Preterm Labour: Signs, Causes & Management

13/11/2023

Finding yourself in the neonatal intensive care unit (NICU), staring at a baby you weren’t expecting to be here for another few weeks, or months, can feel like an out-of-body experience.

But every year, around 53,000 babies in the UK¹ and around 4,500 babies in Ireland¹¹ are born prematurely. Most of these will need² some form of additional care and this can be especially challenging for new parents.

We’ve put together this useful guide to help parents who find themselves on a journey they weren’t expecting. We’ll cover the signs of preterm labour, common causes, and useful tips on how to make sense of becoming a parent when you maybe still don’t feel ready.

What is considered a premature birth?

A baby born earlier than 37 weeks is considered premature or preterm. Globally, one in 10 babies born are premature¹. Many premature babies will require some form of additional care and will need to be placed in a specialist unit, with an appropriate neonatal service.

How premature can a baby be?

The likelihood of survival for babies born before 22 weeks of pregnancy is extremely low. This is because their lungs and organs are not yet developed enough. Babies born at 24 weeks⁴ of pregnancy have a good chance of survival but may be at increased risk of disability.

What are the different levels of prematurity in babies?

Premature babies can be classified based on when they are born:

Extremely preterm (less than 28 weeks)
Very preterm (28 to less than 32 weeks) ²
Moderate to late preterm (between 32 and 37 weeks) ²

What causes early labour?

It can be hard to tell exactly what causes early labour. However, several factors may increase the risk of a premature birth, including:
Smoking, drinking, or drug use
Being pregnant with twins or multiple babies
Diabetes, Type 1, Type 2 or Gestational
Infections such as Group B Strep or Urinary Tract Infections (UTI)
Your waters breaking early
Previous experience with a premature birth

Sometimes, your obstetrician may also decide the baby needs to be born early if:

You’re experiencing pregnancy complications
Your placenta isn’t working properly
Baby is unwell or growth has slowed down or delayed

What are the preterm labour signs?

Sometimes, the signs of premature labour7 may be hard to spot, as they often mimic normal pregnancy symptoms, such as lower back ache. However, to help deal with premature labour, it’s important to be aware of the signs. Acting fast can make a big difference. If you notice any of the following preterm labour signs, call your midwife or doctor right away:

• Lower back ache

• Contractions – every 10 minutes or more – that get faster and more intense

• Cramping – similar to menstrual cramps, which can often be accompanied by diarrhoea

• Flu-like symptoms – such as nausea and vomiting

• Vaginal discharge/fluid leak

• Vaginal bleeding – including light bleeding

How to make sense of becoming a premature parent

If you find yourself next to a tiny baby who you weren’t expecting to meet for quite some time, you may feel like you’ve landed in an alternate universe. And until you've experienced it first hand, it’s hard to imagine what it’s like.

It can take time to come to terms with a situation that you weren’t emotionally or physically prepared for. The first hours, days, and weeks can be consuming and feel scary, so try to focus on just the minutes and hours ahead of you instead of looking too far ahead.

One mum told us: “In the first few days I asked every doctor and nurse who’d listen how long it’d be until we could take our baby home. But no one could answer me. It took me a few days to realise that every preemie is different and I just had to take it one hour, or one day at a time.”

Premature baby milestones

All parents are concerned about their baby reaching certain milestoneson time. But when your baby arrives earlier than expected, those first few months can seem like years of waiting. As premature babies are at greater risk of health complications, it’s normal to worry about whether they will be able to do certain things on time.

But the good news is that premature babies have the same milestones as regular babies. You just need to adjust the typical timeline to match their early birth. To figure out what your baby should be doing, and most importantly when, it’s important to look at their adjusted age, which is based on the original due date.

For example, when a baby is born two months premature and reaches the age of four months old, we can’t expect them to be doing what a typical four-month-old is doing. Instead, we should look at what a two-month-old should be doing.

While most premature babies usually catch up with their peers who were born around the same time, it’s important to remain patient. A baby with medical issues may need a little more time to adjust and reach those milestones. However, the earlier the baby arrives, the longer they may need to catch up ⁷.

Do I need to treat my premature baby differently from a typical baby?

Many premature babies will require extra care8, especially within their first few years.

Small babies

Premature babies and full-term babies with low birth weight may require extra warmth and assistance when feeding.

Premature babies with complications

Premature babies who have an infection may require antibiotics.
Babies with breathing problems may need additional support from a ventilator.
Babies with additional complications may need to be kept in a neonatal intensive care unit.

