Consultant says my baby will probably be premature, what should I do to prepare?

[LittleB]

Hi, I had Lletz treatment last Nov and it has affected my cervix. I have just had a scan today and cervix is 2.8mm, so reasonable and the same as it was 2 weeks ago, but it is showing slight signs of funneling. The consultant has said it should be fine for a while, but I'm in again at 28 weeks and they'll probably give me steroid injections then to help the baby's lungs as they expect he will come early. He says there are other things they can do too, if it looks like its going to come before 34 weeks, but after 34 weeks, they let labour progress as the baby should be ok. This has obviously worried me.
I have a dd who is 5 and was born at 39 weeks, but that was before the cervical treatment.
But I wondered what advice people could give me to help to prepeare for the probable early arrival of my little unborn son?
I want to be as prepared as I can, and reassurance and information would help me.
Thanks.

[hildathebuilder]

Firstly very sorry that you are having this worry. I'll keep my fingers crossed that your little one will keep inside for as long as possible.

I didn't have time to prepare myself (DS gave me two hours notice of his entry to the world at 29 +3.

If I had had time to prepare I think the following would have been helpful.

1. Ask to see the neonatal unit/scbu so that if you lo is early its less of a shock. Very prem babies are tiny and often have odd features - eyes and ears fused shut, transluscent skin etc. It pays to have some idea what you may be looking at.
   

1. Check whether your LO is likely to stay in your local hospital if he is early and when and if they may transfer him or you elsewhere. I was in addenbrokes in Cambridge which was my local hospital, but because is was a level 1 hospital it took babies from all around the region. That meant some babies who were local were trnsferred to make space for more needy babies when they didn't need such intensive care. Again the more you know the less of a shock it would be
   

1. Make sure you know what you can do about care for your DD if you go into labour early. You will probably need a lot of RL emotional support from your partner/family and you don't want the worry of your DD to make things worse. Can your family stay/help out/take dd for a few days at short notice. Find out what the options are.
   

1. Get your hospital bag ready
   

1. Get some food in the freezer, find out local takeaway companies etc. You will need to eat and stay healthy as much as possible. IF your DS is early you may well be discharged before he is. If so you will not want to spend much time at home shopping cooking etc.
   

1. Many prems are born by c section, the decision to deliver is often taken quickly and often the LOs aren't engaged etc. If so you may also need to think about how to get to the hospital etc if you can't drive and your DH is at work.
   

1. Your DH/partner should think about mentioning it to his work. He will typically only get the 2 weeks paternity leave and you may want him to have leave both when the baby is born and when the baby comes home (assuming they are not at the tsame time) can he do this, can he take holiday, parental leave etc. If you work you are on mat leave as soon as the baby is born even if its early.
   

1. Try to relax (easier said than done) sleep and take it easy. It may not come to pass.
   

1. Try not to worry.I don't know how many weeks you are at the moment but I know some healthy children who were born at 23/24 weeks. My ds was born at 29 and as far as I know is healthy. Every day makes a difference but there can be some good outcomes even if there are difficult circumstance to start with.
   

10. Post any more questions you may have and I or someone else will try to answer.

Good luck and hang on in there. I'll be thinking of you .

[LittleB]

Thank you so much Hilda, thats really helpful. Sorry to hear that your DS was born early, but I'm glad that he is well now.
I hadn't thought about asking to see the SCBU or asking about hospital transfers, I can easily do that when I next visit. I'm currently 20wks and keeping my fingers tightly crossed for DS.
I had already planned to pack my hospital bag and freeze some meals, did that with dd, so will just be doing it earlier this time, I also thought I'd prepare a basic online tesco delivery order that we can process when needed. Thankfully I have family near and my mum has already offered to come and stay if we'd like her too.
I didn't realise about prem babies often being born by c section so thats also useful to know, although I have been told I'm more likely to need a c section anyway due to the damage to my cervix. I hadn't thought about alternative methods of getting to hospital if I can't drive either, thats a really useful consideration as the hospital is about 25mins drive/8miles from home, I'll need to chat to friends and family more.
I'll ask dh to talk to his work about it too. My work are aware of my situation and are fortunately very helpful and understanding.
Thanks you so much for your reply, it is really helpful.
Do you think I should buy some cheap tiny baby/prem clothes? dd was 6lb10 when born at 39wks and she had some tiny baby clothes as newborn ones were still big on her, so ds might need them even if he hangs on to 38 weeks (that seems to be about the best they think he'll do, which would be a huge relief), but I thought if I had some then didn't need them I could give them to a charity or the SCBU anyway. What do you think? Do I need to buy some nappies etc too, or would the hospital provide those? I have washable nappies to use when he is bigger.
Any other suggestions/ideas etc would be very helpful.
Thank you.

