I Gave Birth To A Preemie And Here's What I Wish I Knew

September is NICU awareness month.

Neonatal Intensive Care Unit (NICU) is a special unit of the hospital dedicated primarily for babies born early needing special care and attention, typically due to a variety of health concerns like breathing problems, organ defects, organs still developing, jaundice (skin turns yellow) or baby swallowing meconium (newborn’s first poop) during labor.

My son was born at 33 weeks because I suffered from preeclampsia, a condition that can occur during pregnancy where the elevated blood pressure is detrimental to both the mother and unborn child. My baby showed signs of fetal growth restriction and I also experienced preterm labor which led to my son’s early delivery through C-section.

According to WHO, an estimated 13.4 million babies were born preterm which means one in 10 babies around the world is born premature.

In the NICU you’ll find incubators, infant warmers, feeding tubes, oxygen tanks, phototherapy equipment, monitors, ventilators and IV lines. It is an overwhelming sight, especially for a mom with a baby in NICU.

Preterm birth

According to a 2023 report of World Health Organization (WHO), an estimated 13.4 million babies were born preterm (before 37 completed weeks of gestation) in 2020. This means one in 10 babies around the world is born premature.

According to WHO, preterm is defined as babies born alive before 37 weeks of pregnancy and that there are sub-categories, based on gestational age:

• extremely preterm (less than 28 weeks)
• very preterm (28 to less than 32 weeks)
• moderate to late preterm (32 to 37 weeks)

WHO notes that, globally, prematurity is the leading cause of death in children under the age of 5 years.

I see you, preemie mom

Nothing prepares you enough for your motherhood journey—every birth is unique, and so is your child. And the NICU journey is another story to tell, mine was brief—a week, but each day that passed felt like a year knowing that I was trusting the care of my newborn with someone else. 

I was unable to co-sleep with my child during the first days of his life, unable to watch him all the time because visitation hours were strictly enforced, and unable to breastfeed my baby because he was ‘too weak to suck’ so I witnessed him feed through a tube that goes directly to his stomach. I remember looking at him being frail and tiny and I was constantly wondering to myself then, “When are we going home?”

I could only imagine the pain of the parents who worry about their newborns in NICU for weeks and months to no end. It still brings me to tears whenever I try to recall that day I was discharged from the hospital and I had to painstakingly leave my baby in the NICU. All I can remember was that the trip back home was a blur and I had a huge lump lodged in my chest hoping that things would not grow worse so I could bring our warrior home soon.

So I share with you, preemie mom, some things I should have known when I gave birth to a premature baby to let you know that you are not alone in this journey.

8 things I wish I knew when I gave birth to a preemie

1. The importance of strong support system.

Aside from the effects of postpartum, the stress of leaving and trusting your baby’s well-being with someone else goes against your maternal instinct. It is very crucial to find support from family and friends because it is easy to get drowned in your thoughts and worry if you do not have someone to talk to. Find a breastfeeding support group as well. Not all mothers who deliver early can immediately express milk and the babies in NICU will need breastmilk. With such support groups, you’ll learn some tips and hacks, as well as referrals for breastfeeding advocates and lactation consultants. You can also meet people willing to donate breast milk in case you need one.

2. Grunting.

One thing I was not prepared for and worried a lot about was “grunting.” Back then, my preemie constantly gave off a sound like passing a ‘hard poop’ and others would describe it like “demonic possession” because the baby exhales a growling sound.

According to the Irish Neonatal Health Alliance, Ireland’s collaborative platform and network to represent the interests of preterm infants, “Grunting in premature infants is normal and very common. It is due to an immature nervous system and they will eventually grow out of it. Premature infants tend to spend most of their time in light sleep (REM or active sleep) vs. deep sleep (non REM or quiet sleep) and sometimes have a difficult time transitioning from an asleep state to an awake or alert state.”

My son eventually stopped grunting at three months of age, but as always, if your instinct tells you otherwise, it won’t hurt to ask the attending physician regarding your concerns. Be vigilant in terms of skin color, breathing rate, and chest movement to tell if your baby is experiencing actual respiratory distress.

RELATED: 'Ilaban Hangga't Kayang Ilaban Ang Inyong Mga Anak': NICU Mama Shares Incredible Journey Of Her 28-Weeker Baby

3. Soft cries or visual cues.

One thing I learned with my preemie son was that he got tired a lot. I was not able to breastfeed him at the NICU because he fell asleep whenever he tried to feed. The sucking motion made him feel exhausted. We tried cup feeding but he got even more tired. This was the reason why he was tube-fed when he was in NICU. When we brought him home, I learned to be vigilant with his visual cues if he was hungry (pouting or subtly trying to suck air) because his cries were too soft, you could rarely hear them. Crying usually tired him out.

4. Preemie clothes.

Another thing that frustrated me was that the newborn clothes do not fit, even the smallest of size zero. It can be a disappointing experience when you try to fit your baby in newborn clothes and no matter how tiny these newborn clothes are, they still fall off by your babies’ shoulders. My first born was too big for size zero when she was born so I didn’t know that there were preemie clothes available. Trust me, seeing clothes that fit your preemie does wonders to your mental health.

5. Knowing when to hold the baby.

When my husband and I visited our preemie baby in NICU for the first time, even if we donned sterile suits, masks, and gloves, we decided not to hold him yet until we were confident that he’s out of the woods. I learned to hold him close when practicing “Kangaroo Care” or “Kangaroo Mother Care” (KMC) which is the method of holding your baby to your chest, also known as “skin-to-skin” contact. This was advised when he could already breathe on his own to promote weight gain.

6. Preemies can get overstimulated.

According to My Active Health, “If your premature infant is overstimulated, you may notice physical reactions in the presence of too much sound, touch, movement, or light.”

'If it’s too much to take, then take it one day at a time. Babies will depend on your strength and resilience as a mother so make sure you have enough energy to emanate just that.' - on taking care of your premature infant

It is believed that babies who don't have mature nervous systems are still in the process of synthesizing all the sensations and stimuli they are receiving, and thus need help to getting acclimated or organized. Overstimulation can be caused by too much rocking, swaying, or singing very loud, including exposure to blinding lights, so if you notice averting eyes, twisting, arching, scowling or signs of discomfort, you may give your infant some peace and quiet.

7. Post NICU appointment is priority.

Not all preterm babies experience developmental delay but some do. So it is very crucial not to miss your doctor’s appointments after your baby has graduated NICU. Your child’s well-being like any other child is important–premature or not. They will fulfill their milestones at their own pace but learning about early interventions if there are suspicions of possible delays would benefit your child more.

8. Taking it one day at a time.

Having a new baby is already overwhelming in itself but having a baby in the NICU can double that feeling of stress and worry. If it’s too much to take, then take it one day at a time. Babies will depend on your strength and resilience as a mother so make sure you have enough energy to emanate just that.

Want to learn about another mom's realization after having a preemie baby? Read here.