Preterm babies – premature birth

Childbirth is almost always astounding, but when labour begins much earlier than anticipated, it can be quite alarming. So it may be nice to know that premature babies receive excellent specialist care and that almost all preemies are ultimately just fine. How much care a baby who arrived too early needs usually depends on which week they were born – the earlier the birth, the more care is required.

What is considered a premature birth?

Pregnancy usually lasts about 40 weeks, but as of the first day of week 37, you’re actually considered full-term. A baby born earlier than week 37 would thus be considered to be born prematurely.

Babies born before week 32 are considered very or even extremely early, but such births are rare.

Specialist care at the hospital

Most babies who are born too early need specialist care in a neonatal unit, which will have specialist staff and all the necessary equipment to help the baby. If the hospital at which you had planned to give birth doesn’t have a neonatal unit, or if your baby’s care needs change, you may need to change birthing locations.

Babies who are born prematurely require time for some of their organs to finish developing, which makes them particularly sensitive to certain infections. Among other things, this means that the hygiene routines at the neonatal unit are very meticulous and no one is allowed to visit except for parents and possibly siblings. The baby will remain in hospital until the original expected due date, but as long as they’re developing properly, you may very well get to go home earlier. And if so, your family might still receive some support from the hospital.

What kind of medical care do premature babies receive?

The key place for care for a premature baby is in their parents’ arms. Skin to skin contact is important for all babies, but it’s especially important for babies born too early. Body contact has been shown to have a highly positive impact on development, for example by stabilising the baby’s pulse and evening out body temperature. In addition, contact with baby’s soft skin is soothing for the parent holding the baby, and that’s important, too. Since the baby will require round-the-clock monitoring, the parents’ arms will be alternated with an incubator or warming bed. The incubator is meant to be reminiscent of life in the womb, and therefore has soft lighting and low noise levels. It also has an elevated humidity level to protect baby’s skin, which has not yet fully developed. The baby’s lungs also have yet to fully develop and various tools, like oxygen or a face mask, may be necessary to help the baby breathe.

Babies born prematurely often need help with eating at first. In that case, a tube will be passed through the nose to carry breast milk – the mother’s or donated milk – into the stomach. Later on, the baby will learn how to suck. Babies born much too early can’t usually take in the amount of food necessary for development; in that case, they will need an IV, which is connected to a vein, to provide them with nutrients.

Sometimes, it might not be possible to get to hold your baby. Babies born significantly prematurely – prior to week 32 – usually receive some kind of intensive care. In that case, the baby is monitored continuously by medical staff to ensure they are breathing and have enough oxygen. As a parent, you simply have to wait and try to find comfort in the fact that as soon as the situation is a bit more stable, you will get to hold your little baby.

What causes premature birth?

The most common reason why a baby would be born before week 37 is labour beginning too early, or the mother’s water breaking. Medication and rest can occasionally put a halt to early labour, but not always. There are a few different reasons why labour will kick in too early: the mother might have an infection, for example, but genetics, smoking and being overweight could all play a role. Often, it isn’t possible to know the exact cause.
An obstetrician might also decide that the mother needs to give birth earlier if continued pregnancy poses a serious threat to the mother or baby, for example, in severe cases of preeclampsia. If the mother is carrying multiple babies, then being induced earlier is also more common.

Parents are important to neonatal care

If you already know your baby will be born early, medical staff will prepare you for what will happen. In that case, the baby may also be given medication while they are still in the womb to help their lungs develop faster. When premature birth is a surprise, it can often be shocking for the parents, who were not expecting the baby to be born for a few more weeks, or even months. As a parent, naturally you will need help handling what you’ve gone through, and an important aspect of that is being part of your little one’s daily care. The hospital staff are intentional about putting parents at the centre and the better the baby is doing, the more the parents get to handle nappy changes, feeding, and of course, physical closeness. More or less as if you had simply been at home.

Parents can be at the neonatal unit 24 hours a day with their baby; sleeping over is often an option and some hospitals have a family room where you can live for a little while. As a parent, it’s important to talk to the paediatrician and other medical staff so that you can process and understand what has happened and what is going on after the birth, as a part of handling the situation.

How early can a baby be born?

As of week 22 of pregnancy, it is considered possible for a baby to survive outside the womb. If the baby is born, healthcare providers will do everything in their power to save them. But births that early are extremely rare: about 85 percent of all premature babies are born after week 32.

Premature baby prognosis

Medical care for premature babies is excellent these days, and almost all babies born prematurely are healthy and develop as expected. Recent decades have seen excellent developments in the prognoses for extremely premature babies: their survival has increased and about two out of three babies born this early develop normally, or only experience mild impairment.

If your baby is born prematurely

If your baby is born prematurely, it can be a massive psychological stressor. Fear and anxiety will often be present during the birth, and perhaps before and after as well. It’s possible that the situation was an emergency, and you might feel an extreme need to talk about what happened with someone. Adapting to your new reality might also be challenging – especially if your baby was born much too early and nothing about your pregnancy or childbirth experience went as you had expected. In such an unusual situation, it’s completely normal to have many different feelings – such as grief over not having the experience you had expected, and simultaneous love and joy at the arrival of this new little life. These are huge things to handle, but most people do eventually settle in. Sometimes you might have a particularly big need for processing and support, both when your baby is first born, and later, when you feel you can relax and absorb the turn your life took. So don’t hesitate to reach out for support from the neonatal unit or later from your doctor.

Please note that all information above is based on Swedish recommendations.