Labour and birth

Premature labour and birth

10 min read

Giving birth early can be scary, but most premature babies cope well with the right medical care. We run through the options if you go into labour early, and what to expect if your baby is born before they’re full-term.

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When is a baby premature?

A baby is considered premature if they’re born before 37 weeks of pregnancy. This means that they are born before their bodies are fully developed for life outside the womb.

However, there is a big difference developmentally between babies who are born close to full-term and those born before the third trimester. The earlier a baby is born, the more help they’ll need after the birth.

For this reason, the term ‘premature’ is often split further into:

  • extremely preterm (born before 28 weeks)
  • very preterm (28 to 32 weeks)
  • moderate to late preterm (32 to 37 weeks).

How many babies are born prematurely?

Around 7% of newborn babies in the UK are born early, but the vast majority (85%) of premature babies are born between 32 and 36 weeks.

The survival chances for premature babies have increased drastically over the last century, but being born early still poses a serious risk to babies, especially if they are very preterm.

The charity Tommy’s has useful information on birth statistics for premature babies, including survival rates by gestation and how being born early can affect the longterm health of babies.

Why are some babies born early?

It’s sometimes possible to tell why a baby was born early, but most premature births happen because the mother goes into labour spontaneously and medical science often doesn’t have an answer as to why that happened.

These are some of the conditions that can lead to a baby being born early:

  • A premature birth in the past: if you’ve given birth early in the past, it’s more likely that it will happen again in a future pregnancy.
  • Multiple babies: the average delivery date for twins is 37 weeks, and for triplets it’s 33 weeks.
  • Lifestyle factors: such as smoking or drinking alcohol during pregnancy. Talk to your midwife if you’re pregnant and worried about your drinking or smoking habits.
  • Pre-existing conditions or factors: some medical problems or conditions before pregnancy can make it more likely you’ll give birth early, for example if have diabetes or have had a cone biopsy.
  • Pregnancy conditions: if you’ve been diagnosed with certain health conditions during pregnancy, like gestational diabetes, pre-eclampsia or obstetric cholestasis, you’re at higher risk of giving birth early.
  • Problems with your placenta or cervix: things can happen during the course of your pregnancy which mean that you may give birth early, a couple of examples are if you have a low-lying placenta or an infection in your uterus.

Find the right place to give birth

Discover whether birth in a local labour ward, birth centre or at home would be best for you.

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Going into labour early

If you start to experience signs of labour before you’re 37 weeks pregnant, you should contact your midwife or nearest maternity triage straight away so you can be assessed. It’s always safer to be seen one time too many than one too few.

If you’re found to be in labour, you’ll be admitted to hospital so your and your baby’s health can be monitored. Depending on how many weeks pregnant you are, how far along in labour you are and your own wishes, there are a few different courses of action.

Unless it’s a medical emergency, you should have the opportunity to talk through your options with your health care team, ask any questions you have and make informed decisions about your care.

Attempting to stop or delay labour

If you’re less than 35 weeks pregnant and in the early stages of labour, it’s likely that you will be advised that it would be best to try to slow down or stop the birth. Being able to delay the birth by even a few days can make a big difference to your baby’s health chances.

There are several different treatments that can help you and your baby in this situation:

  • Drugs for the contractions: There are drugs which can slow down or stop contractions. It’s not always possible, but often it allows the birth to be delayed a bit.
  • Injections for your baby’s lungs: Corticosteroids help your baby’s lungs to develop more quickly, giving your baby better chances if they are born early. The injections take around 24 hours to work.
  • Injection for your baby’s brain: Magnesium sulphate can help protect your baby’s brain development and you’ll be offered it if you go into labour between 24 and 29 weeks.
  • Transfer to another hospital: Hospitals have different levels of special care for newborns. So if the birth can be delayed, it may give you enough time to be moved to a hospital which has a higher level of care for your premature baby.

Giving birth vaginally

If you’re more than 35 weeks pregnant or if it’s safer for your baby to be born (for example, if you have an infection), you may be advised that the best thing is to let your labour progress naturally.

You’ll be admitted to the labour ward for the birth, and there will be paediatricians on hand to help your baby after the birth if necessary.

As long as you don’t have any other risk factors, there is no evidence to suggest that you should have more monitoring during labour than if you were full-term.

“When I was 32 weeks pregnant I went to hospital with back pain. I was shocked to find out I was 7cm dilated and would be giving birth that same day.” Sheena

Having a c-section

C-sections are not routinely offered if you go into labour prematurely, but it’s something that you can discuss with your consultant. There are no known benefits or harms to the baby from having a c-section, but there is also very little evidence in this area.

