Preterm births are demanding our attention
The fall marks a time when many of the harder realities of pregnancy that typically live in the shadows finally get some public attention. From NICU Awareness Month in September to Pregnancy and Infant Loss Awareness in October to World Prematurity Day here in November, many find themselves feeling relief to be invited to share their experiences of a complicated family-building journey as well as validation to be included in broader conversations.
This month, on November 17, we honor the realities and impact of prematurity. According to the March of Dimes, preterm birth is the leading cause of infant mortality worldwide. Here in the United States, we’re far from immune to it. In fact, the CDC reports that in the United States, a country that touts medical advancements, 1 in 10 babies are born prematurely, and that is just one percent lower than the global preterm birth rate.
Prematurity is a public health crisis because everyone is affected by it. The cost of prematurity has been calculated to be a $26 billion expense per year for the United States alone. That doesn’t include the added costs of extended parental leave, the cost for post-discharge medical care for the birthing person and the baby, early intervention to support healthy development and long-term medical, learning and developmental supports for the varying health complications preterm infants are at risk of developing, as well as the long term health implications for the birthing person and parents after a traumatic birth experience.
Numbers are helpful in giving us a way to quantify the experience of preterm birth, but they do nothing to express the true lived reality of that experience. These are stories that belong in the public discourse of pregnancy and parenthood year-round and we can start to work toward that with World Prematurity Day, a day set aside to create awareness and honor those who have already experienced prematurity firsthand.
What is prematurity?
Prematurity is defined as any baby born before 37 weeks gestation. The impact of prematurity is far-reaching with devastating implications for both the baby and parents that reach beyond the baby’s first day, month or even year.
Not only does prematurity create a higher risk of health complications for the baby such as pulmonary, ophthalmological and digestive issues but it can also cause cognitive, intellectual and motor developmental disabilities or delays, according to March of Dimes. Learning and behavior challenges can impact the child even into elementary and middle school ages.
For the birthing parent, the specific cause of preterm birth can often increase the likelihood of certain long-term health problems. For example, preeclampsia during pregnancy can lead to an increased risk of hypertension, cardiovascular disease and metabolic disorders long after pregnancy has ended. However, prematurity doesn’t just impact the birthing parent. Both parents can experience difficulty in connecting, bonding and forming attachments with their baby as a result of preterm birth and the associated traumatic stress and fear from meeting their baby too soon. This trauma not only impacts prenatal care plans for future pregnancies but also challenges dreams parents may have had about how many children they want to raise and how to space them out. Traumatic stress can also manifest as long-term health issues for both parents ranging from migraines, chronic pain and autoimmune diseases to cardiovascular disease, stroke, lung disease and certain cancers as noted by the works of researchers in the field of traumatic stress such as Gabor Maté. Bessel van der Kolk, and others. These long-term health issues can be traced back to the physiological changes that happen to both parents as a result of the traumatic stress from their experiences of prematurity and a possible NICU stay.
How do we heal from preterm birth?
A common misconception, as noted earlier, is that only the birthing parent is impacted by prematurity. The reality is that both parents feel the physical and emotional effects associated with the realities of raising a preterm baby and both need and deserve to heal. It’s important to note this because often resources are pooled toward the birthing person, especially if they identify as a mother, with very little discussion around the non-birthing parent’s needs.
The healing process has to begin at the body-based level, not the thought-based level, which is unfortunately what most advice revolves around. Just changing thought patterns around the experience of prematurity won’t help undo the trauma that our bodies remember and will instinctively react from when activated or triggered. The healing that is needed is essentially completing autonomic nervous system responses that were left unresolved or incomplete since the pregnancy, birth or NICU stay. This looks like relearning how to access our sensory system, our motor system and our musculoskeletal system in order to integrate the cognitive, somatic and sensory memories that birthing parents have from that time.
This work can be done by first acknowledging that the experience was traumatic. Too often, experiences are minimized by culture and society because baby is alive or baby is home, a message that is unfortunately internalized by the parents. By acknowledging that, no matter the outcome of the preterm birth, parents could have encoded that experience as traumatic, they can give themselves the permission to begin the healing process. From there, it’s essential to take stock of how your body has been impacted by the traumatic stress. In my line of work, I often see a rise in chronic health conditions, an exacerbation of preexisting chronic pain, insomnia, migraines, and so many more health conditions that are closely linked to unresolved traumatic stress. By doing this self-assessment, parents can identify what parts of the body will need the most support to begin the healing journey.
Can we mitigate the risk of prematurity?
Once we understand just how serious the implications of prematurity are, it becomes crystal clear that the time to do something about it is now. Fortunately, we have many different tools at our disposal for how we can prevent preterm births or extend pregnancy to delay delivery. From medical interventions that are ever-evolving to expanding and improving access to prenatal care, as well as improvements in prenatal care to include trauma-informed, neurobiological approaches to care, a different outcome is possible.
The first step for parents is to dig in and do research on what medical interventions, medications and level of monitoring are accessible to them. Ask your providers questions on how they will help you mitigate the risk of prematurity from a medical perspective as well as a whole health and neurobiological perspective. If they don’t have an answer, push back. Remember you are your best advocate when navigating your medical care.
Seek out practitioners who embody a trauma-informed, neurological approach to prenatal care and build out your team with professionals outside the traditional medical institution. These can include doulas, midwives, pregnancy experts and pregnancy-specific somatic professionals who can provide additional strategies to mitigate your risk of preterm birth. In the effort to turn the tide on prematurity, I urge you to embrace a both/and perspective on your care; keep your traditional medical team close while also seeking additional, complementary ways of helping you have a healthy pregnancy and stay pregnant as long as possible.
We also have hope for babies born preterm. With improvements to medical technologies, more and more babies born earlier and earlier are surviving. Thanks to targeted developmental support for growing babies along with more access to somatic approaches for parents in trauma healing, we’re entering into a time where families who have experienced prematurity can overcome many of the long-term health odds staring down both parents and babies. It just takes knowing what support is available and advocating for yourself to receive it.
Prematurity and its implications have the best chance of decreasing when we all work together. Prematurity doesn’t just affect the baby and the family unit, it also impacts the community and the world. The ripple starts in the financial strain associated with the cost of care for the preterm baby and the long-term financial impact of chronic illnesses and chronic health issues for both baby and traumatized parents. It eventually expands, placing a load on education systems ill-equipped to handle the needs of the child with little funding for additional support. And when a child isn’t given the necessary support in developmental years, the effects are felt and seen long into adulthood. Prematurity is a public health crisis that needs everyone’s attention. On November 17, let us all commit to doing our part to help change the statistics.