Most babies are born about 40
weeks after the first day of their mother's
last menstrual period. But about 10 percent
of babies arrive sooner. A baby born more than
three weeks before his or her due date is considered
Premature babies have less time
to fully develop and mature in the womb. As
a result, they're often at increased risk of
medical and developmental problems. One of
the biggest problems facing premature infants
is underdeveloped lungs.
Your doctor may try to delay
your baby's birth if you go into labor earlier
than around 34 weeks into your pregnancy (preterm
labor). Even a few extra days in the womb can
give your baby's lungs a chance to become more
mature. But sometimes, in spite of every effort,
your baby may be born early.
Fortunately, the outlook for
premature infants has improved dramatically
in recent years. Great advances have been made
in the care of premature infants, and even
babies born as early as 23 weeks now have a
good chance of survival.
Signs and symptoms
It's usually best for a baby
to stay in the womb as close as possible to
full term. Recognizing the signs of premature
labor may help you prevent your baby from being
born too soon. The following signs and symptoms
can occur as early as four months before your
Regular contractions of your uterus. At
first, contractions seem like a tightening
in your abdomen that you can feel with
Light vaginal spotting or bleeding.
Menstrual-type or abdominal cramps.
Low, dull back pain.
Watery discharge from your vagina. This
may be amniotic fluid, the protective
liquid that surrounds your baby in the
womb. If so, it's a sign that the membranes
around your baby have ruptured.
A feeling of pressure in your pelvis, as
if your baby is pressing down.
If you suspect you're in premature labor
but haven't had a watery discharge, drink
two or three glasses of water and lie
down on your left side. This helps improve
circulation to your uterus.
About half of women who go into
premature labor do so for unknown reasons.
Or, you may have a medical condition that contributes
to early labor. These conditions may include:
A rupture of your bag of waters (amniotic
sac). Normally, these membranes that surround
your baby rupture during labor or just
before labor begins. But sometimes they
may rupture weeks or even months before
your due date, for no apparent reason.
In that case, there's a high risk that
your labor will begin within a few days.
You and your baby are also at increased
risk of infection.
Certain infections. These include infections
of your uterus, cervix or urinary tract.
Weak cervix. A cervix that opens (dilates)
without contractions (incompetent cervix).
In a normal pregnancy, your cervix dilates
in response to uterine contractions. But
if your cervix is weak, it may open just
from the pressure on your uterus caused
by your progressing pregnancy. The cervix
may have been weakened by a previous pregnancy
or during a previous surgery involving
the cervix, such as a dilation and curettage
(D and C) or a biopsy. Other factors that
may weaken your cervix include carrying
more than one fetus or having too much
amniotic fluid (hydramnios).
Certain chronic diseases. These include
high blood pressure, diabetes, kidney
disease and hypothyroidism.
Uterine abnormalities. These include an
abnormally shaped uterus or a benign tumor
(fibroid) of the uterus.
A previous premature delivery. Women who
have had a premature delivery are at higher
risk of going into premature labor again.
For many women, though, early labor happens
Substance abuse. These include smoking,
alcohol use, or misuse of other drugs.
Malnutrition. Women who are undernourished
or anemic are more likely to give birth
Other conditions. A fetus with congenital
defects or production of an overabundance
of amniotic fluid also can contribute
to early labor.
When to seek medical advice
Good prenatal care includes regular
visits to your doctor throughout your pregnancy
to check on both your health and your baby's
health. If you're at risk of premature labor,
being in weekly contact with your doctor or
another member of his or her staff and carefully
monitoring your own signs and symptoms can
be especially helpful.
If you develop any signs or symptoms
of early labor, such as bleeding with cramps
and pain, a watery discharge from your vagina,
or more than five or six contractions an hour,
call your doctor or hospital right away. It's
a good idea to keep these phone numbers handy
so that you can find them quickly.
Screening and diagnosis
If your doctor suspects premature
labor, he or she will check to see if your
cervix has begun to dilate and whether the
fetal membranes have ruptured. In some cases,
a monitor may be used to measure the duration
and spacing of your contractions. Monitoring
the length of your cervix with ultrasound imaging
may be done. In addition, sampling of the cervical
canal for the presence of fetal fibronectin,
a glue-like tissue lost with labor, also may
help guide your treatment.
If it turns out that you're in
premature labor, you and your doctor will need
to decide whether to try to stop your labor.
Considerations include your baby's well-being,
as well as your own, along with the risks and
benefits of each option.
Premature labor may create complications
for you, for your baby or for both of you:
By itself, premature labor won't put you at
any physical risk unless it's the result of
another problem, such as a uterine infection.
But all treatments used to delay delivery carry
Medications that halt uterine
contractions often cause fluid to collect in
the mother's lungs. This causes breathing difficulties
and can pose a risk for both you and your baby.
