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 period-type pains that are coming regularly
• 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 very quickly, so if you are concerned you should seek immediate advice from Labour Line.

The Labour Line 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 Labour Line midwife will usually advise you to attend the Antenatal Day Assessment Unit (ANDAU) or the labour ward at Poole or Dorchester. Bournemouth Birth Centre does not have a neonatal service so you will not be able to go there if you go into labour before 37 weeks.

What causes premature birth?

In cases where labour starts spontaneously before 37 weeks, it’s often hard to tell the cause, but there are some things that increase the risk of premature birth.

These include:

• Smoking, alcohol or drug use
• Incompetent cervix
• 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 properly
• 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 (this will be determined by the number of babies and whether they share a placenta, as well as their growth and other factors)

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

On arrival at the hospital, a midwife will ask you for more information about your pregnancy and your symptoms, such as contractions, backache, vaginal loss of waters or blood, any change in your baby’s movements, and any other concerns you have.

Your pulse, blood pressure and temperature will be monitored, and you’ll be asked for a urine sample to check for infection.

The midwife will palpate (feel) your tummy, to check your baby’s size and how they are lying. They will also check your baby’s heart rate. If you are 26 weeks pregnant or more, they will 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 (which is used when having a smear test) and possibly a vaginal examination to assess if you are in labour. You may be offered a swab test which will indicate how likely you are to go 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 see how well your placenta is working.

After the assessment is complete, you will be given an individualised care plan. If you aren’t in labour, you’ll either 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 due to increased risk of infection. In some cases, you might be advised to have an induction of labour due to the risk of infection. If the assessment shows that you are in premature labour, you will be transferred to the labour ward. If it is very early and it is safe to do so, you may be transferred to a hospital with a higher category of Neonatal Unit. Depending on how many weeks pregnant you are, you may be given medication called tocolytics, which can slow or stop the labour from progressing or you may be advised to continue labouring naturally.

If there is time, you will be offered two doses of steroids, 12 hours apart, to help your baby’s lungs to mature. This can help your baby to breathe when they are born. You may also be offered a dose of intravenous magnesium sulphate to protect your baby’s brain, if you are between 24+0 and 33+6 weeks of pregnancy.

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

Your baby’s heart rate will be closely monitored throughout labour to make sure they’re reacting well to contractions. If they start to struggle, you may be advised to have a caesarean.

Most women don’t consider the possibility of a premature birth, so it can be a very frightening time. 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 as much of your plan as possible and adapt it where necessary.

Transferring to other units is quite common for premature births. There are different levels of Neonatal Unit at different hospitals, so if your baby is particularly early or has complex medical needs, you may need to be transferred to a hospital with a higher-level Neonatal Unit.

he team will try to transfer you to the nearest suitable hospital wherever possible. The obstetrician and neonatologist will discuss whether it is safe to transfer you and your baby before birth. Sometimes this may not be safe – for example, if you are bleeding heavily, have high blood pressure or you are likely to deliver during the transfer, or if 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 being transferred.

Members of the neonatal team will be on hand to assess and stabilise your baby as soon as they are born. They will assess your baby’s airway, breathing and circulation, checking 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. Having skin-to-skin contact will help to maintain your baby’s temperature and help with bonding. If you are not well enough, your birth partner can be supported to have skin-to-skin contact if you both wish.

Some babies will require some resuscitation on the labour ward or in theatre if you’ve had a caesarean. This means that they will need help from the team to start breathing. Once your baby is stable, they may be transferred to the Neonatal Unit or Special Care Baby Unit in an incubator, a covered plastic cot which keeps your baby warm. Partners are welcome to go with their baby to the unit if they wish. Some partners prefer to stay with you until you are well enough to visit your baby together. This is entirely up to you both, and 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 they can, keeping you updated on how they are responding to their care. You will also receive a daily update about your baby’s condition and management from a neonatal consultant while your baby is staying in the NNU or SCBU.

Premature babies often need help to breathe, as their lungs may not be developed enough to breathe on their own. Your baby might be put on a machine called a ventilator, which helps them to breathe.  The team will do their best to keep you and your baby together.

All babies will have a newborn physical examination, checking their eye reflexes, heart, hips and genitalia as soon as they are well enough. Some babies born prematurely will have problems with their sight or hearing, or other health issues, and will be offered additional checks. 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 like antibiotics. They may have a continuous positive airway pressure (CPAP) mask over their nose to help them breathe, and they may 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, and 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 like magnetic resonance imaging (MRIs).

Some conditions such as jaundice and blood sugar issues are common in premature babies. The team will be monitoring and testing your baby for signs of any health issues and will provide any treatment they need.  You’ll be kept fully informed of your baby’s progress, the tests being done and the results, and you will be involved in any decisions about their care.