What does premature mean?
In medical terms, a premature birth is when a baby arrives before 37 completed weeks of pregnancy. Figures from the Department of Health show that six to seven per cent of babies in the UK are born prematurely each year. A baby who arrives at 36 weeks is unlikely to have any problems, although he may be a bit small and may possibly have some breathing difficulties. However, babies who are born earlier than this still have a lot of growing to do and their internal organs need to mature. They may be quite weak and find sucking and breathing difficult. Babies born as early as 22 to 25 weeks now stand a good chance of survival, but more than half will have disabilities ranging from mild to severe.
Am I at risk of giving birth prematurely?
It is still very difficult for doctors to predict whether a healthy woman will go into labour prematurely. There is evidence to show that the presence of certain bacteria in the urine, even if there are no signs of infection, makes premature labour more likely. Because of this, it is now recommended that all women have their urine tested for bacteria early in pregnancy. Treating the infection seems to reduce the risk of premature labour. The vagina can also contain bacteria, which are thought to precipitate premature birth. Unfortunately, an overview of the research has concluded that giving antibiotics to get rid of these bacteria when they are not causing any symptoms of infection does not help prevent premature birth.
Possible risk factors for premature birth
There are a number of other risk factors. Remember that you could have all of these and still carry your baby the full nine months, or you could have none and still give birth prematurely.
The risks factors are:
- infections of the vagina and urinary tract
- expecting twins or more
- using recreational drugs, such as cannabis, ecstasy or cocaine
- living in poverty
- being the victim of domestic violence
- some abnormalities of the uterus
- previous surgery to the cervix
- previous terminations of pregnancy (abortion)
- previous miscarriages, especially between 16 and 24 weeks
- previous premature birth
- changing partner between your first two babies
What should I do if I think I’m in premature labour?
If your waters break, or you start having contractions before 37 weeks of pregnancy, contact your midwife, doctor or hospital immediately. Even if it’s the middle of the night, don’t wait until morning – get on the phone straightaway! You will almost certainly be asked to come into the hospital. Don’t drive yourself. If you have nobody to give you a lift, explain the problem to the hospital and they will send an ambulance for you.
At the hospital
You will be given a vaginal examination to see whether your cervix is shortening and opening.
A number of tests may be carried out to check for infection:
- urine test
- vaginal swab
- blood test
You may be offered a vaginal ultrasound scan to see how long your cervix is. A short cervix may indicate that labour has started. Another test is for a substance called fetal fibronectin in the fluid in your vagina. Finding this substance often indicates that the baby will be born soon.
If your doctors are not certain whether you are in labour, you will be admitted to the antenatal ward for observation.
Doctors can’t stop labour if it’s really underway and resting won’t help either. However, if you are less than 34 weeks pregnant, your doctors can offer you a drug to delay the birth for a short while so that there is time to transfer you to a hospital with an intensive baby care unit. You will also be offered steroid drugs to help your baby’s lungs mature. A baby’s lungs are not ready to breathe air until about 36 weeks of pregnancy, so, if he is born before then, he may have breathing difficulties. Steroid injections help his lungs to mature more quickly.
If you are more than 34 weeks pregnant, your doctors will probably allow labour to continue at its own pace. Your baby is likely to do very well even though he will be small (see When your baby is born, below).
What is a premature labour like?
It’s probably hard to describe the shock of finding that you are going to give birth several months earlier than you had anticipated. You will naturally feel very worried, and perhaps out of control because of all the medical attention you are receiving. Do ask your midwives and doctors to explain everything to you.
Your baby’s heartbeat will be monitored throughout labour, probably using electronic transducers strapped to your tummy. If you want some pain relief, you will be advised against pethidine because this drug can affect your baby’s breathing. An epidural is a better option.
Just because labour is premature does not mean that you will have to have a caesarean section. However, a caesarean might be necessary if you have gone into labour following a haemorrhage or your baby seems to be in severe distress.
When your baby is born
If your baby is born before 34 weeks, he may need to go immediately to the Special Care or Intensive Care Baby Unit. You might only have a brief glimpse of him before he is whisked away. This is very frightening and you will need the support of your midwife who will understand how you are feeling.
You can see your baby as frequently as you want. You may feel that there is nothing you can do for him, but this isn’t true. You can still change his nappy, stroke him, talk to him, and perhaps hold and feed him. Remember that he needs the special comfort that only his Mum and Dad can give him every bit as much as he needs medical help.
A baby born between 34 and 37 weeks may not need any medical treatment. He may be able to go straight to the postnatal ward with you. Or he may be admitted with you to a special ward where there is a high ratio of staff to mothers and you are given extra help with your baby. You may be encouraged to carry him close to your breasts. This seems to provide just the right physical and emotional conditions for your baby to grow quickly.
Will I give birth prematurely next time?
If you have already had one premature birth you are at an increased risk of having another premature baby. Tommy’s, the baby charity, says there is about a 15 per cent chance that your next baby will also be premature. At the moment, doctors do not know how to prevent a woman giving birth prematurely. However, if you smoke or use recreational drugs, giving up will certainly reduce the risk. At least next time round, you will be able to make preparations for the possibility that your baby may arrive early. Your midwife will monitor your pregnancy closely and will help you cope with the anxiety you are bound to feel.