Premature Labour and Birth

You should call Labour Ward if you are before 37 weeks and you have any signs of labour, including:

• Contractions or regular period-type pains
• Waters breaking or leaking
• A ‘show’
• Vaginal bleeding that is fresh and red
• Severe backache
• Pressure in your vagina or rectum

Do not wait – premature babies can be born quickly, so if you are concerned, you should seek immediate advice from your local hospital labour ward.

The midwife will ask you questions such as:

• How many weeks pregnant are you?
• Have you had any problems during your pregnancy?
• Have you had a premature baby before?
• Are you having contractions, cramp or backache?
• Are you feeling unwell?
• Have your waters broken?
• Are you leaking fluid or bleeding vaginally?
• Is your baby moving normally?
• Do you have vomiting, diarrhoea or nausea?

The midwife will usually advise you to attend the nearest hospital for assessment.

In cases where labour starts before 37 weeks, it’s often hard to tell the cause. Some things result in a higher risk of preterm birth. Risk factors include:

• Smoking, alcohol or drug use
• Previous premature birth
• Your waters breaking early (PPROM)
• Having twins or multiple babies
• Some infections, such as Group B Strep or urinary tract infections (UTI)
• Diabetes, Type 1, Type 2 or Gestational
• Previous removal of abnormal cervical cells

Sometimes, your obstetrician might decide that your baby needs to be born early. This can be because:

• You are experiencing complications, such as pre-eclampsia.
• Your placenta is not working correctly.
• Your waters break early (PPROM), and there is not enough amniotic fluid around the baby.
• Your baby is unwell.
• Your baby’s growth has slowed or stopped (IUGR).
• You are having multiple babies (the number of babies, whether they share a placenta, their growth and other factors determine this).

If your baby needs to be born early, the team will explain why this is necessary. You may need an induction or caesarean and may need a hospital with a neonatal unit to ensure your baby has the proper care.

On arrival at the hospital, a midwife will ask you for more information about:

• Your symptoms, such as contractions, backache, vaginal loss of waters or blood
• Changes in your baby’s movements
• Any other concerns you have

They will ask if they can monitor your pulse, blood pressure and temperature and ask you for a urine sample to check for infection.

The midwife will offer to palpate (feel) your tummy to check your baby’s size and how they are lying. They will also ask to check your baby’s heart rate.

If you are 26 weeks pregnant or more, they will offer to monitor your baby with CTG monitoring. If you are less than this, they will listen to your baby’s heart rate with a handheld sonic aid. 

You will be offered an examination with a speculum (used for a smear test) and possibly a vaginal examination to assess if you are in labour. You may be offered a swab test, indicating your likelihood of going into labour within a week.

An ultrasound scan may be offered to assess your baby and their movements, check the amount of amniotic fluid and check how well the placenta is functioning.

After the assessment is complete, you will receive a care plan.

• If you aren’t in labour, you’ll be discharged with advice on when to call back, or you will be admitted to the antenatal ward.
• If your waters have broken and labour hasn’t started, you may be advised to have a course of antibiotics because of the increased risk of infection.
• In some cases, you might be advised to have an induction of labour because of the risk of infection.
• If the assessment shows you are in premature labour, you will be transferred to the labour ward.
• If it is very early and is safe to do so, you may be transferred to a hospital with a higher category of Neonatal Unit.

If there is time, you will be offered two doses of steroids, 12 hours apart, to help your baby’s lungs mature. This can help your baby breathe when they are born. If you are 24-33 weeks pregnant, you may be offered a dose of intravenous magnesium sulphate to protect your baby’s brain.

A member of the neonatal team will talk to you about your baby’s care before they are born. They may also show you the Neonatal Unit or Special Care Baby Unit and answer your questions if there’s time.

They will closely monitor your baby’s heart rate throughout labour to ensure they react well to contractions. If they struggle, you may be advised to have a caesarean.

Most women don’t consider the possibility of a premature birth, so it can be frightening. You may not have completed your birth plan, or some of the choices you made may no longer be possible.

Your midwife will be there to support you. They will do their best to accommodate your plan and adapt it where necessary.

Transferring to other units is quite common for premature births.

There are different levels of Neonatal Units at different hospitals. If your baby is early or has complex medical needs, you may need a hospital with a higher-level Neonatal Unit.

The team will try to transfer you to the nearest suitable hospital wherever possible. The obstetrician and neonatologist will discuss if transferring you and your baby before birth is safe. Sometimes, this may be unsafe – for example:

• You are bleeding heavily.
• You have high blood pressure.
• You are likely to deliver during the transfer.
• Your baby is not coping well with labour.

In this case, you will deliver where you are, and you and your baby will be stabilised before transfer.

Neonatal team members will assess and stabilise your baby as soon as they are born. They will assess airway, breathing, and circulation, check that they can maintain their temperature and see how they are adapting to the outside world.

Some premature babies won’t need much support – they will breathe spontaneously and can be given back to you quickly.

Skin-to-skin contact will help with bonding and maintaining your baby’s temperature. If you are not well enough, your birth partner can conduct skin-to-skin contact if you both wish.

Some babies require resuscitation in the labour ward or theatre if you’ve had a caesarean; this is to help them start breathing. Once stable, they may be transferred to the Neonatal Unit or Special Care Baby Unit in an incubator, a covered plastic cot that keeps them warm.

Partners are welcome to go with their baby to the unit. Some partners prefer to stay with you until you are well enough to visit your baby together. This is entirely up to you both; the neonatal team will take excellent care of your baby until you are well enough to visit.

The neonatal team will update you on your baby’s condition and management plan as soon as possible, updating you on how they respond to their care. A neonatal consultant will also update you on your baby’s condition and management in the NNU or SCBU.

Premature babies often need help breathing, as their lungs may not be developed enough to breathe independently. They might need a ventilator to help them breathe. The team will do their best to keep you and your baby together.

All babies have a newborn physical examination, which checks their eye reflexes, heart, hips, and genitalia as soon as they are well enough. Some premature babies will undergo additional checks because of health conditions or sight or hearing problems. Oral vitamins are offered to all premature babies.

Your baby may have a cannula (a small plastic tube) inserted into a vein in their arm or leg, or sometimes elsewhere if necessary. This allows the team to give your baby fluids, nutrition and medications, such as antibiotics.

They may have a continuous positive airway pressure (CPAP) mask over their nose to help them breathe. They may also have a feeding tube inserted via their nose or mouth. Their heart rate, oxygen levels, temperature and breathing will also be monitored.

Blood samples may be taken to check for infection, anaemia, and other issues, as well as to check their oxygen levels. Chest x-rays and ultrasounds may be taken on the unit, or your baby may be sent for other scans, such as magnetic resonance imaging (MRI).

Some conditions, such as jaundice and blood sugar issues, are common in premature babies. The team will monitor and test your baby for signs of health issues and provide any needed treatment.

You’ll be fully informed of their progress, the tests and results, and you will be involved in decisions about their care.