A baby that is born before 37 weeks is known as being premature or preterm. Roughly 1 in 13 babies born in the United Kingdom (UK) are premature – that’s around 60,000 premature babies each year.
The World Health Organisation uses the following terms to describe premature babies, based on when they are born:
Before 28 weeks: extremely preterm
Between 28 and 32 weeks: very preterm
Between 32 and 37 weeks: moderate to late preterm
Most premature babies will need some form of additional care, depending on how early they are born.
All premature babies should be born in a consultant-led unit with an appropriate Neonatal Service:
Dorset County Hospital in Dorchester has a Special Care Baby Unit (SCBU) for babies born after 32 weeks
St. Mary’s Maternity Unit in Poole has a Neonatal Unit (NNU) for babies born after 28 weeks
Babies born before 28 weeks, or with complex health needs, may need to be transferred to another hospital such as Southampton or Portsmouth with a Level 3 Neonatal Unit.
Causes of premature birth
In cases where labour starts spontaneously before 37 weeks, it’s often hard to tell the cause, but there are some things that increase the risk of premature birth.
Smoking, alcohol or drug use
Previous premature birth
Your waters breaking early (PPROM)
Having twins or multiple babies
Some infections, such as Group B Strep or urinary tract infections (UTI)
Diabetes, Type 1, Type 2 or Gestational
Previous removal of abnormal cervical cells
Sometimes your obstetrician might decide that your baby needs to be born early. This can be because:
You are experiencing complications such as pre-eclampsia
Your placenta is not working properly
Your waters break early (PPROM) and there is not enough amniotic fluid around the baby
Your baby is unwell
Your baby’s growth has slowed or stopped (IUGR)
You are having multiple babies (this will be determined by the number of babies and whether they share a placenta, as well as their growth and other factors)
If your baby needs to be born early, the team will explain why this is necessary. You may need an induction or a caesarean, and they may need to transfer you to a hospital with a neonatal unit to make sure your baby has care they need.
Signs of labour before 37 weeks
You should call Labour Line immediately on 0300 3690388 if you are before 37 weeks and you have any signs of labour, including:
Contractions or period-type pains that are coming regularly
Waters breaking or leaking
Vaginal bleeding that is fresh and red
Pressure in your vagina or rectum
Do not wait – premature babies can be born very quickly, so if you are concerned you should seek immediate advice from Labour Line.
The Labour Line midwife will ask you questions, such as:
How many weeks pregnant are you?
Have you had any problems during your pregnancy?
Have you had a premature baby before?
Are you having contractions, cramp or backache?
Are you feeling unwell?
Have your waters broken?
Are you leaking fluid or bleeding vaginally?
Is your baby moving normally?
Do you have vomiting, diarrhoea or nausea?
The Labour Line midwife will usually advise you to attend the Antenatal Day Assessment Unit (ANDAU) or the labour ward at Poole or Dorchester. Bournemouth Birth Centre does not have a neonatal service so you will not be able to go there if you go into labour before 37 weeks.
What to expect
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, she will listen to your baby’s heart rate with a handheld sonic aid. Read more 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 an injection of intravenous magnesium sulphate to protect your babies brain, if you are between 24-29 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.
Transfer to other units
Transferring to other units is quite common for premature births. There are different levels of Neonatal Unit at different hospitals, so if your baby is particularly early or has complex medical needs, you may need to be transferred to a hospital with a higher-level Neonatal Unit.
Before 28 weeks: You will be transferred to a hospital with a Level 3 Neonatal Unit such as Southampton or Portsmouth
Between 28-32 weeks: If you are in labour at Dorchester, you will be transferred to Poole
The team will try to transfer you to the nearest suitable hospital wherever possible. The obstetrician and neonatologist will discuss whether it is safe to transfer you and your baby before birth. Sometimes this may not be safe – for example, if you are bleeding heavily, have high blood pressure or you are likely to deliver during the transfer, or if your baby is not coping well with labour. In this case, you will deliver where you are, and you and your baby will be stabilised before being transferred.
After your baby is born
Members of the Neonatal team will be on hand to assess and stabilise your baby as soon as they are born. They will assess your baby’s airway, breathing and circulation, checking that they can maintain their temperature and see how they are adapting to the outside world.
Some premature babies won’t need much support – they will breathe spontaneously and can be given back to you quickly. Having skin-to-skin contact will help to maintain your baby’s temperature and help with bonding. If you are not well enough, your birth partner can be supported to have skin-to-skin contact if you both wish.
Some babies will require some resuscitation on the labour ward, or in theatre if you’ve had a caesarean. This means that they will need help from the team to start breathing. Once your baby is stable, they may be transferred to the Neonatal Unit or Special Care Baby Unit in an incubator, a covered plastic cot which keeps your baby warm. Partners are welcome to go with their baby to the unit if they wish. Some partners prefer to stay with you until you are well enough to visit your baby together. This is entirely up to you both, and the Neonatal team will take excellent care of your baby until you are well enough to visit.
The Neonatal Team will update you on your baby’s condition and management plan as soon as they can, keeping you updated on how they are responding to their care. You will also receive a daily update about your baby’s condition and management from a neonatal consultant while your baby is staying in the NNU or SCBU.
Premature babies often need help to breathe, as their lungs may not be developed enough to breathe on their own. Your baby might be put on a machine called a ventilator, which helps them to breathe. Babies born at Dorchester who require ventilation will need to be transferred. Poole is a level 2 Neonatal Unit – babies can be ventilated there for 48 hours. If they still require the ventilator, they will be transferred to a level 3 unit such as Southampton or Portsmouth to continue their care. The team will do their best to keep you and your baby together.
