Premature (preterm) labour and birth

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Most babies are born after 37 weeks of pregnancy. We call 37 weeks onwards ‘term’.  However, some babies are born earlier than this, and this is called a premature or preterm birth.

Some pregnant people may know that they have a higher chance of giving birth early. For example, if you have been cared for in the Preterm Prevention Clinic. For others giving birth early is a complete surprise and very unexpected.

Hear midwife Sasha describe the signs of preterm labour.

Different Types of Neonatal Unit

Babies that are born early need to have the right care in the right place. This is in a neonatal unit, which are usually alongside the maternity unit.  Although your local maternity hospital will have a neonatal unit, there are different types of neonatal unit in the NHS.

Special Care Baby Unit (SCBU)

SCBU’s care for babies born from 30 weeks onwards if you are having one baby, and from 32 weeks onwards if you are having more than one baby. Babies can receive some respiratory (breathing) support, feeding by tube and monitoring until they are ready to go home.

Neonatal Unit (NNU)

Neonatal units care for babies born from 27 weeks onward if you are having one baby, and from 28 weeks onward if you are having more than one baby. Babies cared for in a NNU can receive short term intensive care treatment and breathing support on a ventilator.

Neonatal Intensive Care Unit (NICU)

NICU’s care for babies born from 22 weeks onward, babies who need surgery or who have prolonged intensive care needs. In the East of England, we have three NICU’s – Addenbrookes in Cambridge, Luton and Dunstable in Luton and Norfolk and Norwich in Norwich.

Why are babies born early?

We do not always know why babies are born prematurely. Often preterm birth happens unexpectedly and is a surprise. Sometimes a preterm birth is planned because it is safer either for mum/baby or both to be born earlier. This might happen because of a health condition such as pre-eclampsia, or because of an infection.

Lifestyle choices, such as smoking or drinking alcohol can cause premature labour, as well as some medical conditions such as diabetes.

We do know there are things that can increase your chance of premature birth.

If you know you have a greater chance of having an early birth you can download the free My Prem Baby App.

Signs of preterm birth

  • Tummy or back pain, especially if you have period-like pains or uncomfortable cramps that come and go regularly
  • If you are leaking any fluid or unusual discharge from your vagina
  • If you have bleeding from your vagina
  • Pressure in the vagina area
  • Backache that is not common for you

You may not be looking for signs of labour if you are early in your pregnancy. They can be harder to spot, or you may dismiss them. Remember that your maternity unit is open 7 days a week, 24 hours a day, and you can call at any time. Even if you feel unsure, call for advice.

Do not go to your GP or emergency department instead as it can take longer to get you and your baby the right care.

The maternity and neonatal services are open 24 hours a day, and are always happy to take your call.

Hear Sophie talk about her premature labour

What happens when I arrive?

Your maternity team will offer you a full check-up. This includes

  • Checking your blood pressure
  • Checking your temperature
  • Testing your wee
  • Checking your baby’s heartrate

You may also be offered:

A vaginal examination to see if your cervix (neck of the womb) is starting to open, and to see if there are signs that your waters have broken
A vaginal swab to test for hormones which may be released when your body is starting to go into preterm labour. This can be used to calculate your risk of preterm labour
Growth Scan, Ultrasound image
A scan to check the length of your cervix or growth of your baby.

What happens next?

After your check up, your maternity team will explain the findings to you and discuss your options for what happens next. It may be that your labour is not starting early and it is safe for you to return home. Please do not worry if this happens, it is always best to get checked out if you think you may have signs of preterm labour.

Early labour – what will happen?

If your labour has started early, you will be advised to stay in the hospital. You will be offered a package of care which is personalised to you and your baby’s needs. This will depend on how early your baby is born and how many babies you are expecting. Your maternity and neonatal team will plan the care together with you.

Your midwife will begin to complete a document called the PERIPrem passport. This is a record of everything that needs to be done for a preterm baby. It will follow your baby to the neonatal unit where staff will continue to record the care.

Your maternity team may try to slow down or delay the birth until later in your pregnancy. They can do this by offering you a medication called tocolysis. It will depend on how quickly your labour is progressing. Tocolysis medication is not usually offered if you are having more than one baby because there is not proof that.

