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. More information about monitoring.
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.