[summerof76]

Hi LittleB

Great advice from Hilda - just a couple of things to add

If you are planning to breastfeed, you might want to invest in a good electric pump. Babies born before 34/35 are not normally able to breastfeed (the do not have the sucking reflex and tire very easily). Therefore if your baby comes early and you want to breastfeed you will need to express for the first few weeks and baby will be fed your milk through a tube.

The hospital will normally have tiny baby clothes that you can use, but it is nice to have some of your own. Unfortunately these don't tend to come cheap though. Asda do some small baby clothes, but to get really small ones you need to go to mothercare or boots where they general the same price as the larger clothes.

Again the hospital will normally provide nappies for the first couple of days, but after that you will be expected to bring your own in. We used pampers micro which were good.

Very best of luck and fingers crossed your little one doesn't arrive too early. I have had 2 x lletz treatment and both my DC were early, but not extremely prem (33 and 36 weeks) and are both well. Hopefully you will be them same.

One last thing - if you have cervical problems and a vaginal delivery, chances are it could be very quick (both of mine were less than 2 hours from start to finish). I am sure your consultant has told you this, but I would advise you to get to the hospital asap at the first sign of anything happening and not to wait at home.

Finally (!) check out the Bliss website which has lots of info and a great messageboard

[LittleB]

thanks summer thats useful too. My consultant hasn't said about a quick delivery yet, but he did make a point of telling me that he'll give me more info further down the line but didn't want to tell me too much yet so I don't worry. Thats helpful to know about though as I had a really long latent stage with dd (4+ days, popping in and out of hospital with sporadic contractions slowing and speeding up) so its helpful to be prepared that it could happen much more quickly this time, otherwise I'd have been assuming it would be really slow again.
Also useful to know about the pampers and baby clothes etc.
Can I ask if they monitored your cervical length in your pregnancies and what it did? Did you know your babies were going to be early?
Glad that your babies are healthy too.

[ArseHolio]

Hi LittleB :)

I replied to your post in pregnancy I think.. have I got the right person ?

I have an incompetant cervix due to lletz and both of my DC were premature because of it. DD was born at 32 weeks and DS at 27.

If your 20 weeks with funnelling why on earch havent they stitched you and got you started on progesterone ? I hope that with funnelling they are not leaving you another 8 weeks for a cervical length scan ?

As to what you can do to prepare there really isn't much. Have the steroids at 24 weeks and try to relax. You don't need to buy anything or do anything, if you do have a prem the hospital will lend you a breastpump and you can buy small clothes and nappies as and when you need them.

2.8cm is a decent length, you have a decent chance of getting somewhere near term. Did your cons tell you how prem they expected ?

[hildathebuilder]

Hello again

On the issues about nappies and clothes, and breastfeeding find out what your hospital policy is on each issue

In addenbrokes, they provided nappies throughout DS stay (Pampers micro again)so we only bought them when DS came home which was good as one less thing to worry about. There were plenty of clothes which was helpful as there are many babies that are too small for even mothercare prem clothes. Prem clothes are expensive (although there is a very good choice on ebay!) Personally we only put DS into his stuff when he came home - albeit that he was 4lb 14 then so still in tiny baby stuff. Mothercare has the smallest stuff of ordinary stores, then asda, boots and john lewis - at least in our experience but DS is long and thin. Again it was one less thing to worry about as the hospital did the washing. we donated many of the prem clothes to scbu after DS grew out of them and they get a lot of stuff that way

