This information is for you if you want to know about premature labour. You may also find it useful if you had a baby born prematurely in a previous pregnancy. It may be helpful if you are a partner, relative or friend of someone who has been in this situation.
What is premature labour? Labour is when regular contractions lead to opening up of the cervix (neck of the womb). This normally occurs at between 37 and 42 weeks of pregnancy. If it occurs before 37 weeks, it is known as premature labour. In the UK, having a baby early is common: eight in 100 babies are born before 37 weeks. Very premature birth is much less common, with less than one in 100 babies being born at between 22 and 28 weeks of pregnancy. About one-quarter of babies born prematurely are delivered early by the team looking after them because there are concerns about the health of the mother and/or baby. This is done either by having labour started off (being induced) or by having a caesarean section. However, most babies are born early because labour starts naturally sooner than it should.
What could premature birth mean for my baby? Having a baby born early can be worrying and distressing for parents. Your doctor and/or midwife will be happy to talk to you about this and give you information about support groups that you might find helpful. Premature babies have an increased risk of health problems, particularly with breathing, feeding and infection. The earlier your baby is born, the more likely he or she is to have these problems and your baby may need to be looked after in a neonatal unit. However, more than eight out of ten premature babies born after 28 weeks survive and only a small number will have serious long-term 2 disability. Many survivors (as children) who have long-term health problems still rate their quality of life as being good. If you give birth before 24 weeks of pregnancy, it is sadly much less likely that your baby will survive. Babies who do survive after such a premature birth often have serious health problems. The possible treatment and outcomes for your baby in your individual situation will be discussed with you. You will be supported to spend as much time as you can with your baby. Breast milk is very important for premature babies: the doctors and nurses will talk to you about this and provide any support you need.
What causes premature labour? For most women, the cause of premature labour is not found. It is thought that a number of factors, sometimes involving infection, can bring about a change in the cervix that causes labour to start. However, there are certain factors that increase the risk.
These include if:
- Your waters have broken early
- You have had a prematurebirthor your waters broke before 37 weeks, in a previous pregnancy • You have had a previous late miscarriage (after 14 weeks of pregnancy)
- You have had vaginal bleeding after 14 weeks in this pregnancy
- You have an abnormality in the shape of your womb
- You are carrying twins or triplets
- You have excess fluid around your baby
- You have a short cervix
- You are a smoker
- You have had fertility treatment
What happens if I think my labour may be starting early? If you are having regular, painful tightenings or you think your waters have broken, it is important that you contact your maternity unit straight away. You are likely to be asked to come in. Your doctor or midwife will ask whether you have had a premature birth in a previous pregnancy. You will also be asked about your general health, whether you have had any abdominal pain, tightenings or bleeding, and whether you think your waters have broken.
You will have a check-up that may include:
- A general examination and a check of your temperature,pulseand blood pressure
- An examination of your abdomen
- A check of your baby’s heartbeat
- Being asked to give a blood sample to check for signs of infection
- Being asked for a urine sample for testing
The start of labour is usually diagnosed by vaginal examination:
- Your doctor or midwife will use a speculum (an instrument used to separate the walls of the vagina) to see whether the cervix is changing in preparation for labour or has alreadyopened up.
- Your doctor or midwife will also be able to see whether there is fluid leaking, which mayindicatethat your waters have broken. Sometimes the waters break before 37 weeks but labour doesn’t start.
- A vaginal swab may be taken to check for infection.
- Another type of swab calledfetalfibronectin may be taken from the top of the vagina, if you are at between 24 and 34 weeks of pregnancy. This test helps to see whether you are likely to go into labour soon or not: Most women who are suspected of being in premature labour have a negative swab. This is very reassuring because less than one in 100 women with a negative test will go into labour within the next 2 weeks. A positive swab means that there is an increased chance you may go into labour. One in five women who have a positive swab go into labour within 10 days. The swab will be less accurate if you have any bleeding, if your waters have broken or if you have had sexual intercourse in the previous 24 hours.
What happens if I am not in premature labour? If labour is not confirmed or if you have a negative fetal fibronectin swab, you should be able to go home if you are well and there are no concerns for you or your baby.
What happens if I am thought to be in premature labour? If labour is suspected, you will be advised to stay in hospital.
You may be offered:
- A course of two to four corticosteroids injections usually over a 24–48 hourperiod to help with your baby’s development and reduce the chance of problems caused by being born early (unless you have already received steroids in this pregnancy).
