The history of the NHS is deeply embedded within personal histories of birth. It is often a central figure in bringing both ourselves, and our children, safely into the world. While most births occur close to their due date, there are times when NHS neonatal services are essential in ensuring premature newborns not only survive but begin to thrive in the first days, weeks or months of their lives. During the lifetime of the NHS, the ability of medical services to provide care to babies of increasingly low birth weight has helped reduce the infant mortality rate to very low levels. The utilisation of a variety of medical technologies to assist the preterm baby in growing outside the womb, alongside the establishment of dedicated special care units, has marked the survival of premature babies as an NHS success story.
At the beginning of the twentieth century infant mortality remained high and the likelihood of a preterm baby surviving infancy was very low. While mortality rates for full-term babies underwent a fairly rapid reduction during the first half of the twentieth century, the fate of premature babies remained uncertain. As the 1946 Maternity Survey revealed no baby under 2lbs 3oz survived and at this was still the case at the launch of the National Health Service. While incubators had been used since the early decades of the twentieth century for creating a controlled environment in which premature babies could be monitored to increase their chances of survival, those preterm babies that did survive often experienced brain damage and both intellectual and physical disabilities.
The launch of the National Health Service coincided with an increased commitment to providing systematic neonatal care. In particular, the decades after the Second World War witnessed a marked increase in the types of antenatal and neonatal medical technologies available to the midwife and obstetrician for the safe delivery and care of the premature baby. After the War special baby care units were established, with early units at Bristol, Manchester and Birmingham. However, it was not until after the establishment of the NHS that the availability of these units expanded, growing in number throughout the 1950s and 1960s. Most early units in the 1950s relied almost solely on the incubator alongside careful infant monitoring by nursing staff. It was primarily used as a way to administer large amounts of oxygen to premature babies to encourage lung development as well as keeping them warm and clean. This reliance on large quantities of oxygen ceased by the end of the 1950s when it was discovered that oxygen therapy could cause retinopathy of prematurity, which can lead to blindness. Instead babies are now provided with a small top-up of oxygen only if needed and when the baby does not need pressure to keep the lungs open.
As the century progressed so too did the variety of technological machines used to assist the development of the premature baby. These included, and still include, mechanical ventilation to help the newborn breathe – especially as many preterm babies are born with underdeveloped lungs. These newborns are also fed through tubes to ensure they are receiving the correct balance of nutrients to encourage their continued growth and development. Routine blood sampling obtained from a heel puncture on the newborn is also performed to ascertain blood sugar levels, blood gases and blood counts as well as urea and electrolyte counts. Monitoring systems are used routinely as are life-support machines when necessary. Major neonatal advances since the late 1990s have included the giving of steroids to mothers at risk of giving birth prematurely to boost the infant’s lungs before birth and the use of a ‘cooling suit’ to improve brain function and reduce the likelihood of oxygen-deprived infants developing cerebral palsy and learning disabilities. Medical technology went hand in hand with the care provided to premature babies in special care units. The tailored care provided in such units ensured that nurses needed to be specially trained to operate these machines as well as to provide the type of care required by the newborn. By 1982, paediatricians could train and qualify with a sub-specialism in neonatal medicine, which greatly increased the number of experts employed by NHS hospitals to provide such care.
During the early years of the NHS, parents of preterm babies were seen as potential carriers of germs and were consequently almost always discouraged from visiting the nursery, and if permitted in the nursery banned from physical contact with the infant. Principles of care were driven by a clinical focus on sterility and cleanliness and hospital policies of parental exclusion were seen as a necessary consequence. From the 1960s, however, many special care units began permitting parental ‘access’ to their premature babies through large glass windows on viewing corridors, which allowed parents to ‘see’ their babies, while maintaining the hygienic integrity of the nursery as a whole. By the 1970s, parents were allowed enter the special care unit dressed in a gown, hat and gloves and were permitted to hold their babies for short periods during their visitation.
By the mid-1970s, almost 18% of all babies born under the NHS were admitted to special baby care units raising concerns about admissions policies, especially as many babies born by caesarean section were placed in these units routinely, rather than by necessity. Issues of cost effectiveness entered the political and medical conversation around special care units especially as treating low-birth weight babies is very expensive as well as labour-intensive. Special care units for babies now almost exclusively specialise in treating very small, premature or congenitally ill newborns. They have also become more ‘parent-friendly’, encouraging the new parent to maintain a strong involvement in the growth and development of their newborn. Skin-to-skin contact is seen as particularly valuable for all but the very frailest babies, recognising the value of emotional attachment for parent and baby alike.
Yet, the number of babies born prematurely is on the rise. One in nine babies born in England in 2015 needed neonatal care, amounting to 77,000 newborns, driven in part by rising fertility rates and the increase in age at which women are having children. But premature baby survival rates are also on the rise. Survival amongst those born between 22 and 25 weeks (on average from 1lb to 1lb 6oz in weight) rose from 40% in 1993 to 53% in 2006. 11% more babies born at this stage are also making it to three years old without any of the disabilities often associated with premature birth. While these figures speak to the great strides made in enabling premature babies to survive infancy at increasingly low-birth weights, the rise in numbers needing this type of care has put stress on the already overstretched resources of special care units operating under the NHS. A 2015 Report by Bliss, the sick and premature baby charity, found that 64% of special baby care units did not have sufficient nurses to meet the standards set out by the British Association of Perinatal Medicine, particularly the ratio of one nurse for each baby in intensive care. It also found that 65% did not have sufficient nurses with a specialist qualification in neonatal care. These shortages are worrying for the NHS at a time when neonatal demand is at unprecedented levels and it emphasises the need for co-ordinated, high-quality neonatal care for all babies born prematurely. Yet the true success story of the special baby care unit is the premature baby, surviving against all odds, nestled in an incubator that helps them grow until they are strong enough to leave, go home and begin the next stage of their lives.
JH
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“They gave me a scan, and I asked if they could tell me the sex of the baby – it was a boy. [Please note that finding out your baby’s sex is not part of routine antenatal care.]
“Then, at 24 weeks, I bled again. We rushed to hospital and I was there for three days, having steroid injections to make sure the baby’s lungs were healthy enough to breathe if he was born. It was very scary.”
I was born by Emergency Ceasarean at 32 weeks in 1949 and placed in an incubator and was obviously given a lot of Oxygen as stated in this article. I weighed 5lbs, so did I need as much Oxygen as smaller babies? I would also like to know how Incubators were tested before babies were put in them please. I do know a lot of babies were brain damaged or physically different. I have always known I was “different” so I need answers please. I have been classed as being depressed for many years, but I know me better than any Doctor, so need to find out if I am correct please. The article also states how good our premature baby rate is very good!! I think we know that is not the case as for a so called good rate we are not very high on the rating list!! Many cases have been reported and the public is always told the NHS Will learn from it’s mistakes. How come it never does as both Mums and Babies keep dying. I do not expect a reply BUT I will keep going until I get some answers. L.E.Johnson.
I was born 1 in 10 oz in 1949 one of twins and with the care of the staff of neath general hospital I am able to say I survived. I have sight problems due to oxygen leavels but other I am so greatfull to be part of the changes then toned natal care
Trying to find survival rates for 1960; 29 wks, 2lbs.
The British Medical Journal has released a lot of their archives, which is searchable, and a valuable resource for early neonatal care in the UK, An article entitled “origins of neonatal care in the UK, by Christie and Tansie, is an verbal account of modern neonatal care by those involved. Low birth weight at the time, was anything under 1500g (3lb 5oz)
Hello, my name is Thomas Kendrick Penland Jr and I was born in New Orleans La at charity hospital on April 20 1956 @7mo. According to my Mother I made medical history for being the first premature to come out of an Oxygenated incubator.
I’m sorry for the incompletion of my comment I meet to say I was a complete success of the use of an oxygenated incubator no mental or eye site problems I’ve been trying to find out but can’t find it.
Wow thank you for commenting, that is fascinating, it’s brilliant to hear from you. What an amazing invention the oxygenated incubator was!
I was 2 months premature in 1946. What did that mean in those days?
I was born 1lb premature baby in 16.3. 1960 in belfast. I am now 58. My son was 2lb premature baby in the Royal Victoria Hospital, 11th November 1980.
We would love to hear more about your experiences of the HSCNI — we have not heard very much about health services in Northern Ireland, or how the integration with social care has worked and been experienced there. We hear a lot over here in England about ‘loving the NHS’: do you think people feel the same affection for the HSCNI, or maybe do people focus on their local services, like the Royal Victoria?
As a 1960 vintage premie – no complaints. As my family tells it the only major complication is that I learned never to show up early for anything ever again and am habitually or maybe fashionably late
The over use of oxygen happened in the 1970s also. To me.
Thank you NHS. I was born 13 weeks prem weighing in at 2lb 10oz in 1961 at St Luke’s Hospital, Bradford, West Yorkshire. Mum was admitted a month or so earlier than my birthday due to low blood pressure. When I arrived I was whisked away to the prem ward and into an incubator for quite a while (3 months I think) and Mum and Dad we not physically allowed to hold me, only through holes at the side of the unit. After I was“released” I was monitored closely and quickly caught up with my pals. I have never spent a day sick in hospital and I would just like to say a huge thank you to all of the doctors, midwives and nurses as I would not be here had there not been an. NHS. Xxx
I believe the incubator pictured is the the Vickers 5:9 (historically a baby under 5lb 9oz was considered premature), I owe my life to this machine, and the staff at Southmead Hospital, Bristol. My favorite photo is of myself alone in this incubator at 13 weeks, still only 3lb 12ox, and mostly nappy!!