The best way to make sure your baby is developing on track is to schedule regular check-ups with their doctor and other healthcare specialists. They’ll be able to catch any issues as they develop and ensure that they receive the best care possible.

Do premature babies have problems later in life?

Not all premature babies will develop problems later in life. However, some may be at a greater risk10 of experiencing long-term complications involving their:

Heart
Brain
Digestive system
Blood
Vision
Hearing
Learning and behaviour

You may also need to look out for additional health problems, such as asthma.

Letting go of the journey you’d imagined

Julie’s twins were born at 23+6 weeks. Here’s what she had to say about her premature birthing journey: “It was a surreal experience. I was initially a little naive about NICU, thinking that they’d be fine and will be discharged when they reached their due date. Of course, as the days went on, I knew our journey as parents would be so, so different.”

Premature babies might need to stay in hospital for weeks or even months.

While it’s normal to grieve for the birth and beginning you thought you were going to have, part of the NICU experience is learning to let go and accept that this is out of your control. Your baby is fighting a brave fight with an incredible team around them.

Julie shared: “I learnt to accept and let go of the picture of what I thought life would be like.”

Riding the premature parent rollercoaster

Every minute of every day in the NICU can feel like an emotional rollercoaster you never wanted to be on. However, it’s important to remember that your premature baby is unique and will follow their own development path. Comparing them to the other premature babies around you is only natural, but may not prove beneficial.

One mum told us: “Things can change in a moment – they might have had a really difficult night then by the morning things are looking positive again. You can go through every emotion in the space of a day: fear, guilt, jealousy, anger, pride, happiness. It’s exhausting, but all totally normal.”

Befriending the other NICU parents around you can be a great support. You’re going through the same thing – they get it. That sense of shared experience is vital, as it means you have someone to listen to when things get tough and celebrate moments of joy.

While not being by your baby’s incubator is hard, allowing yourself to leave the NICU and take short breaks to clear your mind, get some fresh air, or hear the voice of a friend is also important. Taking some space for yourself can help you re-centre and come back re-energised – after all, your baby needs you at your full strength.

Celebrating every premature baby milestone

Premature baby development can be unpredictable. Every little step your baby makes is amazing progress, and a huge victory in their journey to coming home – so it’s important to find joy in and celebrate every milestone. The day their feeding tube is removed, the day they come off oxygen and the day they are ‘promoted’ to the Special Care Baby Unit (SCBU) mean you get one step closer to taking them home. Celebrate inchstones, rather than milestones.

Julie remembers: “When Jack was about 5 months, I came in one morning and called his name. He instantly smiled as he knew it was his mummy and that it was his name. It was such a special moment.”.

It takes a village

If it takes a village to raise a child, imagine the supportyou need as a premature parent. Not just during their NICU stay but well beyond as you rebuild and recuperate from your experience. Although well-meaning requests for updates from friends and family can feel annoying, always take up offers of help. Or better still, ask.

They will be desperate to support you through this difficult time in whatever way they can, but they won’t know what you need. Ask them to make you some home-cooked meals to heat up when you get home from a long day at the hospital. If you have other children, let your family take them out to free up your hands at this difficult time. And if they offer to come and meet you for a coffee, take them up on it.

Recognising your resilience

Premature parenthood may prove tough. But caring for a premature baby can teach you so much. You’ll also discover reserves of strength and resilience you never knew you had. This will be your parenting super-power which you’ll use endlessly on the rest of your parenting journey.

Read more about how WaterWipes is supporting and raising awareness of World Prematurity Day, and supporting premature parents.

For more information on your journey with your newborn be sure to check out our other articles on the Parenting Community:

FAQs

What does prematurity mean?

Prematurity means something that happens earlier than usual or expected. For example, if a baby is born before 37 weeks of pregnancy, they are often described as being ‘premature’.

Do premature babies teethe later?

When it comes to teething, all babies are different⁹. Most start teething at around six months but premature babies tend to teethe according to their adjusted age. This means a baby born at 30 weeks may not start teething until around eight months. However, delayed tooth eruption (when a child starts teething at a later stage than normal) is also common among premature children, especially those who were born underweight or with health complications.

Do premature babies struggle at school?

Premature babies often lead perfectly normal, healthy lives and won’t automatically struggle once they reach school. However, studies suggest that some premature babies may be at a greater risk of having special education needs than full-term children¹⁰.

References

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^{The information in this guide is based on a variety of medical and parenting sources such as the NHS, WebMD, and Northamptonshire Maternity Services.}

Updated 13/11/2023