What can be done if a baby is likely to be born too early?
Babies who are born long before their due date aren't completely ready for life outside their mother’s body. But if there are signs that a child will be born prematurely, a number of things can often still be done to reduce certain risks.
Some babies are unexpectedly and very suddenly born too early. There are usually certain warning signs, though. Then it is often possible to delay the birth somewhat. During the time gained in that way, things can be done to increase the baby’s chances of survival and healthy development. The most important of these is giving the mother steroids. Steroids help the unborn child’s lungs develop more quickly.
What is preterm birth?
Labor usually starts after nine months of pregnancy. This is known as a "term pregnancy" or "full-term pregnancy.” A birth is considered to be full-term if the baby is born after about 40 weeks of pregnancy (also called weeks of gestation). But sometimes labor starts weeks earlier, or there are complications in the pregnancy that mean the baby has to be born sooner. If a pregnancy is ended prematurely by doing a Cesarean section (operation) or inducing labor, it is called an “elective preterm birth.” If labor starts by itself, it is called a “spontaneous preterm birth.”
Preterm births can be caused by various factors, including infections, a weak cervix (the opening between the womb and vagina), and problems with the placenta. Multiple pregnancies are also a risk factor: Around half of all twins and almost all triplets are born prematurely. But there is often no explanation for why pregnancy ended before term.
All babies born before 37 completed weeks of pregnancy are considered to be preterm. In Germany, about 9 out of 100 births are preterm. Because the baby's body is still developing quickly at that time, each extra week in the mother's body can make a big difference to the baby's health and ability to live after being born.
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).
Three categories of preterm birth
The younger babies are, the smaller and less developed they will be. Being born too early particularly affects the child’s breathing: Although their lungs have been developing since the beginning of pregnancy, they are only ready to work on their own after about 34 weeks. This means that healthy babies who are born “moderate to late” preterm are less likely to have breathing problems than "very" and "extremely" preterm babies.
How can I tell if I am in preterm labor?
Women who think they might be having premature contractions are usually right, and should get in contact with their doctor, midwife or hospital as soon as possible. Preterm labor is an emergency, especially if it starts before the end of 34 weeks of pregnancy. The sooner the woman has special medical care, the more the baby can be helped.
The following things are the main signs that a woman might be going into preterm labor:
- Having regular contractions, accompanied by cramp-like pain.
- 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.
The contractions being regular is more important as a sign of preterm labor than the associated pain. Occasional contractions of the womb are normal in pregnancy. But if they're very regular and aren't going away, it could be labor.
What can be done if you're in preterm labor?
There are four important things women can discuss with their doctor if they're in preterm labor:
- Where to give birth – you might have to change your plans to go to a hospital with good facilities for preterm babies;
- The use of particular medications (called tocolytics), to try to stop labor contractions;
- The use of antibiotics if you and/or your baby are at risk of infection;
- 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.
- Reducing physical activity: Depending on the situation, it may be a good idea to do less exercise and lie down more. In some cases strict bed rest is needed.
Tocolytic drugs can sometimes stop preterm labor, but they usually only delay the birth for a few days. Still, with the help of steroids, it is often possible to speed up the development of the baby’s lungs during this short time.
After the birth
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. Even if their baby needs specialist care, there are things mothers can do to help. For instance, they can stimulate the production of breast milk and express their milk (perhaps with help), to give to their baby once he or she is able to drink it.
It's normal to focus on your child after a preterm birth. But 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 one month of age they will be the size of an unborn baby at eight months of pregnancy. So, for a while, the baby will be smaller and less mature than babies who are born full-term around the same time. How well the baby gets on will depend on a lot of 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.
American College of Obstetricians and Gynecologists' Committee on Practice Bulletins - Obstetrics. Practice Bulletin No. 171: Management of Preterm Labor. Obstet Gynecol 2016; 128(4): e155-164.
Haas DM. Preterm birth. BMJ Clin Evid 2011: pii: 1404.
Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017; (3): CD004454.
Schleußner E. The prevention, diagnosis and treatment of premature labor. Dtsch Arztebl Int 2013; 110(13): 227-236.
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