In The Womb

Foetal growth &
development

The baby is best protected in the womb and stimulated to develop normally. Therefore, understanding the womb environment will help you to understand the behaviour of your preterm baby and learn the appropriate handling to support her.

During the months in the womb, different sensory systems develop in a specific sequence. First is the tactile (skin), followed by the vestibular (balance and movement), olfactory (smell), gustatory (taste), auditory (hearing) and finally the visual system. If you keep this development in mind, it is easier to understand why your baby reacts in certain ways, for example startling when there is a loud noise.

In the fetus, touch develops first around the mouth and proceeds in a head-to-toe direction. The fetus is exposed to continuous tactile (skin) stimulation, which includes touch, pain and temperature. The mother's movements simulate a massaging action with deep pressure, calming the baby. As early as eight weeks the fetus already experience touch sensation around the mouth.

At 20 weeks skin receptor cells are in place all over the body. At 24 weeks, the baby responds to touch of the palm with weak grasp and at 26 weeks, the palmar grasp reflex will be stronger. The baby will hold onto anything placed in her palm, such as the umbilical cord, when still in utero or dad's finger after birth. Baby may also begin to show a stepping response to touch on the foot sole.

Babies do suck and swallow while in utero, but the sucking reflex is only developed properly and matures into a coordinated reflex at 36 weeks gestation. This is important to understand when baby can start to feed.

Hands-to-mouth A natural self-soothing behaviour that already develops in utero is that baby's hands are brought up to the face and around the mouth. This "hands-to-face" position helps to calm and comfort the fetus while in utero and this skill becomes even more important after birth and must be supported.

Baby in amniotic sac The legs are supported in flexion, this is when the legs are crossed at the ankles and legs are drawn up as shown here, thereby providing support at the soles of the feet. Continuing this after birth promotes the development of flexion, because muscles develop correctly. This in-utero support is also provided by a flexible ‘boundary', the amniotic sac. It is important after birth to maintain an environment as close as possible to baby's womb experience with the return to flexion. For more information on this got to the section on positioning.

You can read more on the fetal development and how the fetus experiences her environment in Chapter one of Prematurity – Adjusting your Dream.

Behaviour stages of the preterm baby

Your baby will react different depending on the age she was born. A baby born before 32 weeks gestation will not be able to communicate with the environment or her caretakers at all. This baby will need intensive care nursing, will be physiologically unstable and will be unable to come into and maintain the quiet alert state. This is called the turning-in stage. The baby's behaviour is similar to that of a porcupine, since she reacts on pain (or touch) by turning in to herself and trying to protect herself from possible harm.

Between 32 and 35 weeks gestation your baby will become physiologically stable, start to communicate and interact, breathe comfortable and absorb calories when fed by mouth. This is the coming-out stage and the baby is similar to a tortoise, since she will shyly start to explore the environment, but as soon as it becomes too much she will withdraw to try to recover.

When your baby is 36 weeks or older she will be able to actively interact with the environment and her parents. She will be able to recover from agitation by using self-quieting behaviours (which the staff and her parents taught her). This stage is the reciprocity (interaction) stage and similar to a puppy. During this stage she mainly sleeps and feed — just like a newborn full term baby does.

Keep these stages in mind when starting to interact with and getting to learn your baby. It is important to remember that your baby may be outside the womb environment, but the development will be at the same level than that of her counterparts who are still in the womb, receiving the protection they need. Preterm babies may also be compromised from over stimulation that is too must for her fragile system.

You can read more on preterm infant behaviour in Chapter four of Prematurity – Adjusting your Dream. This chapter also provide valuable activities you can do to get to know your baby. The next section will discuss the preterm behaviour a bit more.