On breatfeeeding yes if your LO is early he is unlikely to be able to suck. If he is very early there will be a LOT of pressure on you to express milk as they try not to give nicu babies formula as their stomachs can't easily digest it. So whatever you plan to do about feeding in the long term do bear in mind the hospital will be pushing you to express promptly. I did both carry on breatfeeding - which is quite another story, but many don't. If your LO is in scbu but not nicu again addenbrokes does provide formula for the whole stay and nutraprem, the usual prem formula is prescription only anyway (although they have lots of rules about not displaying it). They also loan out breastpumps although there are never enough. If the hospital will loan you a pump it may save you a fortune if you aren't going to express long term. So personally I wouldn't buy a pump at this stage unless you were sure you'd want it longer term. If your ds is very early then you can buy one (or get your DH to buy one very quickly from boots, mothercare etc - also a couple of websites express yourself moms, nct etc). the earlier your LO is the more it is worth investing in a good one and if like me you may be expressing for weeks, a double electric pump is a god send.

If you do plan to breastfeed a prem it is possible. There have been a couple of threads on the breastfeeding topic about it recently but in spirit of try to relax and not worry about it I would say you don't know what the issues if any may be and cross that bridge when you know when your LO is arriving. A very prem baby may well need supplementing in a way a 34-35 weeker wont. If your hospital is good they provide a lot of support with your choices.

It sounds like you have a lot of family and local support and that should make things a lot easier.

I'll keep my fingers crossed...

take care

[hildathebuilder]

Oh and I second the comment from summer about going to hospital as soon as there is anything which might possibly be a sign of labour. I didn't know I was in labour until I was 5cm dilated as I hadn't notice anything other than a twinge by way of contractions, and it was only bcause I was examined that I knew. DS turned up 2 hours later. I'd sent my husband home as I thought I was just in for observation at that stage but he walkd in the door turned around and came back. We only live minutes from hospital so that was fine thankfully.

[summerof76]

I didn't know DS1 was going to be early, so he came as quite a surprise. With DS2 I had cervical length scans at 16 and 20 weeks (if I remember correctly) and measured 2.4 both times. No funneling though, so slightly different from your situation. I also had the steroid injections just in case.

[LittleB]

Thanks for that summer, and everyone else.
Hi arseholio, it was me you replied to before, thankfully, the funneling isn't bad, there is just a shadow of funnel on the cervix which hasn't started to become a proper funnel yet, but its likely to in time. They don't want to stich as my cervix is still staying the same, so they think it will hold for a few weeks yet, and stitching at this late stage has risks associated with it. He hasn't given me any indication as to how early ds could be, I don't think they can tell yet. They aren't planning to scan my cervix again until 28 weeks, which is a long way off, but the midwife has said if I have pains I'm worried about, or I'm very concerned she can refer me for an earlier scan, I'm seeing her at 24 weeks so I will see if I can persuade her to send me for a scan then.
I have asked about progesterone but my local hospital don't use it as it still hasn't been proved in clinical trials, I did ask for it, I also asked for more cervical scans, which they said no to, but as I said above, my midwife can refer me earlier.
I will ask my midwife about what the hospital provide for premature babies too, I do find the midwives are much more understanding and more friendly, easier to talk to than the consultants.
I'm very keen to breastfeed, did so with dd, and I'm happy to express, but I only have a manual breastpump currently, but I'll see what happens before I invest in an electric one.
I have just ordered some bargain tiny baby clothes in the mothercare sale, many half price and further discounts for buy one get one half price, and I had a £5 off voucher, so I've spent about £30 and got lots of sleepsuits, lots of vests and a snuggly jacket. Didn't buy any early baby clothes though as I'm hopeful that ds will only need the tiny ones. Just wanted to get a few of our own, I still have a couple of dd's tiny ones that were unisex too. I have family who will knit tiny things for ds too, they're pleased that they know what colour wool to use now!
I will check out the bliss website too, and keep lurking here for more information.
Thank you everyone.