- Treatment with magnesium sulphate, through a drip in your arm. This would be considered if you are less than 30 weeks pregnant and likely to give birth within the next 24 hours. This treatment reduces the chance of complications for your baby, in particular cerebral palsy. You may experience minor side effects such as flushing and nausea. Ifyou are advised tohave this treatment, your doctor will discuss it fully with you.
- A course of antibiotics if it is confirmed that your waters have broken, to reduce the risk of an infection getting into the womb
- An opportunity to talk to one of the neonatal team about the care that your baby is likely to receive, if born early. You and your partner may also wish to visit the neonatal unit.
- Medication (tablets or through a drip) to try to stoplabour, ifyour waters have not broken and there are no concerns about you or your baby. This is only advised in the following circumstances:
– While you are having your course of corticosteroids
– If you need to be transferred to a hospital where there is a neonatal intensive care unit, which could be some distance away; this is particularly the case if you are less than 32 weeks pregnant.
These medications are not routinely recommended for women having twins or triplets because it is not clear that they are beneficial in that situation.
Can premature labour be prevented? In some circumstances, particularly if you have had a baby born prematurely or a late miscarriage in the past, you may be offered vaginal scans in pregnancy to measure the length of your cervix or you may be advised to have a suture (stitch) put around it to prevent it opening early.
What if I don’t go into labour? You are likely to be able to go home. You should be offered a follow-up appointment with your midwife or a consultant depending on your individual circumstances. If your waters have broken but you aren’t in labour, you will be asked to return to the hospital for regular check-ups.
What about a future pregnancy? Having your baby early means that you are at an increased risk of having a premature birth in a future pregnancy. However, you are still likely to have a baby born at more than 37 weeks next time. You will be advised to be under the care of a consultant obstetrician who will discuss with you a plan for your pregnancy. This will depend on your individual situation and on whether a cause for your early delivery, such as infection, was found.
What to do if I have concerns or further questions? Talk to your midwife, who should be able to help. You can also ask to speak to your team of doctors and midwives at your maternity unit.
Having your baby early at Harrogate Hospital:
At Harrogate Hospital our Special Care Baby Unit provides care to babies born from 32 weeks gestation to term. Any babies born before 32 weeks of pregnancy or those requiring more specialised intensive care are transferred to larger regional units by EMBRACE, a dedicated transfer team who specialise in the care of babies and children. We have seven special care cots, providing short and medium term care for sick and preterm infants and one intensive care cot. The unit is well serviced with specialised equipment and expertise to provide care for babies who require specialised nursing. We have two parent bedrooms with kitchen and bathroom facilities. There is also a dedicated breastfeeding room. Breast pumps are available for use on the Unit and may be able to be borrowed for use in the home while the baby remains on the Unit. We offer flexible visiting hours for parents/carers and siblings. Grandparents, aunts, and uncles can visit between 12pm-7pm. To minimise cross infection, no other visitors are allowed. We only allow two visitors per baby at any one time. We want to make you feel as comfortable as possible when you visit our wards, and all our staff aim to adhere to our values of Passionate, Respectful, and Responsible.
What if my baby needs to be transferred to a regional unit? In maternity services it is always our aim to keep parents and babies together. If your baby requires additional care and needs to be transferred to a regional unit we will communicate with maternity services at that unit and organise for you to be transferred to be with your baby. We try to minimise the time that you and your baby are separated but there may be a delay if you have had a caesarean section or are unwell yourself. In this case the doctors will assess your condition and whether it is safe to transfer you to another hospital. If you are not stable enough to transfer we will regularly reassess and aim to transfer you as soon as you have recovered. If you have additional care needs you may also need to be transferred via ambulance to the regional unit (this will always be a separate ambulance to baby). If you have recovered well from your birth you may be fit for discharge and advised to travel in your own car.
The periprem passport:
The periprem passport was designed to be given to the parent of any preterm baby to help inform and involve you in the care of your preterm baby. You may be offered some or all of these options throughout your journey.
Multiple languages can be accessed here: please ask a health professional to print this for you:
www.humberandnorthyorkshirematernity.org.uk/professionals/safety-inc-lmns-guidelines/
A midwife is always available in the maternity assessment centre or on delivery suite to talk to if you need some advice or reassurance. Single point of contact: 01423 557531, if you are unable to speak on the phone and need urgent care – please just attend maternity assessment centre (MAC) First floor, Strayside Wing (follow the signs for Central Delivery Suite/Pannal Ward).