It is more difficult to perform c-sections the earlier in pregnancy you are, and there is a higher chance of you having a cut from the top of your stomach to the bottom (rather than bikini line cut, as is standard) which can affect any future pregnancies.

Waters breaking early (P-PROM)

If your waters break when you’re full-term but you don’t go into labour, you’re usually advised to have labour started (induced) after 24 hours to reduce the risk of infection.

However, if you’re in the same situation but you’re not full-term (what’s known as P-PROM), the risk of your waters being broken for a longer period of time has to be measured against the risk to your baby if they’re born prematurely.

To find the best course of action, you’ll be admitted to hospital and a number of different tests will be performed to check yours and your baby’s health.

  • Blood and urine tests: These can show if you have pre-eclampsia, a UTI or other types of infection.
  • Monitoring your baby’s heartbeat: If your baby’s heart is beating very fast, it could be a sign of infection which means that your baby needs to be delivered straight away, often by c-section.
  • Antibiotics: if you and your baby are well, you’ll probably be prescribed antibiotics to help prevent infection so your baby can stay in the womb for as long as possible. The antibiotic course is a maximum of ten days.

If you don’t have an infection, you may be able to go home again after around 48 hours and wait for labour to start, while taking your antibiotics course. You’ll be advised to contact your midwife immediately if you develop any signs of infection or you notice a change in your baby’s movements.

Being induced early

Around 1-in-4 premature births are planned (either induction or c-section) because of a condition with the mother or baby which means it’s safer for the birth to happen earlier rather than later.

This can happen for example if you suffer from pre-eclampsia, or if your baby’s stopped growing.

The process of induction is the same whether you’re pre-term or full-term. Read more about induction of labour.

What happens when a baby is born early?

If you give birth early, there will be a medical team specialised in caring for newborn babies ready to give your baby a check-up and medical help if they need it.

It can be scary to see so many people in the room for the birth, but try to remember that hospital staff want to be prepared for any eventuality, so they can give both you and your baby the best help possible.

As soon as your baby is born, a paediatrician will check them over to make sure that they are stable and can breathe on their own. They will also do your baby’s first Apgar score.

If your baby’s born close to full-term, breathing on their own and doing well, you may be able to have skin-to-skin contact straight after the check.

Your baby may also not need to go to special care, but can receive the observation they need with you on the postnatal ward after the birth.

Breathing help

Even though you probably want nothing more than to hold your newborn baby in your arms, many premature babies need medical help after birth which means that skin-to-skin contact is not possible straight away. For most premature babies, the bit they struggle with the most is breathing.

If your baby needs a bit of breathing help, the paediatrician may put them on a CPAP ventilation system, where your baby has nose prongs or a mask hooked up to a machine that keeps your baby’s lungs open in between breaths.

If your baby needs more help, they may instead be incubated. In this case a plastic tube is inserted through your baby’s nose or mouth down to the windpipe, and the machine blows in air and oxygen to your baby.

Special care

In the case where your baby needs more medical help after the birth, they’ll be taken to a special care unit. This could be in the same hospital or, if the facilities required are only available elsewhere, they’ll be taken to a different hospital via ambulance.

Your birth partner may be able to go with the baby to the special care unit if that’s what you want to happen, while you’re taken to the postnatal ward for recovery.

How long do premature babies stay in hospital?

How long your baby will spend in special care can vary from a few hours up to several months, depending on their gestational age at birth and how well they’re coping with life outside the womb.

Generally speaking, premature babies tend to stay in special care until they’re close to full-term (when you would have been 37 weeks pregnant).

If your baby’s born at 19 weeks they will probably stay in hospital for around two months, whereas if they’re born at 35 weeks, they may only stay in hospital for a week or two.

Premature birth – help and support

Being told you’re at risk of giving birth early, or going into labour unexpectedly before you’re full-term, can be a shock and frightening. It’s only natural for you to have a lot of thoughts, questions and concerns.

There are several charities that offer specialist support and information about giving birth early and life with a premature baby.

  • Bliss: information and support for parents whose babies are born premature or ill.
  • Tamba: support for parents of twins, triplets or more babies.
  • Tommy’s: pregnancy information and support for families affected by miscarriage, stillbirth and premature birth.

More from Which?


References

These are the sources of information used in this article:

NICE, Preterm labour and birth. NICE Guideline NG25, National Institute for Health and Clinical Excellence (2015)

ONS, Birth Characteristics in England and Wales: 2016, Office for National Statistics (2017)

ONS, Pregnancy and ethnic factors influencing births and infant mortality: 2013, Office for National Statistics (2015)

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