What happens if my baby is born prematurely?

Babies born before 34 weeks are likely to need extra help with breathing, feeding and keeping warm, and would therefore be transferred to the neonatal unit for care. This care is provided by a highly skilled neonatal team. Your baby may need to be in an incubator, however once they are stable you should be able to hold them and have skin-to-skin contact. A delay in clamping the umbilical cord for up to one minute after birth is recommended for most preterm babies, unless there is urgent need to pass the baby to the care of the baby doctor (paediatrician). There are other reasons that might mean delayed cord clamping is not possible. These are:

• you have monochorionic twins (identical twins that share a placenta)
• trauma to the cord, such as a snapped cord
• you have HIV with a high viral load
• the baby is not breathing or has a very low heart rate
• you need to be resuscitated.

Colostrum and breast milk are very beneficial for babies that are born early. Most hospitals will encourage you to express colostrum from your breasts, either by hand or with a pump, so that this can be given to your premature baby within the first six hours of birth. If your baby is too small to feed itself you can express your breast milk and this will be given to your baby via a tube. The neonatal team will support you with expressing your milk. Once your baby/babies can breathe on their own, feed via the breast or bottle and have gained weight, you will be able to take them home. This can often take several weeks if your baby was born extremely preterm. You will be supported by the maternity team whilst you and your baby remain in the maternity unit. There are also many organisations that provide support to parents of preterm babies.

What happens if I go into preterm labour?

If you think you are showing signs of premature labour you should contact your nearest maternity unit as soon as possible. You will be seen by a midwife or doctor who will ask you questions about your general health, the symptoms you are having, including any pain or bleeding, and if you think your waters have broken. Your assessment will include:

• checking your temperature, pulse, blood pressure and urine
• examining your abdomen for any contractions or pains
• checking baby’s heartbeat, by listening with a handheld device if baby is less than 26 weeks or using an electronic monitor
• taking a blood sample to check for signs of infection
• doing an ultrasound scan to check your baby’s wellbeing and position
• doing a speculum (vaginal) examination to find out if the cervix is opening (dilating) and the presence of any fluid. This may feel uncomfortable but is done quickly
• using a special swab test which can predict the risk of going into premature labour.

If there is no suspicion of preterm labour, your tests are negative and you and your baby are well, then you will be discharged home. If some or all of your tests suggest you may be at risk of preterm labour and birth, you will be advised to be admitted to the hospital. You may be offered some or all of the following:

• a course of two corticosteroids injections usually 24–48 hours apart to help with your baby’s lung development and reduce the risk of respiratory problems when baby is born
• a course of antibiotics if your waters have broken or if you are in active labour, to decrease the risk of infection
• A medication (through a patch or tablets) to try to stop or slow down labour, if your waters have not broken, in order to give enough time to administer the 2 doses of corticosteroids
• Magnesium sulphate, a medication administered through a drip. This would be considered if you are between 23+6 and 32 weeks of gestation and likely to give birth within the next 24 hours. This treatment provides protection to the baby’s brain (neuroprotection), reducing the chance of complications for your baby, in particular cerebral palsy. If you or your baby require emergency delivery however, delivery will not be delayed in order to administer the medication.

The neonatal team (baby doctors) will inform you about the care plan for your baby if born prematurely. You and your partner may be offered the opportunity to visit the neonatal unit. If you are extremely preterm, you may need to be transferred to a hospital that is better equipped to care for your baby. Confirmed preterm labour does not mean you will need to birth your baby by caesarean section. The risks and benefits of caesarean birth versus vaginal birth will be discussed with you. Factors to be considered will include the gestational age of the baby, how well they are, their position in your womb and if you have had a previous birth or surgery to your womb.

Causes of preterm birth

A baby may be born prematurely as a result of preterm labour or because an earlier birth is recommended, due to complications that may have arisen during the pregnancy (affecting the mother or the baby). In many cases, it is not clear why labour starts early, however factors known to increase the risk of preterm labour include the following;

• premature rupture of the membranes (your waters breaking early)
• some infections, such as urinary tract infection, or chorioamnionitis which effects the membranes and amniotic fluid protecting the baby
• multiple pregnancy (the average twin pregnancy is 37 weeks in length, and the average triplet pregnancy is 33 weeks in length)
• previous preterm delivery
• having a placenta that is ‘low-lying’ (meaning it either partially or completely covers the cervix) or having a placental abruption (meaning the placenta starts to separate from the wall of the womb)
• maternal medical conditions, including diabetes or conditions linked to inflammation (eg. Crohn’s disease)
• being a smoker, drinking alcohol or using illegal substances
• low Body Mass Index (having a weight that is considered to be low for your height)
• biopsies or LLETZ treatments to remove abnormal cervical cells
• undergoing subfertility treatment
• having a weak (short) cervix that might open during pregnancy
• polyhydramnios (excessive amniotic fluid)
• intrahepatic cholestasis of pregnancy (a pregnancy condition affecting your liver)
• abnormalities of the shape of the womb
• previous late miscarriage (after 14 weeks) or having vaginal bleeding after 14 weeks in this pregnancy
• having previously had a baby by caesarean section at full dilatation of the cervix.

Sometimes, you may develop a complication during your pregnancy and your healthcare professional may recommend preterm delivery. Examples of conditions that may require preterm delivery include:

• moderate to severe pre-eclampsia (a pregnancy condition causing high blood pressure which can also affect some of your internal organs)
• poorly controlled diabetes
• intrauterine growth restriction (when your baby’s growth slows down or stops)
• if your waters break early and you are developing an infection
• other medical complications of pregnancy.

Women who are considered to be at risk of starting labour prematurely may be offered treatment to maintain the pregnancy for as long as is safely possible.

Can premature labour and birth be prevented?

Sometimes preterm labour can be predicted especially if there is a history of preterm birth or your cervix is found to be short during a routine scan appointment or you are being seen in a preterm birth clinic because of previous surgery to your cervix. If your cervix is found to be short, you may be offered special medication, or a cervical stitch to reduce your risk of early birth.

Preterm labour and birth

A baby that is born before 37 weeks gestation is considered to be ‘premature’ or ‘preterm’. There are different categories of prematurity:

• extremely preterm (less than 28 weeks)
• very preterm (between 28 and 32 weeks)
• moderate to late preterm (between 32 and 37 weeks).

In the UK, roughly eight one in every 100 babies will be born prematurely. Extremely preterm birth is less common with less than one in 100 babies being born between 22 and 28 weeks gestation. Preterm birth carries risks because babies who are born too soon may not be fully developed, and need specialist help for life outside of the womb. Preterm babies are also at risk of longer term health problems, including learning disabilities and visual and hearing impairment.

Call your midwife or maternity unit if you are less than 37 weeks pregnant and you have:

• regular period type pains or contractions
• constant abdominal pain
• a “show” – the mucus plug that sits inside the cervix during pregnancy. This can be clear or blood stained
• fresh red bleeding from the vagina (take a photograph to show the midwife)
• a gush or trickle of fluid from your vagina – this could be your waters breaking (place a sanitary towel (pad) inside your underwear to show your midwife)
• backache that is not usual for you, or pressure in the vagina or rectum.

In most cases of preterm birth contractions and labour start spontaneously. Sometimes preterm birth happens when obstetricians or fetal medicine specialists intervene because of concerns about your health or the health of your baby. You may find this range of videos about premature birth from Best Beginnings helpful: