of loss at not having the ideal bonding with them, and then you feel as though you’re responsible, that your body has failed them.”
It was 10 days before Bianca got to hold her son. “I didn’t realise how much of an impact that had until I was actually holding him,” she says. “I just started crying. I realised then what I had missed.”
Bianca was able to establish breastfeeding with Charlie – even though her first feed, when he was three weeks old, lasted just 10 minutes. “It was beautiful. It felt like a delayed birth experience. I was able to resurrect some of the normal process.”
Charlie was in hospital for four weeks before coming home. “The fragility of a premature baby is something I was anxious about, especially during those first weeks at home,” Bianca says. “After a prolonged medical intervention, you do lose a bit of confidence bringing them home.”
Bianca credits breastfeeding and Kanga care as key elements in helping her establish a strong bond with Charlie, saying, “The skin-to-skin contact was really important. I was so happy to experience that physical connection.”
At 10 months of age, Charlie is now developing well. “There are some subtle delays, like crawling, but I can see him progressing,” Bianca says. “He’s thriving now.”
*Names have been changed