Premature baby

A baby born before 37 weeks of pregnancy is known as a premature or pre-term baby. In Australia, about 8 in every 100 babies is born prematurely.

Babies born between 32 and 37 weeks may need care in a special care nursery (SCN). Most of these babies don't have any serious long-term problems.

Very premature babies (those born before 32 weeks) have a higher risk of health and developmental problems. Many babies born before 32 weeks may need help breathing. They will usually be cared for in a neonatal intensive care unit (NICU) at first.

Often the cause of premature labour and birth is not known. However, your chance can increase if you:

• are younger than 20 years or older than 40 years
• smoke during pregnancy
• do not have antenatal care during your pregnancy
• have a multiple pregnancy (twins or more)
• have a short cervix (this can be detected during pregnancy) or have had previous surgery on your cervix
• have previously had a premature labour
• have a chronic (ongoing) medical condition

Other factors that can increase your chance of premature labour are:

• having a genital infection or urinary tract infection (UTI)
• vaginal bleeding
• preterm prelabour rupture of membranes (waters breaking early)
• having too much or not enough amniotic fluid
• having a serious medical condition such as pre-eclampsia, that means your baby must be born early

Some of these risk factors can be managed to reduce your chance of preterm labour.

Signs of premature labour include:

• contractions
• your waters breaking
• mucous, blood or fluid leaking from your vagina
• pressure in your pelvis
• cramping or pain in your lower tummy
• lower back pain

Find out more about the signs of labour.

At the hospital, your doctor or midwife will ask about your symptoms. They will examine you, and you will probably have a pelvic examination or an ultrasound scan.

Your healthcare team will check whether your cervix has started to open for labour. They will monitor you and your baby. They may do some tests.

Management of preterm labour will vary depending on your situation. Your doctor and midwife will consider:

• your health
• your baby's health
• how many weeks pregnant you are

You may be given medicines to try to delay the birth. You may also be offered injections of corticosteroids or other medicines. This is to reduce your baby's risk of some complications of being born very early (for example, breathing difficulties).

Preterm birth

Premature babies can be born very quickly. In some cases, your doctor may recommend that it will be safest for you to give birth by caesarean section. Your doctor will discuss the risks and benefits with you, so that you can make an informed decision.

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 your baby.

Once your baby is stable, they may be transferred to the NICU or SCN. If the hospital where your baby is born does not have an NICU, your baby may be transferred to another hospital.

How soon you can hold your baby will depend on their medical condition.

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

After your baby is born, you may be asked to try breastfeeding your baby or express breastmilk. Maternity staff, lactation consultants and Australian Breastfeeding Association counsellors can all help you.

Breastmilk is full of antibodies and nutrients that will be very important for your baby's health and growth. Your baby can be given breast milk through a feeding tube initially 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's safe to do so, can help your baby feel secure and can help to stimulate your milk supply. Skin-to-skin contact can be a good way to help prepare both you and your baby for breastfeeding.

If you do not want to breastfeed or don't make enough milk, the staff will discuss donor milk or formula feeding with you.

Most premature babies will thrive as they grow. But some can have health and development problems.

Some health problems premature babies may experience include:

• breathing problems
• heart problems
• having trouble keeping their body temperature constant
• infections
• jaundice
• feeding problems
• slow weight gain

Most premature babies will develop normally, but they do have a higher risk of developmental problems.

You child 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 in children who were born prematurely can include:

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

When you're considering whether your premature baby is developing normally, it's 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.

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's 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.

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. 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.

If you need support, contact the Miracle Babies Foundation or call their NurtureLine on 1300 622 243.

The Life's Little Treasures Foundation also has information and support — you can call them on 1300 697 736.

You can also call the Preterm Infants Parents Association on 1300 773 672.

The Royal Women's Hospital has information on premature babies, including in languages other than English.

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