From ‘What is prematurity?’ to ‘Why does it happen?’, we’ve got the answers you’ve been searching for…

No matter how many books you read or antenatal classes you attend, nothing can prepare you for the challenging yet fulfilling role of parenthood. The arrival of your little one simply surpasses all expectations.

However, meeting your baby earlier than expected can flood you with emotions, and for those who haven’t experienced prematurity before, it’s natural to have lots of questions.

We sat down with Karen McEwen, a registered midwife at My Expert Midwife, to answer the most common questions and help you navigate your journey through premature parenthood and beyond.

What is premature birth?

A typical pregnancy is considered full-term when a baby is born anywhere between 37-42 weeks. Babies that are born after 42 weeks are known as ‘post-dates’, while premature babies (also known as preterm) are considered to be born before 37 weeks of pregnancy.

What categories do premature babies fall into?

Although prematurity is considered to be before the 37 week window, medically, premature babies can be put into three categories:

• Extremely preterm – born less than 28 weeks of pregnancy

• Very preterm – born between 28-32 weeks of pregnancy

• Moderate to late preterm – born between 32-37 weeks of pregnancy

Why does premature birth happen?

Growing a baby is one of the greatest gifts you can experience, but some women may carry feelings of guilt when their baby is born prematurely, especially if they require specialised care. However, it’s important to remember that nothing can be done to prevent premature birth and it can be very unexpected – so be kind to yourself, you’ve done an amazing job.

There can be many reasons why a baby can be born prematurely, so we’ve covered some of the most common.

Rupture of membranes (waters breaking)

This may or may not mean that labour is starting, as it depends on the individual circumstances. Your midwife or nurse will discuss your options with you, which includes the possibility of trying to stop contractions with medication.

Having an infection which triggers labour to start

This could develop from either a urine infection or your waters breaking. Usually, antibiotics are given to prevent or treat these, while also stopping labour from happening.

Multiple pregnancies

Twins, triplets or more can often trigger labour as the uterus becomes larger and more stretched.

The cervix may start to dilate before full term

This may happen for some women, and if this is the case in more than one pregnancy, a cervical suture procedure (a stitch in the cervix) can be offered to help it stay closed.

Other reasons may be:

• If there’s been any health problems during your pregnancy, such as developing pre-eclampsia (a condition that affects certain pregnant women)

• If some babies have certain genetic conditions, this may trigger an early birth

How does premature birth happen?

Premature birth happens the same way as a regular birth – the only difference being that premature birth can sometimes be unexpected and quite overwhelming. If your baby isn’t due and you’re not ready give birth, you and your partner may feel in denial but it’s important to understand what to expect so you can prepare and act quickly.

Signs of premature birth are:

• Having contractions and/or abdominal pain

• The waters breaking, either a gush or a slow trickle

If you think you might be going into labour before 37 weeks, you should contact your maternity assessment centre at the hospital for help and advice.

How common is premature birth?

Around 60,000 babies a year are born prematurely in the UK, this is around 8% of all births. However, as advances in modern medicine progress, premature babies have much better chances of survival, especially in modern western countries such as the UK.

When can premature babies survive?

The further through pregnancy you are, the better the baby’s chances are of survival and future health. This is because they’ll be more developed, especially their lungs, and need less support with their vital functions once they’re outside the womb.

If you go into preterm labour and it’s clear the baby will be born soon, you’ll be able to talk through what to expect with a member of the neonatal team.

If premature babies have access to the appropriate care at birth, survival rates are:

• 34 weeks – almost the same as a full-term baby

• 31 weeks – 95% likely

• 27 weeks – almost 90% likely

• 24 weeks – 60% likely

• Before 24 weeks – babies can survive but will need several months of intensive care and support and are very likely to have problems which affect their long-term health

• Before 22 weeks – it’s unlikely that the baby would survive

What are the problems a baby can have as soon as they’re born?

A premature baby can face several problems when they’re born. Your medical team of doctors, midwives and nurses can explain how they can help the baby immediately after they’re born, but they may need all or some of the following:

• Help to start and continue breathing when they’re born

• Help to keep their body temperature stable

• Continued help to breathe and to keep blood oxygen at normal levels

• Help with keeping a normal blood sugar level, including regular feeding, sometimes via a tube

• Help to fight off infections due to their immature immune system, often needing antibiotics

What type of medical care is available for premature babies?

Although a premature baby will look just like a small full-term baby, their bodies and organs are often under-developed, and they usually need special care for a while. This can range from regular observations to check on their wellbeing, to intensive life support treatment.

Here’s what to expect from different types of units providing care for premature babies:

Neonatal Intensive Care Unit (NICU)

The NICU provides a high level of care and expertise, often for extremely preterm babies. Although you can expect to see some full term babies who need extra medical care after they’re born in there, too.

Special Care Baby Unit (SCBU)

This is usually for babies from 32 weeks of pregnancy who are now doing well and no longer need as much additional input. Babies that have also had intensive care and need less support will then move into this area.

Transitional Care (TC)

TC wards are usually for babies beyond 34 weeks who are thriving but may need little extra observations to regularly check their wellbeing. You’ll often find TC next to general postnatal wards, but they’ll have a dedicated nurse or midwife, as well as access to a neonatal team if needed.

Will a premature baby’s development ‘catch up’?

Many premature babies can thrive as they grow up and go on to lead a healthy life. Unfortunately, prematurity can be linked with some disabilities as the baby may not have had enough time to mature and develop in the womb before being born.

One in 10 premature babies will be permanently affected by their disability, which can mean having problems which are related to their brain (such as cerebral palsy), lungs (such as breathing difficulties) or have loss of hearing and sight. Although these can’t necessarily be predicted and they’ll need to be individually assessed, many premature babies will have caught up with their milestones by the age of two.

Where can I get help and support after having a premature baby?

Having a premature baby can be unexpected and worrying for families, but thanks to advances in medicines and the facilities available, even extremely premature babies now have a much better chance of survival than a few years ago.

If you’ve had a premature baby, your midwife and neonatal care units can signpost you and your family to the available resources, as well as provide further support and information specific to your local area.