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Tiny but Mighty: Preemies and Pre-Term Birth

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Globally, an estimated 1 baby out of 10 is born prematurely. World Prematurity Day, on the 17th of November, celebrates ‘the little things’, these tiny but mighty infants and raises awareness for pre-term birth and it’s many challenges for all parents, including intended parents around the world.

The days after birth are meant to be serene and blissful as new parents cradle their newborn and glow with the radiant joy of family. At least this is what we have been taught to expect. Parents that have faced premature delivery and an extended hospital stay for their baby, speak about a very different experience; the intense feeling of helplessness and anxiety as they surrender their baby’s healthcare to anonymous medical professionals. Being brand new to parenthood and usually out-of-their-depth trying to comprehend the associated medical treatments and health implications, parents of preemies tell of feeling “overwhelmed” and “traumatized” during the post-birth period.

This is no different for intended parents on a surrogacy journey, and perhaps even more so. Having already experienced such an enormous loss of control during the gestational phase of the process, birth is the light at the end of the tunnel. The time when, finally, intended parents will be pro-actively and singularly responsible for their family unit – a goal long strived for. Despite the good fortune of having
access to NICU medical treatment, intended parents often experience a multitude of hurdles before ever even arriving to the option of surrogacy, and can be left doubly vulnerable in the face of pre-term birth. Parents of preemies with severe medical problems might feel angry they aren’t in a position to fix the issue or grieve the loss of the healthy, perfect baby they dreamed of bringing home. The added fear and challenge can feel as though the blows will never stop coming or even that in some way they are being punished for having ‘pushed the envelope a little too far’ by creating their family through ART (Assisted Reproductive Technology).

How is premature birth defined?

A premature or “preemie” baby is an infant born ahead of schedule, approximately 3 weeks before the predicted due date. A standard full-term pregnancy counts 40 weeks, so pre-term birth is considered as a delivery at 37 weeks or earlier.
‘Preemies’ are categorized as:
• Late preterm (born between 34 -36 weeks)
• Moderately preterm (born between 32-34 weeks)
• Very preterm, born (born before 32 weeks)
• Extremely preterm (born before 25 weeks)
How does prematurity impact health?
For Preemies As a fetus can take 40 weeks in utero to fully develop and must make many physical adjustments to start life outside the uterus, if born too prematurely, certain functions and organs may not be prepared to work independently without help from the the surrogate carrier’s blood supply and placenta. The earlier a baby is born ahead of plan, the greater the health complications and the care required to ensure successful growth outside of the uterine environment.

Common health conditions affecting preemies include:

• Breathing difficulty
• Reflux
• Jaundice
• Feeding issues
• Eye problems
• Infections
• Brain injury

For Intended Parents and Surrogate Partners

The effects of a premature delivery extend beyond the newborn and also impact all parties involved in a pre-term surrogacy journey. The surrogate partner is more likely to experience an extended period of anxiety and postpartum depression whilst intended parents can struggle with forms of post-traumatic stress disorder (PTSD) and post-birth bonding.

Why does prematurity occur?

Pre-term birth can occur with no warning and for no definable reason. The cause of preterm delivery isn’t always known and can be completely out of the surrogate carrier’s control.

1. Underlying or developed health conditions

Conditions developed during pregnancy, can contribute to a baby’s early arrival such as:
• Abnormal situation of the placenta
• Hypertension
• Infection
• Gestational diabetes
• Early inducing of labor for medical reasons

2. Lifestyle choices

A surrogate’s lifestyle choices, in regards to nutrition, stress levels, toxic
substances and alcohol consumption during pregnancy also weigh into the risk of
prematurity and all candidates for a surrogacy journey should:

• Be thoroughly screened in advance of candidacy – with special attention paid to
education in these areas

• Participate voluntarily in regular testings throughout gestation to assess the
body’s proper nutrition and a system clear of toxins

3. Multiples

Twin or triplet births can frequently result in pre-term labor due to over-extension
of the uterus from carrying more than one baby at a time.

Can pre-term delivery be prevented?

