At full term, a baby is born at least 37 weeks after the date of the mothers' last period and a baby is considered to be premature when born before the end of week 37. The incidence of premature birth in the UK is currently around 7% (about 45,000 babies every year), and rising. Because premature babies have had less time in the womb to fully develop and mature, they need more intensive care after birth and there is a higher risk of medical complications: the earlier a premature baby is delivered, the more serious the health problems he or she faces are likely to be. Thanks to the medical advances of recent decades even babies born as early as 24 weeks stand a chance of survival, though babies born this early are at high risk of long-term health problems. After this, the outlook for a baby improves with every day spent in the womb and by 32 weeks' gestation, the health implications of prematurity are likely to be short-term and by 36 weeks, a premature baby may need help breathing initially but many will need no special medical attention.
If preterm labour threatens, rapid medical attention can make all the difference to the outcome and the health of the baby, so it's important to be aware of the symptoms. If you experience regular contractions (you will feel your abdomen tightening or hardening at regular intervals, not unlike severe period pains), more than five contractions in an hour, or you think your waters may have broken (you have any watery discharge from the vagina) then you should contact your midwife, doctor or the hospital right away. Other signs that may indicate a possible preterm labour include: vaginal spotting or bleeding, low, dull backache and a strong sensation of pressure in the thighs and on the pelvis.
If it looks like labour may be beginning you will usually be advised to rest and drink plenty of water while you wait for an ambulance to take you to the hospital (you shouldn't drive yourself). At the hospital you will be given a vaginal examination and several tests to establish whether you are truly in labour and to check for infection. If the test results are inconclusive you'll be kept in for observation.
Before 34 weeks' gestation, an expectant mother who appears to be going into early labour is usually given two drugs: The first works on the mother to delay, or even stop, the labour and the second, a steroid, works to speed up the development of the baby's lungs so that they are ready to breathe oxygen after the birth if labour continues. If the drug to delay labour is given early enough it may actually stop a threatened labour and the pregnancy could then go to term. If this is the case then the mother might be given regular top-ups of the steroids to develop the baby's lungs more quickly while the pregnancy continues. However, if labour is established, the best doctors can do is to delay labour for 24 - 48 hours to give the steroids time to better prepare the baby's lungs for birth. At 35 weeks gestation or later, doctors will usually let the labour procede.
In certain circumstances where mother, baby, or both, are at risk, an early delivery by caesarean section may be planned rather than waiting for labour to begin spontaneously. Even where labour has begun spontaneously, there are several reasons why premature babies are often, but not always, delivered by caesarean: because of the position in which the baby is lying, to protect the baby's (still soft) skull, to relieve a distressed baby, or due to other medical emergency. Where a vaginal birth is possible, delivery is usually faster than in a full-term labour because the baby is smaller and so passes through the cervix more readily.
During a premature labour your baby's heartbeat is frequently monitored, which restricts your birthing options in itself: You won't be able to try for a waterbirth and your movements may be quite restricted depending on the type of monitoring equipment used. So an 'active birth' is unlikely. You can still try to deliver without pain relief if that's what you want, but if you do want some form of pain relief then you will probably be recommended to use an epidural and you won't be able to use pethidine.
You can expect a lot of people to be in the room for the delivery of a premature baby, which can be disconcerting even if it's something you think you're prepared for. During labour you'll probably have the usual number of people in the room, which can vary but is usually only two or three at any one time. When you come to the final minutes before birth, however, the team for your baby will arrive, and that's likely to be bigger the more premature your baby is. And of course with these people will come a whole lot of specialist premmie equipment.
While on the one hand it can be reassuring that so many people are there just to look after your baby, it can also be quite alarming.
"There were 14 people in the room at one point" says ThinkBaby member Jeremy, who's son was born at 28 weeks at the end of 2005, "The team for our son at birth was 7 people."
The earlier a baby is born, the smaller it will be, as much of a baby's fat and bulk is put on in the final weeks of pregnancy. A baby born before 30 - 32 weeks will be very small and thin, with the head looking quite large in relation to the body. The skin will appear quite transparent and may be covered in lanugo, the fine, downy hair that protects the baby's skin in the womb.
After the birth
A premature baby is likely to need assistance breathing (because the lungs haven't had chance to fully mature), eating (because he may not yet be able to suck properly) and keeping warm (because he doesn't yet have the adipose tissue, or fat, that helps him regulate his temperature). Many babies born prematurely will spend some time in a neonatal unit of a hospital receiving specialist care and attention appropriate to their needs. However, babies born after 34 weeks may be able to go direct to the post-natal ward with their mothers.
If time in the neonatal unit is necessary, where possible, mother and baby will be kept in different units of the same hospital, and you may need to transfer to a hospital with the appropriate facilities. While your baby is in the unit you will be encouraged to interact with her as much a possible: feeding, changing and holding her. In a small number of cases your baby may be sent to a specialist unit of another hospital, if the facilities there are more suitable to his needs.
If your baby is whisked immediately away to the neonatal unit after birth it can be very frightening for the parents, not least because of the array of medical machinery surrounding the baby. If this happens the neonatal unit staff should be able to offer you good support, and it may also help to talk to other parents at the unit and exchange experiences.