You may have been signposted to this information page if are at a greater risk of your baby/babies being born early (premature). Premature labour is labour that happens before the 37th week of pregnancy. We know that the idea of your baby coming early will be stressful, so this information has been co-produced with parents who have shared their lived experience of premature birth and neonatal care, producing this information in order to support you. We want to work with you, your partner and your family in your pregnancy planning, while you are still pregnant, during labour, and beyond, to improve your pregnancy journey and your premature baby’s outcome. It is really important that you are involved in every decision about your care and your babies treatment. On this page we focus on the individual baby, if you are having twins or multiples your babies will be treated as individuals and we will work with you to develop a plan to suit your circumstances.
Bacterial vaginosis
Sometimes preterm birth happens naturally without any reason, and sometimes your maternity and neonatal care team will recommend preterm birth for the health of you or your baby. About 8 out of 100 babies will be born prematurely. We use the term preterm to mean the same as premature. There are things you can do to reduce the risk of preterm birth.
There are many signs and symptoms in pregnancy that may cause you concern. Experiencing any of the symptoms listed below may not mean you are going into preterm labour, but if you do have any of them you should call your maternity team to discuss.
It is very important that you are aware of the above signs and symptoms as your womb, where your baby is growing may not tighten and contract before 30 weeks, in the same way you would experience contractions later in pregnancy. You may instead experience period pains and cramps.Trust your instincts and call the numbers you have been provided with. Never feel you are being silly, you will always be listened to and asked to attend the unit when needed. Your maternity and neonatal care team will always discuss your care in an open and honest way, ensuring you understand and involving you every step of your journey.
If possible, always make the call yourself- your care team will get a clearer idea of what your concerns are by speaking with you rather than your partner of family member. You will be offered translation services if needed.
If you attend the unit, you will be asked questions and offered a full antenatal assessment with your consent:
There are tests you will be offered to understand if you are in preterm labour or at risk of preterm labour:
PREM7+ is a project by health professionals across the South East that has looked at the best things that can be done to help you and your baby when you are at risk of preterm birth, and when your baby is born prematurely.
The best things (sometimes called interventions) you should be aware of are explained in this booklet:
It may be that the hospital you have been receiving care in or the hospital closest to you is not able to provide the specialist care and support for your preterm baby needs. Your maternity and neonatal care team may discuss transferring you while you are still pregnant or soon after your baby is born to ensure your baby, where possible, is born in the most appropriate setting.
If you are admitted in preterm labour at 30 weeks or before, your maternity care team should discuss magnesium sulphate (MgSO4 ) with you. MgSO4 is very good at protecting your baby’s brain and it can also reduce the risk of cerebral palsy and sight and hearing problems. The best time to give you this is 24 hours before the birth, but any time up to the birth of your baby will still be good.
If you are admitted to hospital in preterm labour at 34 weeks pregnant or earlier, you should have a discussion with your maternity care team about antibiotics that will help you make an informed choice. Antibiotics are recommended to everyone in preterm labour as there is an increased risk of Group B Streptococcus (GBS) infection. GBS is a natural bacteria that both men and women carry. It is not a sexually transmitted disease.
Antibiotics can reduce the risk of:
If you are admitted to hospital in preterm labour at 34 weeks pregnant or earlier, you should have a discussion with your maternity and neonatal care team about steroids that will help you make an informed choice. Steroids are an anti-inflammatory medicine that will help to prepare your baby’s lungs to start working and reduce the risk of long-term breathing problems. Ideally, you should receive two doses of steroids, given 12-24 hours apart, as timing of steroids is important. The steroids are given by an injection usually in the upper thigh or buttock. The injection site will be uncomfortable. If you are a diabetic or have gestational diabetes, your blood sugars will need to be monitored during administration of steroids.
They can reduce the risk of:
If you are admitted to hospital in preterm labour at 34 weeks pregnant or earlier, you should have a discussion with your maternity and neonatal care team about optimal cord management (OCM)that will help you make an informed choice. OCM is achieved by waiting at least one minute after birth before clamping and cutting the cord. Your care team will discuss situations where OCM may not be possible.
OCM has significant health benefits:
You may have already decided about how you want to feed your baby, or you may still be undecided or change your mind if your baby is born prematurely. How you feed your baby is your choice and this decision will be supported by your maternity and neonatal care team looking after you and your baby. We recommend and encourage maternal breast milk, sometimes referred to as ‘milk as medicine’ because research informs us of the enormous benefits it brings for your baby’s health and your health and wellbeing. Choosing to express doesn’t mean you have to feed direct from your breast as you can give maternal breast milk in other ways. If you do express, even for a short time, the benefits for you and your baby are huge.
Breastmilk can:
If your baby is born preterm at 34 weeks or earlier, your maternity and neonatal care team will help to regulate their temperature. Your baby’s temperature should be taken within one hour of birth and remain between 36.5°C to 37.5°C . Preterm babies tend to have a lower birth weight and will have less or no fat under their skin. This means that it is harder for them to regulate their own temperature, meaning they can become very cold quickly. This can be dangerous for your baby. After birth, depending on their gestation (how many weeks you were when they were born) your baby may be placed in a special plastic bag, which protects their delicate skin and helps to keep them warm. There are different ways the team will manage your baby’s temperature, including the use of a heated cot.
Regulating temperature can reduce the risk of:
If you give birth at 30 weeks or earlier your baby will be supported with caffeine. Caffeine is widely used to prevent and treat apnoea (temporary stoppage of breathing) which is common when born preterm.
Why caffeine is used for babies in South East neonatal units:
If you give birth at 34 weeks gestation or earlier, your neonatal care team should discuss respiratory management (ventilation) with you. The use of a specific type of ventilation called volume targeted ventilation is known to benefit your baby.
The benefits of volume targeted ventilation are that it:
Having a baby in neonatal care can be a very stressful time for parents and it is often hard to think about looking after yourself. Across the country are organisations who can support you Some units have counsellors, psychologists and therapy services available. Never feel that you won’t be listened to.
The Neonatal Unit caring for your baby will advise what support is available.
Taken from NHS SE Prem7 leaflet