No single solution exists to prevent prematurity but certain measures can be taken to lower the risk of an early birth such as:

• A healthy, nutritious diet
• The avoidance of toxins: tobacco, alcohol or drugs
• Consistent prenatal care
• Manageable stress levels
• Cervical cerclage if medically prescribed ( a stitch which closes the cervix until the
baby is born)

Risk factors for premature delivery

To decrease the risk of pre-term labour surrogate carriers should not:

• Be younger than 20
• Be older than 40
• Have a history of pre-term labor
• Have a too low or too high BMI before pregnancy

It is important to note that any pregnant woman can be at risk for early delivery and many have no known risk factors at all. Approximately half of premature deliveries have no identifiable cause.

NICU and preemie care

For pre-term babies having trouble making the transition outside the womb after birth, a stay may be needed in a specialized wing of the hospital called the neonatal intensive care unit (NICU). NICU provides a vigilant environment designed meet the unique needs of premature infants mainly in regards to breathing, weight gain and warmth.


‘Preemies’ sometimes need help to breathe through a ventilator or endotracheal tube while others will only need extra oxygen.


Premature infants have special nutritional needs, as their growth rate is faster than full-term babies and their digestive systems are still in development. Neonatologists provide fortified preemie formula and can administer total nutrition via slow-paced or intravenous (IV) feedings if needed.

Maintaining a stable body temperature

Pre-term babies lack the body fat needed to maintain their body temperature, even when swaddled. Incubators, radiant warmers or kangaroo care keep them warm in the NICU. Preemies can typically maintain their own body temperature once they weigh in and around 1.8 kg.

Intended parent concerns and stresses

There can be an instinctual drive to assume newborn care and in particular for intended parents, who’ve been kept on the sidelines, in many ways, for months. To have your pre-term infant whisked away after birth, often immediately, can be a devastating combination of frustration, fear and loss.

You might not be able to visit or even see or hold your baby initially. The concern about your baby’s health with the added stress of being in a foreign country with language and culture barriers can make it challenging to feel positive and delay bonding with your premature baby.

Although not commonplace, NICU can be a sudden reality and along with this comes the financial burden specialty medical care can present. Always check a surrogacy program’s insurance coverage to understand your financial responsibility so as to avoid the stress of unexpected NICU fees.

Establishing a bond in NICU

Although the circumstances aren’t ideal and the post-birth period isn’t what you’d imagined, there’s much you can do to feel close to your baby and develop a bond in NICU. Bonding lays the foundation for all aspects of newborn development as this helps your baby feel loved, safe and secure. Bonding doesn’t usually happen overnight but is built by repeated, loving interactions and consistently responding to your baby’s needs.

Tips for preemie attachment

• Touch and hold your baby whenever possible, even just holding your baby’s hand
or stroking their feet. When allowed, you can try skin-to-skin kangaroo care so
your baby can feel your warmth and heartbeat.

• Your baby will understand you are a source of calm and they can rely on you
during medical interventions and times of stress.

• Babies speak to you through their body language. You’ll become attune to their
signs and signals for both stimulation and calm.

• Share your smell so it becomes familiar. Avoid perfume which can disguise your
natural scent and if holding isn’t possible ask to keep a well-worn clothing item in
the incubator with your baby.

• Stimulate your babies senses – smile a lot, read favourite poems, sing. Tonal and
facial expressions will help your baby’s brain to develop and help your baby grow
emotionally and physically.

• Be predictable and do things in a consistent pattern so your baby learns cues
and can predict that you will be a reliable source of comfort. Use repeated
actions, expressions or words ahead of your interactions so your baby learns to
recognize and rely on you.

• Participate in your baby’s care whenever possible – repositioning, wiping, and
changing diapers.

• Look after yourself. Your baby will need you to be healthy as they are depending
on you for their care and growth. Don’t underestimate the stress of an early
birth; long days in the NICU can be physically and emotionally draining. Accept
offers of help from family and friends; get enough rest, eat well, and try and
exercise moderately or at least get out into the fresh air. Reach out for
encouragement from your medical team, your personal coordinator, other
intended parents and support groups.

Taking your preemie home

While pre-term babies are often discharged around the time of their original due date, some babies return home well before this time. There’s no single formula that determines how long your pre-term baby’s NICU stay will be as there are several milestones that must be met before your baby can thrive independently. As much as you’ve been hoping for the day that you can finally bring them home, it is perfectly normal to feel scared leaving the security and the familiarity of the hospital behind. It’s important to trust your NICU team and to know that they won’t release your preemie until they are ready and you are comfortable managing any specialized or extra care required.