Your premature baby’s health
All babies will have a newborn physical examination, checking their eye reflexes, heart, hips and genitalia as soon as they are well enough. Some babies born prematurely will have problems with their sight or hearing, or other health issues, and will be offered additional checks. Oral vitamins are offered to all premature babies.
Your baby may have a cannula (a small plastic tube) inserted into a vein in their arm or leg, or sometimes elsewhere if necessary. This allows the team to give your baby fluids, nutrition and medications like antibiotics. They may have a continuous positive airway pressure (CPAP) mask over their nose to help them breathe, and they may have a feeding tube inserted via their nose or mouth. Their heart rate, oxygen levels, temperature and breathing will also be monitored.
Blood samples may be taken to check for infection, anaemia and other issues, and to check their oxygen levels. Chest x-rays and ultrasounds may be taken on the unit, or your baby may be sent for other scans like magnetic resonance imaging (MRIs).
Some conditions such as jaundice and blood sugar issues are common in premature babies. The team will be monitoring and testing your baby for signs of any health issues and will provide any treatment they need. You’ll be kept fully informed of your baby’s progress, the tests being done and the results, and you will be involved in any decisions about their care.
Coping with a premature birth
Neonatal Units can be quite scary places when you first go in. The constant beep of monitors and alarms can be overwhelming at first. It can be extremely difficult to see your baby attached to machines, wires and tubes. Premature babies can look very small and vulnerable, and it can be distressing for parents, especially if your baby needs to stay in hospital for a long time. If you are struggling emotionally, it’s important to talk to your midwife – they can offer support and refer you for extra help if you need it.
Your baby might look quite different to how you pictured them, especially if they are born very early. This can be upsetting for you, and the staff understand that this is a difficult time. The team will support you, explain everything, and encourage you to touch and care for your baby as much as possible. If it’s not possible to hold your baby right away, this will be explained to you.
You will be encouraged to have as much skin-to-skin contact with your baby as possible – this is also called “kangaroo care”. A paediatric physiotherapist may also be involved to support your baby’s care and advise you on how to place your baby in the best positions for their development. Your baby may sleep on their front while in an incubator – their oxygen levels will be constantly monitored so this is nothing to worry about.
Hormonal changes after birth can make any new mum feel emotional. With the additional worry of your baby being born early, you might find it difficult to cope, especially if you have other children to care for. You might be suffering from birth trauma too. Tell your partner, family and friends how you are feeling if you can, as they will be able to help support you. The midwifery and neonatal teams are also there to support you and answer any questions at this difficult time. Talk to your midwife about the help that is available to you and have a look at our birth trauma and emotional wellbeing sections.
Feeding your premature baby
The team will support you to feed your baby in your chosen method. Breastfeeding is recommended for premature babies wherever possible, as breastmilk strengthens their immature immune systems, and helps to protect them from infections, such as necrotising enterocolitis (a condition affecting the gut) as premature babies are susceptible to this. Read more about breastfeeding.
If you have chosen to breastfeed and your baby isn’t strong enough to feed from the breast, you will be shown how to express your milk. You will need to express milk every 2-3 hours. It is important to express through the night too, as this is when your hormones for milk production are raised. The team will show you how to hand express and use a pump. Electric pumps are available to use in the neonatal and postnatal wards. Milk can be stored in the hospital in fridges or freezers – the staff will show you the process for this. Read more about expressing and pumping.
Don’t worry if you are only producing small amounts of colostrum at first – this is very normal until your milk comes in. Your milk supply may be low initially, as feeling anxious and upset can slow lactation. Pumping regularly and continuing skin-to-skin contact with your baby will help, as breastfeeding is a supply and demand process. Watching videos of your baby and smelling an item of their clothing while pumping at home can help to boost your supply when you are apart. Even small amounts of breastmilk will really benefit your baby’s health – every drop helps.
Some babies will require formula – this might be regular formula or specialist formula for premature babies. If you wish to formula feed, the team will support you with this. Read more about formula feeding.
Some women choose to give their babies human donor milk rather than formula – talk this through with the staff caring for your baby.
Depending on your baby’s gestation and condition, you will be advised on the most appropriate way to feed your baby. Babies can safely be fed by more than one method. They may receive fluids that contain nutrients through a cannula (a small plastic tube inserted into a vein) or be given milk through a soft plastic tube that is passed through the nose to the stomach (nasogastric tube). Babies may also be fed via syringe or cup. You will be shown how to use these methods of feeding so that you can do as many of their feeds as possible yourself. Find out more about other methods of feeding.
Taking your baby home
Whether your baby has had a brief stay in hospital or a much longer one, you may feel both excited and nervous about taking them home. The team will make sure that your baby is safe in their car seat, give you any medications your baby needs, and instructions on how to manage any health issues at home. They will also give you information on how to perform cardiopulmonary resuscitation (CPR) in an emergency. If your baby needs ongoing care and monitoring, they will be referred to other healthcare professionals – this might include paediatricians, physiotherapists, occupational therapists, dieticians, or other specialists depending on your baby’s needs.
Your heath visitor and general practitioner (GP) will be notified by the neonatal team when you are discharged. Your midwife or health visitor will support you with the transition to caring for your baby at home.
Premature baby loss
Tragically, some premature babies do not survive, despite the best efforts of everyone involved. If you experience the loss of a baby, the team will offer you lots of support.