DOVER –– For most moms, there is nothing more exciting than expecting a new baby. But when the newborn comes much earlier than expected, the excitement can be replaced with concern.

November is Prematurity Awareness Month and many difficulties aside from low birth weight come with a preterm birth.

According to March of Dimes, 9.3 percent of babies born in 2014 in Delaware were born premature, (before 37 weeks). Delaware’s premature birth rate is slightly lower than the national rate of 9.6 percent. By county, 10.1 percent of babies born in New Castle in 2014 were premature, 9 percent in Kent were premature and 7.8 percent in Sussex were.

OB/GYN Christos Hatjis said one of the first steps in reducing the number of preterm births is eliminating correctable causes like smoking and obesity.

“Obesity is an epidemic across the country and although it’s not directly related to preterm births, obesity causes a lot of conditions that can lead to a preterm birth,” he said.

But for many women, the cause of preterm birth is idiopathic or unknown. Dr. Hatjis said a large portion of women who have preterm babies may face no risk factors and experience a normal pregnancy up until labor begins.

Two tales of early births

“It was my first pregnancy and everything seemed to be going well until I woke up with contractions,” Holly Malone of Dover said. “I went to the hospital and they suggested bed rest but when I woke up the next morning, the contractions started again and I knew I had to get to the hospital.”

Ms. Malone’s son Gavin was due at the end of September 1984, but was born on July 31, two months early.

“I was a first-time mom and it was scary because you go in having a plan of how things are supposed to go, then everything changed,” she said.

“Everything was normal until I started having some problems with leakage about two weeks before she came,” Tiffany Casti of Georgetown said. “I went to get checked out right away but they thought the baby might just be pressing on my organs and was told to maintain all my normal activities.”

Ms. Casti’s daughter Olivia was due Dec. 28, 2014, but was born on Sept. 26, three months ahead of schedule.

“The doctors thought they’d be able to stop the labor and keep me on bed rest until she came but it wasn’t my first pregnancy so I knew at that point there was no going back, I wouldn’t be able to fight my body any longer,” she said.

Gavin and Olivia both were born underweight with Gavin weighing in at 4 pounds, 4 ounces (although his weight quickly dropped to under 3 pounds due to feeding complications) and Olivia weighed in at 2 pounds, 3 ounces.

When a baby is born so small and underdeveloped, there are many complications that can arise and according to March of Dimes, of the 15 million babies born preterm every year, about 1 million die in infancy due to complications that come with a preterm birth.

“One of the biggest concerns we have for preterm babies is the respiratory system,” Dr. Hatjis said. “Not only is breathing vital but it effects how every other system in the body works.”

In Ms. Malone’s case, her son was born with cerebral palsy and Moebius Syndrome while Ms. Casti’s daughter had brain bleeding.

“It was scary because things were really touch and go for a while,” Ms. Malone said. “He had to be transported from Milford up north and I couldn’t go with him so I didn’t know if that night would be the last time I saw him or not.”

Gavin was kept in the hospital for two months and Olivia was kept for 10 weeks. Both had to grow to a healthy weight. Dr. Hatjis said doctors usually wait until the baby reaches the average weight of a full-term baby before discharge. Other vital tasks must be reached like breathing independently and maintaining a regular body temperature.

“Most preterm babies will need special care and attention when they go home because even upon discharge, they may not be as strong as a baby who was carried to full term,” Dr. Hatjis said.

“So many of the other parents who had kids in the NICU were worried to death about what was going to happen to their kids and how everything was going to turn out but I tried my best not to worry and stay positive because all those negative thoughts aren’t going to help anyone,” Ms. Casti said.

So far things have been going well for one-year-old Olivia who has been reaching all the milestones for her adjusted age although she did receive therapy for brain bleeding to prevent further complications. Her health and growth have been closely monitored since her birth to ensure early intervention can be taken if problems arise.

Ms. Malone and her husband had to be taught how to feed Gavin because his medical conditions prevented him from nursing or using a bottle and as he grew, he required respiratory, physical and speech therapy.

“It’s hard caring for a premature or sick kid, not only emotionally but financially too,” Ms. Malone said. “Just from being in the hospital for two months, insurance didn’t cover much so we had basically cleared out our entire savings just over that short time.”

High cost of premature births

The Institute of Medicine reported in 2007 that premature births total about $26.2 billion in costs each year in the United States alone. The figure includes $16.9 billion in hospital costs for premature babies, $1.9 billion in costs in labor and delivery, $1.1 billion in special education services and the remaining sum is comprised of intervention services, losses in wages and early intervention services.

“My advice to anyone with a premature baby is to have faith and stay positive because there may be a time when you don’t know if you’re baby will make it through the night but after seeing your baby so fragile and sick, everything can really turn out okay,” Mrs. Malone said. “Even though it can be hard in the beginning, it’s such a joy to see your child reach so many milestones in their life.”

Gavin is now 31 years old and graduated college with a double major before earning two master’s degrees.

For more information about premature births and Prematurity Awareness Month, visit marchofdimes.org.