Most babies are lucky enough to be born at the right time of pregnancy, but some do arrive prematurely. The earlier that a baby is born, the more likely it is to have problems and need care from the Neonatal Intensive Care Unit (NICU).
Whilst medical advances have been rapid over the last decade, there are limits to what can be done for babies born very prematurely. The reason behind this is the speed that babies’ lungs develop. Out of all the organs in their body, babies’ lungs develop the slowest and don’t finish developing until 24 weeks of pregnancy. Before this, oxygen is not able to pass from the air to the blood which makes caring for babies born this early very difficult and sadly in some cases, impossible.
What has helped over the last few years is more accurate scanning in early pregnancy. This allows professionals to accurately know how far on a pregnancy is and how best to help.
Globally, more than 1 in 10 pregnancies will end in preterm birth (and this number is rising). In the UK, around 80,000 babies are born each year needing specialist hospital care – this is 1 in 9 babies.
In babies born preterm, the chance of survival at less than 23 weeks is close to zero, while at 23 weeks it is 15%, at 24 weeks 55% and at 25 weeks about 80%.
What happens if I think I am going into labour very early?
You should go straight to your local maternity unit if you think you may be going into premature labour. They should assess you and examine you internally to check your cervix.
They may do a test called a ‘fetal fibronectin’ test. This is a swab that can be taken when you are examined internally. It can give you a guide as to whether you are likely to go into labour or not. If this test is negative, this is a very good sign that you are not going into labour. If it is positive, it means that you may go into labour, but not definitely.
What can be done and why?
The aim of treatment of very premature labours is aimed at prolonging pregnancy for as long as is safe. This can be a difficult judgement to make and often it is frustrating for you as you will not get a definite answer to a lot of your questions.
After 22+6 (22 weeks and 6 days) of pregnancy, the doctors are likely to give you two steroid injections to help mature your baby’s lungs. These injections are given into your buttock and are 12 or 24 hours apart (depending on the unit policy). They work by rapidly maturing the lungs over the following 24 hours, which enables your baby to breathe more easily when they are born and require less help.
As long as it is safe, doctors can try to stop the labour progressing. It does not work in all cases and can be attempted with a range of medications. Recognised treatments include Atosiban, Nifedipine, GTN patches and Ritodrine. The first two are the most widely used in current practice.
Is it safe to stop labour?
Most of the time, yes. Sometimes it is unwise to stop labour because it can cause you or your baby more problems. Reasons for not stopping labour include:
- Vaginal bleeding – this can be a sign that the placenta is coming away from the womb in which case it is safer for the baby to be born. Also the medicines to stop labour can make bleeding worse.
- Infection – if there is enough infection in the womb to start a labour, then your baby is better off being born.
- A baby that is known to need delivery anyway – some people know already from scans etc. that their baby may need delivery soon. If this is the case, they will be allowed to labour if it starts.
How will my baby be delivered?
Most babies born between 22 and 25 weeks of pregnancy will be born normally. For babies born at this stage of pregnancy, caesarean section does not seem to increase their chances of survival or overall wellbeing. Also, by virtue of being small, there is less resistance during birth and they tend to be born quite quickly if you are already in labour. Occasionally they may need to be born by emergency caesarean, but this will be decided by the team looking after you if they feel that your baby is not coping with the labour.
Sometimes a caesarean section will be recommended if your baby needs to be born for either your health or their own benefit. Induction of labour can be tricky and has a high failure rate at this stage of pregnancy so is very rarely attempted unless your waters have broken.
Caesarean section for very premature babies
Usually at the end of pregnancy, a caesarean section will be performed through a part of the womb called ‘the lower segment’. This is a thin part of the womb that bleeds less, has less impact on future fertility and allows a normal delivery in future pregnancies.
Before 28 weeks of pregnancy, this part of the womb has not formed yet and caesarean section is more frequently called a ‘classical’ caesarean section. This has implications for your future fertility and mode of delivery in future pregnancies. Whilst the operation is generally safe, there is higher blood loss and a greater chance of problems after delivery.
In summary, a caesarean section will be offered if the benefits for you or your baby outweigh the risks. If you have a classical caesarean section, then all future babies should be born by caesarean section.
What will happen after delivery?
Your baby will be looked after by the neonatal doctors. If you are less than 24 weeks pregnant, you should have already had the chance to have a discussion with them about what treatment your baby will receive. As a rough guide, you should expect the following, although each unit does vary with their protocols, experience of staff and facilities available at that particular unit.
If your baby is successfully resuscitated and stabilised, they will be moved to the neonatal intensive care unit (NICU). You will get the chance to say a quick hello, but they need intensive care, so once they have been stabilised you will get a chance to go to the NICU to see them later.
NICU staff are very good at getting you as involved as possible in their care and helping you through this time which can be emotionally tough for both you and your husband/partner.
Unfortunately, not all babies are able to be resuscitated and are allowed to pass away as peacefully as possible. You and your baby will be cared for by the midwife looking after you and they will give you as much time to spend with your baby and support that you need. This is a very difficult and emotional time and people react in many different ways. Some are visibly upset whilst others are quiet and keep their feelings in. Sometimes the way that we react can surprise us and our partners. It is important to express your feelings in a way that you find comfortable and allow your husband/partner the same chance. You should be seen and helped by the bereavement counselling midwife/team. They should help to look after you, give you any paperwork that you need and answer any questions that you have. The ward midwives will also look after you for as long as you need to be in hospital for.
There are various support groups that are there for you. The most widely known is the Stillbirth and Neonatal Death charity (Sands).