What is a premature baby?

Most pregnancies last 40 weeks. A baby born before the 37th week is known as a premature or pre-term baby. Medical advances have meant that more than 9 out of 10 premature babies survive, and most go on to develop normally.

In Australia, almost 1 in every 10 babies is born prematurely. Most Australian premature babies are born between 32 and 36 weeks and don't have any serious long-term problems.

Very premature babies are at a higher risk of developmental problems. It is possible for babies born at 23 to 24 weeks to survive, but they are at a greater risk of health complications.

Many babies born before 32 weeks, and those weighing 2.5 kg or less, may need help breathing. They will usually be cared for in a neonatal intensive care unit (NICU) until they have developed enough to survive on their own. Babies born between 32 and 37 weeks may need care in a special care nursery (SCN).

Why are babies born prematurely?

Often the cause of premature birth is not known. However, some of the reasons babies are born prematurely include:

• problems with the cervix, when it is too weak to hold the weight of the baby and uterus so it starts to open prematurely (your doctor may call this ‘cervical incompetence’)
• multiple pregnancy (twins or more)
• birth parent has a medical condition that means the baby must be induced early, such as pre-eclampsia
• problems with the placenta such as placental insufficiency, placenta praevia, placenta accreta or placental abruption
• preterm (premature) rupture of membranes, when the amniotic sac spontaneously ruptures (also known as ‘waters breaking’)
• the birth parent has a health condition like diabetes, or an infection
• the birth parent has a history of premature labour

What are the signs of premature labour?

Signs of premature labour include:

• contractions
• your waters breaking
• a 'show' of mucus from your vagina, or a change in your vaginal discharge, or mucous, blood or fluid leaking from your vagina
• a sudden decrease in your baby's movements
• pressure in the pelvis, as if the baby is pushing down
• cramping in the lower part of the belly, diarrhoea, nausea or vomiting
• constant lower back pain

You should also contact your midwife or doctor if you experience swelling in your face, hands or feet, or double vision, blurred vision or other eye disturbances. These are signs of pre-eclampsia, which is a common cause of pre-term births.

Find out more about the signs of labour.

What should I do if I experience signs of premature labour?

If you are less than 37 weeks pregnant and you experience any of the signs of premature labour, contact your doctor or nearest birthing centre immediately. It may be possible to slow down or stop the labour. Each day your baby stays inside your womb, the better their outcomes are likely to be.

If your labour starts prematurely, it’s best to go to a hospital that can care for your newborn, such as a hospital with a neonatal intensive care unit (NICU) or special care nursery (SCN). You can find your nearest suitable hospital on the Miracle Babies Foundation website.

How is a premature labour managed?

At the hospital, you will probably have a pelvic examination or an ultrasound. The medical team will check whether your cervix has started to open for labour and monitor your baby. If the hospital where the baby is born does not have an NICU, you and your baby may be transferred to another hospital.

When you are in labour, you may be given medicines to stop the contractions for a while. This allows you to be transferred to another hospital if necessary. You may also receive injections of corticosteroids 12 to 24 hours before the birth. Steroids will reduce your baby’s risk of some of the complications of being born very early (for example, breathing difficulties).

Premature babies can be born very quickly. They will usually be born through the vagina. However, in some cases the doctor may decide it is safest for you to give birth to your baby by caesarean section. Your doctor will discuss this decision with you.

A medical team from the neonatal (newborn) unit will be there for the birth. As soon as your baby is born, they will care for the baby in your room. The health team might use some specialised equipment, for example, your baby may need a neonatal resuscitation bed.

The team will keep your baby warm and may help them to breathe with an oxygen mask or breathing tube, and possibly medicine. Some babies need help to keep their heart beating with cardio-pulmonary resuscitation (CPR) or an injection of adrenalin.

Once your baby is stable, they may be transferred to the NICU or SCN.

Will I be able to hold my baby?

How soon you are able to hold your baby will depend on their medical condition. You may be able to hold them on the day they are born, but you might need to wait a few days or weeks until they are stable enough.

Holding your baby, known as kangaroo care, is an important part of your baby’s health and wellbeing, and the maternity staff will support you to do this as soon as you are able to.

Will my baby be able to breast feed?

