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Key takeaways

• Preterm birth is when your baby is born before 37 weeks of pregnancy.
• Symptoms can include regular contractions, changes in vaginal discharge, or pelvic pressure.
• Treatments can be given to help your baby's development if they are likely to be born early.
• Premature babies often need specialist care in a neonatal unit.

Understanding preterm labour and birth

Premature birth, also called preterm birth, is when a baby is born before 37 weeks of pregnancy. About 8 out of every 100 babies in the UK are born prematurely.

Signs of preterm labour

It is important to call your hospital maternity unit or midwife straight away if you have any of these symptoms before 37 weeks of pregnancy as they may be signs of early labour:

• Regular contractions – this is your womb tightening then relaxing.
• Period-type pains – or pressure in your vaginal area.
• A show – when the mucus plug that has sealed the cervix during pregnancy comes away. This may be a sticky, jelly-like blob, sometimes with streaks of pinkish or brown blood.
• A gush or trickle of fluid – from your vagina. This may be your waters breaking. If the fluid is smelly or discoloured (green, brown, or black), it could indicate infection.
• Bleeding – from the vagina.
• Backache – that comes and goes and is not usual for you.

Risk factors for preterm birth

Doctors often do not know why someone goes into preterm labour. However, several factors are known to increase the risk of preterm birth. These include your medical and past pregnancy history, and complications in the current pregnancy.

Factors that can increase the risk include:

• Previous preterm birth – if you have given birth preterm before, you are more likely to give birth early again.
• Cervical insufficiency – a cervix that shortens and opens too soon.
• Cervical surgery – such as treatment to remove abnormal cells after cervical screening.
• Uterine abnormalities – having a womb (uterus) that is a different shape or size.
• Multiple pregnancy – being pregnant with more than one baby, such as twins or triplets.
• Polyhydramnios – having too much amniotic fluid surrounding your baby.
• Infection – certain infections during pregnancy.
• Maternal age – being pregnant in your teens, early 20s, or over 40 years of age.
• Maternal weight – being underweight or overweight.
• Smoking – tobacco use in pregnancy.
• Alcohol consumption – drinking alcohol in pregnancy.
• Recreational drug use – during pregnancy.

Treatments if preterm labour starts

If you are in preterm labour, your healthcare team may offer treatments to delay birth and prepare your baby. Slowing down or stopping labour is not always appropriate. Your midwife or doctor will discuss your individual situation with you. They will consider how many weeks pregnant you are, and which neonatal care facilities are available at your hospital.

Medicines to slow labour

You may be offered medicine to try to slow down labour or delay birth. This can give you more time to be moved to another hospital if higher-level neonatal care is needed and not available locally. It may also allow time for other treatments that will prepare your baby for birth.

Antenatal corticosteroids

You may be offered a course of injections called antenatal corticosteroids to help your baby’s lungs mature in preparation for breathing after birth. These are given as injections into a muscle, usually in your thigh or upper arm. A single course usually consists of two injections given 24 hours apart, although this may vary slightly.

Antenatal corticosteroids are very effective at improving outcomes for babies born early.

They are most beneficial if given between24 hours and 7 days before birth. They are most commonly offered between 24 and 35 weeks of pregnancy. In some cases, they may be offered after this following individualised assessment of the benefits and risks.

Magnesium sulfate

If you are in preterm labour between 24 and 29 weeks of pregnancy, you should be offered a medicine called magnesium sulfate .You may also be offered it if you are between 30 and 34 weeks of pregnancy. It is given through a drip (infusion), and can help protect your baby's brain development.

Magnesium sulfate helps reduce the risk of complications linked to being born too early, including cerebral palsy. It is very unlikely that you will be given magnesium sulfate for more than 24 hours.

What to expect if your baby is born early

Your healthcare team will monitor your premature baby closely. Babies born early may need extra help to adjust to life outside the womb, depending on how early they are born and other individual factors. This may be provided with you on the postnatal ward, or your baby may need to be admitted to the neonatal unit for specialist care.

They may need extra help with:

• Breathing.
• Maintaining their temperature.
• Maintaining normal blood sugar levels.
• Jaundice – where they need help to break down a substance called bilirubin.
• Fighting infection.

Breathing support

Some premature babies may need help with their breathing. They may involve small prongs being placed into their nostrils or a mask over their nose. These are connected to a machine that provides oxygen or pressurised air to make breathing easier.

Premature babies, especially those that are born very early, may need a breathing tube. This tube goes through their mouth or nose and into their lungs (intubation). It is connected to a machine called a ventilator. Your baby may also be given a special liquid medicine into their lungs called surfactant, which helps the tiny air sacs stay open for breathing.

Pauses in breathing (apnoea) is a common condition where a baby may pause their breathing. Caffeine treatment can help reduce or treat apnoea.

Temperature regulation

Premature babies often find it hard to keep themselves warm. They might be placed in an incubator or on a heated mattress in a cot. An incubator is a clear, enclosed bed that keeps the baby warm. For extremely premature babies, the incubator may be humidified.

To help them stay warm, babies born very early may be placed in a special, sterile bag up to their neck right after birth. This helps keep them warm and protects their fragile skin.

Feeding support

Many premature babies will need support while they are learning to feed. They will need a thin tube passed through their nose or mouth into their tummy. Milk can be given through this tube.

They may also need fluids or nutrition through a thin tube into a vein (intravenous, or IV, line). This is often placed into one of the veins in their umbilical cord stump. If your baby has challenges with feeding, your midwife or neonatal nurse can help you express breastmilk.

Other care

Your baby will be tested and may be treated for infection. Babies born very early are at risk of infection. They will be given antibiotics until blood tests confirm they do not have an infection.

Babies born very early may also have low blood pressure. The healthcare team may need to raise your baby's blood pressure with extra fluids or medicines.