Prematurity – Stories from the Mothers and Babies Unit

Yet another day had started on MBU, the Mother and Baby Unit of the Komfo Anokye Teaching Hospital where sick newborn babies are cared for. The day had begun as usual – handing over by the night doctors and nurses who had had a hectic night and couldn’t wait to leave the hospital for their homes, preparing the ward to receive new babies etc etc.

There was the usual never ending stream of admissions; some coming from our own labour ward downstairs, some from other surrounding hospitals and clinics and some from their homes. Somewhere around ten ‘o’ clock when the business of the ward was at the peak of the heat, an elderly woman walked nervously into the ward with a bundle in her arms and clutching a sheet of paper. She obviously wasn’t sure what to do so one of the nurses asked her to see the paper which was obviously a referral note. It was from a District Hospital and had obviously been written in a rush. It read:

“Preterm male infant delivered at 5.45 am, weight 0.8 kg, please see”.

So “see” we did – we took the bundle from the old lady who was obviously his grandmother and started unwrapping it. We unwrapped layers and layers of cot sheets and other pieces of material until we got to the baby, a tiny and delicate little thing about as big as a small finger of plantain. His skin was almost transparent and he was freezing cold, despite the layers of cloth which had surrounded him. His body temperature which should have been around 37 degrees was as low as 34 degrees. He was hardly breathing and we immediately placed him under a heater and began to assist him to breathe by gently pumping air mixed with oxygen into his lungs with a special piece of equipment called an ambu bag. The House officer checked his blood sugar and as expected it was dangerously low. She managed to find a tiny vein and a “sugar” filled drip was set up on the baby. When we were satisfied that he was warm, pink and breathing regularly, we turned to ask the old lady where his mother was.

The mother had delivered at home that dawn. She was less than 7 months pregnant and no one was expecting her to go into labour, which had started at midnight. She had had a fever the day before, probably from malaria and this was what had caused her to go into labour before the normal time. After the delivery, she herself had begun to bleed and she and the baby had been taken to the nearby District Hospital. The mother was admitted but the district hospital had neither the staff nor the equipment to take care of the baby so they had referred him to us.

To be honest we did not have much hope for the baby’s chances of survival. Born at just under 7 months, with a weight of less than one kilogram (a normal baby born at 9 months would weigh about 3.5 kilograms) his chances of survival were poor. All the vital organs in his body, his brain, lungs, liver, kidneys, heart, – everything, were very immature and not ready to work outside his mother’s body. If he was still in his mother’s womb, her body would have taken care of everything. He just was not ready to be born…

His mother took 4 days to come to us from the District Hospital where her bleeding was being treated. The baby wasn’t ready to be fed; he was too ill and too unstable. Despite the incubators and other treatment, he remained very ill. His body temperature and blood sugar kept dropping to dangerously low levels. This was not helped by the fact that every now and then our incubator would stop working because of fluctuations in power. We suspected that the baby had an infection and started him on antibiotics. Unfortunately the only suitable antibiotic for the baby was not available under the National Health Insurance Scheme and was very expensive. Many of the lab tests he needed were also not covered by Health Insurance. It took the grandmother a day or two to find money to buy the antibiotics and even then, some of the doctors and nurses had to help her out.

But slowly, slowly, slowly the baby began to get better. The episodes where he would stop breathing became fewer and fewer. We passed a tube through his nose into his stomach and began to feed him tiny quantities of his mother’s healing breast milk, just a few drops at a time. Initially he would vomit out even these tiny amounts but eventually he began to tolerate the feeds and the amounts were increased.

The big day came when he was moved out from the incubator into a cot. His mother began to place him naked between her naked breasts wearing only a napkin to prevent him from soiling his mother’s chest with faeces. She would then wrap a cloth round herself and the baby to hold him in place. To add extra warmth, she would cover his head with a little woollen cap. This is called Kangaroo Mother Care and is an excellent way of taking care of a very small baby. It keeps the baby warm because his skin is in contact with his mother’s body, right against her skin. The breathing movement of his mother is like a gentle rocking of the baby and it is almost like being back in the womb again. The gentle movements of the mothers breathing also stimulates the baby and keeps him breathing. The mother can then carry the baby with her all the time except of course when she is bathing or cooking with an open fire.

Baby Sammy (as his mother had named him) began to gain weight. Almost every day, tiny babies like him would come in and die but Sammy had come to stay. We took the feeding tube out and he began to feed on breast milk from a small cup. He even began to suckle at his mother’s breasts a little. After one month on admission he weighed 1.2 kilogram and was ready to go home. By this time his mother and grandmother were both doing the Kangaroo Mother Care and had been thoroughly counselled on how to take care of him at home. No enemas, no formula or other feeds, very little bathing and lots and lots of Kangaroo Mother Care and breast milk. He was discharged at one month of age and mother was asked to bring him back twice a week for us to be sure he was doing well and gaining weight.

Sammy was fortunate. More than half of babies born under 7 months of pregnancy will die in the first few days. The situation is different in more developed countries where a lot of very expensive equipment is used to keep these babies alive. However every doctor agrees that preventing prematurity is much better than treating it. Even babies born where the best facilities are available sometimes grow up with some disability and may find learning difficult.

Many, though not all, of the causes of prematurity can be treated during the pregnancy. They include malaria, infections, anaemia, malnutrition in the mother etc and many of these can be picked up early during antenatal care and treated. Sammy’s mother spent a whole month in the hospital at great cost to herself. She could have been doing her trading and earning some income. Perhaps she started her antenatal care late in pregnancy, perhaps she did not take her medicines to prevent malaria. Whatever the cause, it cost her (and the nation as a whole) time and money that could have been used elsewhere.

Families and healthcare workers should all join hands together to reduce the number of babies born before their time, at a time when they are just not ready to face the world…