After your baby is born, you’ll be asked to start expressing breastmilk. Maternity staff, lactation consultants and Australian Breastfeeding Association counsellors can help you.

Breastmilk is full of antibodies and nutrients that will be very important for your baby’s health and growth. Your baby may be given breast milk through a feeding tube initially because if they aren’t able to breastfeed. However, there are things you can do to help your baby learn to breastfeed:

• Holding your baby skin-to-skin, as soon as it is safe to do so, can help your baby feel secure and can help to stimulate your milk supply. Skin-to-skin feeding can be a good way to help prepare both you and your baby for breastfeeding.
• When your baby is held skin-to-skin you may notice them becoming more alert, sucking their fingers or lips, and moving closer towards your breast. These are signs that your baby may be ready to feed.
• Babies in the NICU usually progress through several stages when starting to breast feed. They may start by nuzzling and licking your nipple. They may then move towards your breast and take a few sucks. With time they will take more sucks and start to swallow, and will do so for longer periods of time. Eventually they will be looking to breastfeed with every feed.
• If your baby is very premature or sick it may take time for your baby to breastfeed well. It may take weeks – this is very normal. Hold your baby skin-to-skin when you can, and always go at their pace. With time your baby will start to feed better.
• If you do not want to breastfeed or don't produce enough milk, the staff will discuss formula feeding with you.

What will my premature baby look like?

Babies born at 36 to 37 weeks usually look like small full-term babies. Very premature babies will be small (perhaps fitting in your hand) and look very fragile.

Skin: Your baby’s skin might not be fully developed, and may appear shiny, translucent, dry or flaky. Your baby may not have any fat under the skin to keep them warm.

Eyes: The eyelids of very premature babies may be fused shut at first. By 30 weeks they should be able to respond to different sights.

Immature development: Your baby might not be able to regulate their body temperature, breathing or heart rate. They may twitch, become stiff or limp or be unable to stay alert.

Hair: Your baby may have little hair on its head, but lots of soft body hair (called 'lanugo').

Genitals: Your baby's genitals may be small and underdeveloped.

Will my premature baby's development be delayed?

Some common issues for premature babies include:

• breathing problems
• heart problems
• problems in their digestive tract
• jaundice
• leukaemia and anaemia
• infections

Most premature babies will develop normally, but they have a higher risk of developmental problems and will need regular health and developmental checks at the hospital or with a paediatrician. If you are worried about your child's development, talk to your doctor.

Problems that may occur later in children who were born prematurely include:

• language delays
• growth and movement problems
• problems with teeth
• problems with vision or hearing
• thinking and learning difficulties
• social and emotional problems

How do I calculate my baby's ‘corrected age’?

When you're considering whether your premature baby is developing normally, it is important to understand their 'corrected age'.

The corrected age is your baby's chronological age (how long ago they were born) minus the number of weeks or months they were born early. For example, a 6-month-old baby who was born 2 months early would have a corrected age of 4 months. That means they might be doing the things that other 4-month-olds do. Most paediatricians recommend correcting age when assessing growth and development until your child is 2 years old.

When will my baby be able to come home?

The hospital will not send your baby home until they are confident both you and your baby are ready. Staff will make sure you understand how to care for your baby at home. They will also show you how to use any equipment you may need.

You will need appointments to see a neonatologist (newborn baby doctor) or paediatrician. Your local child health nurse will also see you regularly.

It is normal to feel a little worried when you are looking after your baby yourself after a while in hospital. Take it slowly, and try to create a calm and quiet environment, until you both become confident being at home.

How do I cope with the stress of having a premature baby?

Having a premature baby can be an overwhelming and stressful experience for many parents. If you have a baby in the NICU or special care nursery you may feel distant from your baby and feel that it is difficult to bond with your baby. You may feel anxious about your baby’s health, now and in the future.

It might be helpful for you to think about other times in your life when you were feeling stressed or anxious and consider the different things you did to help you cope. Talking to close family and friends, speaking to people in similar situations to you, seeking professional help and writing down your feelings, may be useful ways to cope during this challenging time.

Read more how to supporting parents of sick or premature babies.

Who can I talk to for advice and support?

If you need support, contact the Miracle Babies Foundation's website 24-hour support line on 1300 622 243.

The Australian Breastfeeding Association can provide advice and support on feeding your baby on 1800 686 268.