What can be done if a baby is likely to be born too early?

Most babies are born after about 40 weeks of pregnancy. But sometimes labor starts weeks earlier. All babies born before 37 completed weeks of pregnancy are considered to be preterm. In Germany, about 8 out of 100 newborns are preterm.

Depending on how long the pregnancy lasts, preterm babies are classified into three groups:

• extremely preterm (born before 28 completed weeks of pregnancy),
• very preterm (born between 28 and 31 completed weeks), and
• moderate to late preterm (born between 32 and 37 completed weeks).

The baby's body is still developing rapidly during the last few weeks of pregnancy. The lungs in particular are still changing. Only after about 34 weeks of pregnancy are they ready to work on their own. So a preterm birth can result in the baby having breathing problems. Babies who are born “moderate to late” preterm have a lower risk than "very" and "extremely" preterm babies.

Various factors can cause preterm births, including infections, a weak cervix (the opening between the womb and vagina), and problems with the placenta. Preterm births are also much more common in pregnancies involving more than one baby (like twins or triplets). But there is often no explanation for why a pregnancy ends before term.

Sometimes there are pregnancy-related complications that make it medically necessary to induce a preterm birth, such as pre-eclampsia or if the mother's water breaks too early. Then doctors perform a Cesarean section (C-section) or induce labor artificially.

Women who think they might be having premature contractions are usually right. The following things are also signs that a woman is probably going into preterm labor:

• Contractions: Regular contractions can be felt, often (but not always) accompanied by cramping pain. Occasional contractions of the womb are normal in pregnancy. But if they're regular and aren't going away, it could be labor.
• Your "water" breaking: This means that the membranes surrounding the baby have ruptured, releasing amniotic fluid.
• Vaginal bleeding (bright red blood): This is always an emergency situation.

If you think you're in preterm labor, it's important to quickly contact the doctor, the midwife or the hospital to talk about what happens next. Preterm labor is an emergency, especially if it starts before the end of 34 weeks of pregnancy. The sooner medical care is started, the better.

The first goal of treatment is to stop the early labor. This includes the following options:

• Rest: Depending on the situation, it may be a good idea to do less exercise and lie down a lot. Sometimes you may need to stay in bed.
• Medication: Medications that can decrease contractions (called tocolytic drugs) may be used.

Tocolytic drugs can sometimes stop preterm labor, but they usually only delay the birth for a few days. This delay makes it possible to better prepare for a preterm birth, though. The preparation involves:

• Treatment with steroids (medical term: corticosteroids) to help your baby's lungs develop more quickly. Steroids can prevent serious health problems and increase the child’s chances of survival.
• Choosing a suitable hospital: You might have to change your plans and select a hospital with the best facilities for preterm babies.
• The use of antibiotics if you and/or your baby are at risk of infection.

Once a preterm baby has been born, a type of drug called surfactant can help them breathe. Lungs that aren't mature enough are "stiff" and can't easily expand to let the baby breathe in and out properly. Surfactant is a fluid that is usually produced in babies’ lungs after about 31 weeks of pregnancy.

If a baby is born preterm, he or she will be taken care of and carefully monitored by a special team of medical professionals. The baby may need a lot of help to breathe properly, stay warm and get enough food. Depending on how premature the baby is, special intensive care treatment might be needed.

While waiting until a preterm baby is out of danger, parents usually face a lot of fears and worries. But there are also some things that they can do on their own: Besides medical care, their closeness and comfort is important for the baby. Lots of physical contact is helpful, for instance. The mother can also stimulate the production of breast milk and express milk (perhaps with help), to give to the baby once they’re able to drink it.

In addition to focusing on your child after a preterm birth, it's also important to look after yourself so you can recover from the birth, and deal emotionally with your feelings and everything you have gone through. This can help give you the strength to be involved in your baby's care as much as possible.

At one month of age, a preterm baby is likely to be as big as they would have been if they had stayed inside their mother's belly. For example, if your baby was born after seven months of pregnancy, at two months of age they will be the size of other children at birth. So, for a while, the baby will be smaller and less mature than other babies.

How well the baby gets on will depend on many factors. But if no big problems arise, preterm babies are usually ready to leave the hospital at around the time of their original due date.

After leaving the hospital, there are many support options for preterm babies and their families. In Germany, you can find information about support at the website of the federal association "Das frühgeborene Kind." Parents of preterm babies are also eligible to receive parental allowance for a longer time. The German Federal Ministry of Family Affairs has a portal for families that also offers information about support and help for preterm babies.

Nowadays most preterm babies have a good chance of developing normally. But they sometimes need a little more time.