Requirements for Discharge

Usually, before being discharged from the hospital, a premature infant must meet
the following criteria:
• Breathe without oxygen
• Intake all feedings without supplemental help
• Gain weight steadily
• Maintain their body temperature in an open cot for 48 hours
• Pass screenings and tests (hearing, heart disease etc.)

Tips to prepare for discharge

There is a process and a series of steps involved before any premature infant is released from the hospital. This is not only to prepare your preemie for life at home but also for parents to prepare to care of their baby without NICU support. Steps to help with a smooth transition from hospital to home include:

• Verifying insurance conditions and medical records and making sure you have
the details for a contact person in the NICU for the gap between discharge and
your baby’s first paediatric appointment.

• Selecting a paediatrician and booking follow-up medical appointments

• Understanding any specialized training for your baby’s care (feeding, elimination,
weight gain)

• Preparing your residence with your baby’s care gear and outfitting your vehicle
with car seats

At home with your preemie

You and your pre-term baby have been through quite a bit, and as much as it may feel like celebration is in order, the initial weeks at home will feel quiet and calm at first, especially after the busy environment of the NICU.

Preemies are vulnerable as their immune systems are still catching up and they are usually at a higher risk for infection so additional care is required to keep them healthy as they adapt to their life in their new home environment

Do’s and Don’ts

• Postpone flights home to your country of origin for a bit so as to let your baby
become accustomed to you, your patterns and the new environment outside of
the hospital without introducing the stress and contagion of travel.

• Place your baby to sleep on their back. Your preemie will need more rest than a
full-term baby, and will most likely sleep much more but for smaller stretches of
time. To reduce the risk of sudden infant death syndrome (SIDS) it is
recommended practice for all babies to be put to sleep on their backs.

• Be up-to-date on your vaccines. Ensure that all household members are up to
date on their pertussis immunization and have received any required or
recommended seasonal or viral vaccines.

• Steer clear of public places and screen visitors. As tempting as it may be to show
your long awaited little one to the world, family members or friends who may be
ill could threaten your baby’s healthy adaptation to your home environment.
Visits in general should be kept to a minimum and hand washing is
recommended for anyone in advance of handling your preemie.

• Avoid waiting-rooms and notorial offices. Contact your paediatrician ahead of
scheduled appointments and request to wait instead in a separate room or
office. Postpone notarial or passport applications if your baby needs to be in
attendance. These areas can be a hotbed for contagious adults and children,
especially during the wintertime.

• Keep a smoke-free home

• Put in place a support system. Reach out to your personal coordinator and
friends and family for help if you’re feeling down or overwhelmed so you can
fully enjoy new parenthood. Caring for a new baby, whether premature or fullterm, can be stressful as the whole family adjusts to new obligations and a new

‘Adjusted age’ and growth prediction

Measuring when a premature infant might hit developmental and growth milestones can be tricky as all infants have their own individual timeline. Some preemies may catch up within a matter of months, while others may take a full year or two before they can be assessed alongside their full-term peers.

In certain countries, paediatricians use an ‘adjusted growth chart’ designed for preterm babies until about 2 years of age. ‘Adjusted age’ provides the standardized measurement of milestones by considering the degree to which your baby was born early and basing milestone expectations accordingly. As an example, a 6- month-old baby who was born 8 weeks early, would only be expected then to meet the milestones of their ‘adjusted age’ of 4 months old.

Notorious Preemies and their Parents

While pre-term birth can certainly pose additional challenges and risks for both parents and babies, prematurity isn’t a life sentence. Your baby can grow and thrive, surpassing those born on time, to accomplish great things due to their intelligence, physical prowess, and talent. Preemies learn at the earliest stage how to be strong and fight for survival, and can take on their future with the very same determination they had when they were tiny NICU warriors.

Pre-term birth did not hold the following famous figures back in any way:

• Stevie Wonder
• Sir Isaac Newton
• Sir Winston Churchill
• Albert Einstein
• Anna Pavlova
• Mark Twain
• Charles Darwin
• Pablo Picasso
• Renoir
• Victor Hugo

Celebrities, just like you, who brought home preemies:

• Kim Kardashian
• Chris Pratt
• Julia Roberts
• Faith Hill and Tim McGraw
• Angelina Jolie and Brad Pitt
• Celine Dion
• Blake Lively and Ryan Reynolds


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