Types of medication

Magnesium sulfate

Magnesium is used to protect your baby’s brain and reduce their risk of having problems, such as cerebral palsy. It is given through a needle into your vein and has some side effects, such as feeling thirsty, hot, confused, or drowsy. These effects will wear off after a short period of time

Corticosteroids (steroids)

Corticosteroids can help your baby’s lungs develop. There are 2 injections, given 12-24 hours apart. Your midwife or doctor will discuss the benefits and risks with you.

Steroids probably will not be offered after 35 weeks as your baby’s lungs are likely to be ready for breathing on their own.

Antibiotics

If your waters have broken early, you may be offered antibiotics to reduce the risk of infection for your baby. These would be given through a needle into a vein.

Transferring to a neonatal unit

If your baby is likely to be born very prematurely (under 27 weeks) your maternity team will recommend that you go to a NICU at another hospital. When you and the baby are transferred before birth it is called an ‘in utero transfer’.

It means that when you give birth there will be immediate access to the equipment and expertise your baby may require. You will travel to the hospital in an ambulance and an experienced midwife will go with you. If you have a partner or birth supporter, they can meet you at the hospital.

If the maternity team believe that a transfer is the best thing to do for your baby’s health they will discuss all the options with you. They will make sure you understand all the advantages and disadvantages to help you to decide. You cannot be transferred without your permission.

You can ask the team any questions you need to, such as:

  • Why is a transfer the best thing for me and my baby?
  • How long will the transfer take?
  • Who will come with me?
  • What happens if I give birth on the way?
  • What are the risks if I don’t want to go?
If you decide not to give permission for transfer your maternity team will talk to you to make sure that you understand the risks this may pose for you and your baby. However, it’s worth knowing that the healthcare team can overrule your wishes after your baby is born. If they believe that a transfer is in your baby’s best interest, they can do this without your permission.

All these discussions should be fully documented in your maternity notes.

This video was published by the Southwest Neonatal Network and will explain more about a stay in the neonatal unit.

Usually, you and your baby will return to your original hospital when you are both stable and don’t need such specialist care anymore. This may cause you some anxiety, especially as your baby is still so small, but the team will only organise a transfer if your baby is well and stable. Don’t be afraid to ask any questions you need to feel comfortable.

If there is not an opportunity to transfer you before the birth, your local neonatal team will work with a specialist neonatal transfer team to transport your baby after birth to a hospital with a NICU. If this happens, we will support you to be there with your baby as soon as possible. Your baby will be cared for in the NICU until they are ready to come back to your local hospital, who will continue their care until they are strong enough to go home.

Transitional Care

Our local hospitals are starting to set up transitional care units where parents can be with their babies and receive care from neonatal and maternity staff to help them prepare for going home. If the neonatal team feel this would be beneficial for you, they will discuss this with you and explain how it can help you and your baby. West Suffolk Hospital currently has a transitional care unit, and Ipswich and Colchester hospitals are aiming to have theirs in place in 2025.
Going home with your baby can feel both exciting and daunting. There will be lots of support available to you. This video created by Southwest Neonatal Network explains preparing to take your baby home.

Your postnatal care

When your baby leaves the neonatal unit or transitional care unit, their care transfers to the community healthcare team. This is a group of health professionals who specialise in different areas of your baby’s care when you are at home.

Your baby’s care may stay with a midwife for a short while, depending on baby’s age, health and how your local team is set up. You will meet your health visitor, who is a nurse or midwife who specialises in supporting families with babies and young children. Your health visitor will be with you and your family for the next five years and will be an invaluable source of support.

Health visiting services

In Suffolk and north east Essex, the health visiting service works closely with maternity and neonatal services. Once your baby is born the neonatal unit will contact the health visitor to let them know that you have given birth. Your health visitor will contact you to see if you would like a visit either at the neonatal unit or at home. They will work closely with the neonatal team to plan how they will continue to care for you and your baby.

You will be offered three extra development checks for your baby by the health visitor.

They also work alongside other services such as speech and language specialists, nutritionists, and physiotherapists to offer support until your baby is two years old.

Where can I get support?

Once you are home, caring for your premature baby can be stressful at times. You may be worried about taking your baby out of the house because they were born early or maybe because they have some health difficulties. This can make some people feel lonely and isolated. Talk to your health visitor or GP if you feel you need support.

You may have questions about what happened during your birth. You can book a birth reflections appointment to discuss your experience with a midwife.

Watch our main film on preterm birth

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