Premature birth: what parents need to know
Premature birth is classified as the birth of a baby before 37 weeks of pregnancy.
Having a baby arrive earlier than expected can be an emotional and uncertain experience. Premature birth occurs when a baby is born before 36 completed weeks of pregnancy and affects around one in 10 babies in Australia. While premature babies may face additional health challenges, advances in maternity and neonatal care mean that most survive and go on to thrive. This article explores the causes of premature birth, the care available for premature babies, and where families can find support.
Most premature babies in Australia are born between 32 and 36 weeks of pregnancy. Advances in maternity and neonatal care have significantly improved survival and health outcomes for babies born early.
What causes premature babies?
Premature birth can happen for many different reasons, and sometimes there is more than one contributing factor. Factors that may increase the likelihood of premature birth include:
- problems with the placenta, uterus or cervix
- health conditions during pregnancy, including infection, pre-eclampsia, high blood pressure and gestational diabetes
- multiple pregnancies, such as twins or triplets
- a previous premature birth
- fertility treatments, including IVF
- health conditions affecting the baby, including some congenital abnormalities
- smoking, vaping, alcohol or other substance use during pregnancy
Importantly, the exact cause of premature birth is not always known. Many premature births occur without a clear explanation. It is important for parents to remember that premature birth is often beyond their control and is rarely the result of anything they did or did not do.
Many parents experience feelings of guilt, worry or self-blame when their baby is born early. Support from family, friends and healthcare professionals can help parents navigate these emotions and focus on their own wellbeing, as well as their baby's care.
It is important to remember that premature birth is often beyond a parent's control. Many premature births occur without a clear explanation and are not caused by anything a parent did or did not do.
Braxton Hicks vs early labour: how to tell the difference
Being aware of the signs of labour during pregnancy is important, particularly if labour begins earlier than expected. It is also common to experience Braxton Hicks contractions, sometimes referred to as "practice contractions", during pregnancy.
Braxton Hicks contractions are usually irregular, do not become progressively stronger or closer together, and often ease with rest, movement or a change of position. They are generally not a sign that labour has begun.
Premature labour contractions are more likely to occur at regular intervals, become stronger over time, and continue despite resting or changing position. Other signs of premature labour can include pelvic pressure, lower back pain, abdominal cramping, vaginal bleeding, or a change in vaginal discharge.
If you experience contractions or any symptoms that could indicate premature labour, contact your maternity care provider or hospital as soon as possible for advice. Early assessment can help ensure you and your baby receive the care and support you need.
Signs that may indicate labour include:
- lower back pain, such as a dull ache that doesn't go away, or persistent period-like cramping
- uterine tightening or contractions that become regular, persistent and increasingly strong, such as occurring every 10 minutes
- any change to vaginal loss, such as an increase in secretions or a change in colour, including blood-tinged or watery discharge
- simply feeling that you don't ‘feel right’
If you are unsure whether you are experiencing Braxton Hicks or signs of labour, particularly before 37 weeks of pregnancy, contact your care provider or hospital for advice.
When your baby is premature
Whatever the reason for your baby’s premature birth, it can be an emotional and unexpected experience. You may feel worried about your baby, overwhelmed by everything happening around you or unsure about what to expect as you learn how to care for your baby in a different environment.
Seeing your baby surrounded by nurses, doctors, machines and tubes can be difficult, particularly if you had expected to take your baby home soon after birth. It is completely understandable to need time to adjust to this new experience.
Depending on their gestation and individual health needs, a premature baby may need to be cared for in a Special Care Nursery (SCN) or Neonatal Intensive Care Unit (NICU). Babies born between 34 and 37 weeks may require care in an SCN, while babies born under 34 weeks may require care in a NICU. Across St John of God Health Care our Special Care Nurseries generally provide care for babies from 34 weeks with no additional complex needs. Our Subiaco hospital has a NICU and is therefore able to care for babies less than 34 weeks who may require additional complex support. If you would like to know more about the SCN or NICU at your hospital, speak with your maternity care provider.
These specialised units provide expert care to help keep premature babies safe while they grow and develop. Your baby may need support with breathing, maintaining a stable temperature or feeding through tubes or intravenously. They may also need plenty of time to rest and minimise stress on their body as they adjust to life outside the womb earlier than expected.
The nurses and doctors caring for your baby are highly trained in caring for premature babies, and they will guide you through what is happening and how you can be involved. Even with this support, it is natural for parents to feel overwhelmed. You may experience feelings of uncertainty or a loss of control, particularly when you are learning about unfamiliar equipment and treatments. You may also feel worried about your baby becoming unwell, or experience sadness or anxiety. These emotions can sometimes place additional strain on relationships at an already challenging time.
Support and education are available through the NICU or SCN. One of the ways you can feel more involved in your baby’s care is by learning about their needs and finding opportunities to participate in their daily care and bond with them.
Bonding with your premature baby
Even when your baby needs specialised medical care, there are many ways you can build a close and loving connection with them.
You can interact with your baby by holding their hand, talking or singing softly to them. When appropriate, kangaroo care can also provide a special opportunity for closeness. This involves having skin-to-skin cuddles with your baby on your bare chest and can provide benefits for both you and your baby, including bonding and closeness. For your baby, it may also support oxygen levels, weight gain and earlier breastfeeding.
Breastfeeding, when possible, can also provide an important sense of connection and involvement. If your baby is not yet able to breastfeed, expressing breast milk can allow you to provide breast milk for your baby and store it until they are ready to feed. Your healthcare team can support you with expressing and feeding your baby.
If you know in advance that your baby will be born prematurely, you may also wish to visit the NICU or SCN before the birth. Becoming familiar with the environment and meeting some of the staff beforehand may help you feel more prepared and comfortable when the time comes.
Looking after yourself
While your focus will naturally be on your baby, it is important to look after yourself physically and emotionally too. Try to keep up your strength with nutritious food and plenty of fluids and accept help from family and friends where you can. Surrounding yourself with people who are positive, understanding and supportive can make this time a little easier.
Remember that there is no ‘right’ way to feel when your baby is born prematurely. You may experience fear, sadness, anxiety, uncertainty or simply feel overwhelmed. These feelings are understandable, and it is okay to ask for help when you need it.
Accepting support and becoming involved in your baby’s care, in ways that feel comfortable for you, can help you feel more connected and supported as you navigate this experience.
What happens after discharge?
The long-term outcomes for premature babies can be difficult to predict initially and can depend on how early your baby was born and their individual health needs. Your doctors, nurses and community maternal health teams will provide ongoing support and education as your baby continues to grow and develop after discharge from hospital.
Your baby’s journey may not be the one you expected, but you don’t have to navigate it alone. Your healthcare team is there to provide information, support and guidance as you and your baby take each step forward.