Worth the Weight: Pine County Public Health serving its smallest clients

November 27, 2016


According to recent data from the Center of Disease Control, one in 10 babies are born too early in the United States. And during National Prematurity Month, Pine County’s Public Health wants to get out the message that they are there to come alongside parents who might be at risk for having a preemie.

Pine County Public Health Nurse Jessica Fehlen approaches prematurity in public health a bit differently than most of her peers. She has not only been educated in prematurity prevention and coping, but she has lived it. 

“I really do have a passion because I have a son that was born prematurely,” said Fehlen.

The story she shares with her clients began when her own son, Colin, was born early at 23 weeks. Forty weeks is considered full term. The hospital gave them a choice on whether or not they wanted to resuscitate him. He was one pound and one ounce when born, couldn't breathe on his own, and was not much longer than a pencil. The first four months of his life were spent at Children’s Hospital in Minneapolis. There were many complications and surgeries. 

“It was really scary, and we didn't know if we would ever get to take him home,” recalled Fehlen. “But we held on to hope.”

Fehlen said that when the time came for them to take their baby home, it was very overwhelming. There were three surgeries and lots of additional care that first year. Fehlen was one of the more fortunate parents of a preemie, having a support system and knowledge of premature births from her nursing education.

After getting through critical months with her son, she began volunteering at Children’s Hospital and Clinic in Minneapolis sharing her knowledge of preemie care with other parents. While volunteering, Fehlen says she sees lot of scared and worried parents who are at their lowest point, but she sees a lot of hope as well. She added that having someone who has been there, means a lot when they are asking for advice. One of the techniques taught at the hospital and encouraged by Fehlen is a technique called Kangaroo Care. 

Kangaroo Care simply involves holding your baby close to you, said Fehlen. “This technique started in countries where they didn't have many isolettes (incubators for premature infants that provides controlled temperature and humidity and an oxygen supply).They put the babies on mom’s skin, and they found that they did much better in the way of growth and development than the ones in the isolettes,” said Fehlen.

However, for a parent of a preemie, because of their size, holding their baby can be terrifying. “You feel that you don't want to make their condition worse,” said Fehlen. “There are lots of tubes and wires and beeping going on.” Because of all these unexpected challenges in parenting a preemie, Fehlen wanted to give back. Now she spends much of her time as a public health nurse sharing this information with Pine County parents of preemies. 

Fehlen stated that bonding and attachment are very different with a preemie. Having a baby you can’t hold when you want to and that is sick makes parents afraid. They often feel that they don’t want to become too attached. “They have doctors and nurses telling them how to care for their baby, and some of them get taken away for hours or longer,” said Fehlen. But she added that bonding really starts in the womb. “You start bonding and attaching to the baby in the womb, and this is really important after delivery.” 

Fehlen wasn’t able to see her son until six hours after birth. “Seeing your baby for the first time is a moment you won't forget and heartbreaking when it's delayed,” she said. 

One of the things that Fehlen addresses in home visits is the bonding aspect of parenting. “When you get these medically fragile kids, going home can be challenging and overwhelming and stressful, and we want parents to bond so they can create healthy children,” she said. “We can put a child at risk developmentally, relationally and also increase the risk of depression for moms if they don’t have the positive bonding and attachment.” 

Things like talking to your baby in the womb and thinking about your baby help make that bond easier after delivery. “Part of the home visits is promoting positive interactions between mom and baby,” said Fehlen.
Kathy Filbert, Community Health Services Administrator for Pine County Public Health says the goal for nurses working with the public is to help facilitate parent-child interaction, promote regular prenatal care, promote proper nutrition and to and be their support system when having a preemie. 

An important aspect of what public health does is assess risk factors for prematurity during pregnancy. “We do a parent survey which is very in depth,” said Filbert. “We ask them about their parenting and about past abuse. It is a very personal story to see how we can provide the best resources possible for fit their needs. We then lay out a plan.” She added that often families don’t even know they are at risk for having a premature baby. 

Some unique challenges in Pine County, according to Filbert, are a higher infant mortality versus the state average and the rate among Native Americans and African Americans, two times that of the Caucasian rate. She added that working with the tribe and partnering with their own nurses would be something we would like to work toward in the future. 

Risk Factors
Experts don't know all the reasons that some babies are born too soon. Even if a woman does everything "right" during pregnancy, she still can have a preterm birth. Some things (called risk factors) can increase the chance that a woman will have a preterm birth, according to the March of Dimes.
In addition to race, risk factors for preterm birth include—
• Social characteristics: Teens, women over age 35 years, low socioeconomic-a measure that typically includes income, education, and occupation)
• Health behaviors: Tobacco use, alcohol or drug abuse, low or high body mass index 
• Medical and pregnancy characteristics: Mental health-stress or depression, pregnancy history (short time between pregnancies, delivering a baby preterm in the past, carrying more than one baby), pregnancy complications, medical disorders (thyroid disease, obesity, asthma, diabetes, high blood pressure), fertility treatments (assisted reproductive technology or other treatments), infection within the uterus

“We want our babies to live and grow and develop as best as possible,” stated Filbert. “We want to help our parents do the best job they can and give them the knowledge to make the best decisions for their baby.” 

To contact Pine County Public Health’s Family Home Visiting program call 320-216-4150.
For more information regarding prematurity see the following link: http://www.marchofdimes.org/

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