Hi I was born 2 Months premature Feb 1940. Kept alive by my mother and grand mother. Keeping me warm near a fire and rubbing warm olive-oil over my body. I am now 78..Never spent time in hospital. Happy to be hear. John
Do you allow the mother to smell the babys crown immediately after birth for the pheromone bond necessary for the child’s survival? Maybe borderline personality disorder in mothers isn’t a mental illness, maybe medical procedure interrupts important biochemical interactions which cause major problems down the line.
what an interesting article, I believe I was born with a birth weight of about 3 lbs in July 1948 and spent the first few weeks in an ” oxygen tent “, I was allowed home but they told mum not to get attached as I was likely to die. A dedicated nurse fed me and gave me brandy ! every half hour, Mother wrote to her for years after. I was never washed with water but was laid in front of a blazing fire wrapped In cotton wool. and washed with olive oil for the first few months ,it was a very hot summer,. I was still small a year later so that people thought my sister a new born,was though to be my twin ,she met every milestone before me.
I’m part of that very low percentage rate that made it. My mom at 5 months pregnant give birth to me 1lb 1oz… would love to connect with others with similar circumstance. Just wondering if one parent was in the military around the Korean War era and share a similar story. Even perhaps having questionable health issues.
My baby girl was born in 1970 birth weight 1lbs 13 oz she is healthy grown beautiful lady with no problem. Thanks be to God. I was bless.
Hi. I was born 1962 1lb 14ozs. Born at 2 pm baptised at 2.30 pm thought I would not survive. In incubate for 6 month before allowed home.. I’m 58 now. 5ft4. . Had bad eye for about 4 years (had squint) 3 operation later.. Eye nearly normal. Married had 4 kids. All normal..
I was born in 1949 by an Emergency Caesarean Section at 8months. My Mother and I both nearly died and I was Incubated. My Mothers first two girls were born dead, my Older Sister was born Normally and Healthy. My Mother was 35 years old when she had me. I know all my milestones were very slow and as I grew older I realised I was different from other childten. My Mother never took me to a dentist when I fell and damaged my teeth very badly. I had about 7 teeth removed when I was 6/7 years old. If I ever had stomach ache my Mother NEVER took me to see a Doctor. She would sit on the couch with me put her hand on my Stomach and tell me her hand was MAGIC and would cure the pain. When she wanted to work in the kitchen she would sit me on a little stool under The Stairs and tell me to stay there. All I saw was my Mum from the waist down working at the kitchen sink. There were little peep holes under the stairs that looked into a cupboard where she kept household cleaners and she would leave the doors into the kitchen open so I could see part of her. I still remember the smell of tinned polish to this day. No-one ever questioned my problem, and when I told my Sister years later she did not believe me!! By the time I reached 17 years of age I saw a GP on my own and he said I was depressed, I knew I was not and that I was just different. I am now 71years old and I would really like to know what is exactly wrong with me before I die. I live in constant hell as one of my GP’s asked if I wanted to live in sheltered housing. That is not my need, I need to know if my birth was to blame, but no-one will take me seriously
Please would you let me know if my suspicions could possibly be true? Many Thanks.
I was born in 1966 in The Bronx NY with a birth weight of just over four pounds. My mother does not recall how long I was in an incubator. I am writing a book on my life and was wondering if there was any information on what infants experienced in incubator… how they were cared for touched, fed, comforted? Any info would be helpful thank you!
In your article you say that in an NHS survey of 1946 no baby born less than 2lbs 3 ozs had survived. I would like to tell you that I DID SURVIVE! On 25th May 1943 I was born at 26.5 weeks (13.5 weeks premature), in Sutton, Surrey, England. Weighed just 2lbs at birth. According to my Mother, her due date was to be August 28th of that year. My Mother was a trained (and practising) Midwife. I was wrapped in cotton wool and bathed in fish oil. I was taken home at 3 days old (no humidi-cribs back then), my Mother fed me with an ‘eye-dropper’/poppet every fifteen minutes (I was too small to breast feed). At six weeks I had doubled my birth-weight. I still have the first baby bonnet my Mother knitted for me and it will not fit onto the smallest doll. I am 78 this year 2020, and have had very few health problems in that time, except for the normal childhood dramas and probably was a bit skinny as a child. I have always suffered from Asthma/Bronchitis but never allowed to make a big thing of it and only lately have been persuaded to use a ‘Puffer’ , in latter years I had a heart attack. However, none of that prevented me from working jolly hard. My IQ at age 22 was recorded as 160. The Doctor who delivered me is reputed to have said that two things made me survive — an extraordinary long neck and an exceptional pair of lungs –my Father claimed my yelling/voice when I cried (which was most of the time) could be heard above the German Bombers when they came over. During air-raids, my Mother would not take me to a Shelter because of the risk of infection; instead she wrapped me up warmly and tucked me into a shoe box (Dad’s shoes) and put me under her bed. Her argument was that, back then, life was cheap and if the house was bombed then I would have a chance to survive in the air-pocket made by the bed. All of this information comes from my Mother (now deceased) who was extremely proud of my unusual survival and would tell anyone willing to listen to the story. In 1948 we as a family migrated to Australia where I still reside. I am writing this under my Maiden name as I would rather remain anonymous. Sincerely Jennifer K. Leader.
What an amazing story — thank you so much for sharing it with us. I love your Mum’s story of the shoe box shelter, too — and your survival is surely also a great tribute to what midwives do: perfect for a submission that arrived in the week that we celebrate the International Day of the Midwife, 5th of May!