Other side effects depend on the medication
used to stop labor. Some medications can lead
to fatigue and muscle weakness. Others may
cause a rapid heart beat, blood sugar abnormalities
or stomach ulcers.
You and your doctor will need
to consider your own risk if medications are
used to stop labor, as well as the risks to
your baby if he or she is born too soon.
If your baby is premature, how well he or she
will thrive depends largely on the baby's gestational
age at birth. Risks are greatest for the babies
born most prematurely — those born between
23 and 26 weeks gestation.
About a third of these smallest
survivors, who weigh less than 2 pounds at
birth, will have serious medical problems such
as cerebral palsy, fluid accumulation in the
brain (hydrocephalus), seizures, lasting neurologic
problems or developmental delays. Another third
will have some less-serious chronic problems,
such as mild cerebral palsy, the need to wear
glasses and have ongoing eye care, or more
mild developmental delays.
Other babies born at 23 to 25
weeks do very well at first and may show no
signs of problems when they go home from the
hospital. But as childhood progresses, many
of these children display some difficulties
related to their premature birth. In particular,
they may not perform as well in school as other
children their age.
Very premature babies are also
at risk of other conditions:
Bleeding in the brain (intracranial hemorrhage).
If this occurs, it's usually in the first
week to 10 days of life. The more severe
the bleeding, the greater the likelihood
that the child will develop serious problems,
including developmental delays, seizures,
learning disabilities and fluid accumulation
in the brain.
Retinal problems. Another complication
seen in the youngest and most vulnerable
premature babies is retinopathy of prematurity
(ROP), an abnormal growth of blood vessels
in the retina, the light-sensitive inner
lining of the eye. ROP probably occurs
because the vascular system in the baby's
eye hasn't fully developed. Many cases
of ROP disappear on their own, but sometimes
the condition leads to scarring. The most
serious cases may be treated with cryotherapy,
a procedure in which an extremely cold
instrument is used to help prevent the
baby's retina from becoming detached.
Sometimes lasers are used in a similar
manner to treat ROP.
Intestinal problems. Some preemies are
also at risk of a potentially severe intestinal
problem known as necrotizing enterocolitis
(NEC). In the most serious cases, this
condition can be life-threatening. Infants
who have milder cases of NEC need to be
fed intravenously and given antibiotics
for 1 or 2 weeks.
Sudden infant death syndrome (SIDS). Premature
babies are at increased risk of SIDS,
a mysterious condition that claims the
lives of about 2,500 infants each year.
But not all preemies have medical or developmental
problems. By 28 to 30 weeks, the risk of these
complications is much lower. And for babies
born between 32 and 35 weeks, most medical
problems are short-term and may even have resolved
by the time the baby comes home from the hospital.
Treatments related to premature
birth may focus on women in preterm labor,
on babies still in the womb, or on newborns
in hospital neonatal (newborn) intensive care
units (NICUs). These may include:
If you're experiencing preterm labor, your
treatment depends on how far along you are
in your pregnancy and how far your labor has
progressed. Sometimes bed rest and extra fluids
are enough to stop premature contractions.
In other situations, your doctor may recommend
certain medications. These may include some
medications originally used for treating asthma,
such as terbutaline (Brethaire, Brethine, Bricanyl)
and ritodrine (Yutopar). These medications
relax smooth muscles, including those of the
uterus. Magnesium sulfate is a muscle relaxant
that is given intravenously.
Medications that block the calcium
channels in muscle cells can sometimes stop
contractions. So can drugs that block the production
of substances that stimulate uterine contractions
(prostaglandins), such as ibuprofen (Advil,
Motrin, others) or indomethacin (Indocin).
Medications often stop labor
only for a brief period of time. They are best
used to delay labor long enough to accomplish
other goals, such as transferring the mother
to a facility better equipped to handle premature
delivery or allowing other medications to have
a beneficial effect on the baby.
Although rare, preterm delivery
may result from weakness of the connective
tissue of the cervix with minimal pressure
from uterine contractions. If this occurs,
a surgical procedure known as cervical cerclage
may be an option. Using strong thread, an obstetrician
stitches around the cervix to close it. The
thread is removed in the last month of pregnancy.
For babies in the womb
If your labor can't be stopped, you may receive
medications to help prepare your baby for birth.
Corticosteroids such as betamethasone can help
make your baby's lungs more mature in as short
a time as 24 to 48 hours.
Hospital NICUs are designed to provide care
for premature babies and full-term babies who
develop problems after birth. If your premature
baby spends time in an NICU, he or she will
receive round-the-clock intensive care from
doctors, nurses and respiratory therapists
specially trained to care for newborns with
In an NICU, your baby will probably
be kept in an incubator, an enclosed plastic
bassinet that is kept warm so your baby can
maintain normal body temperature. Because preemies
have immature skin and very little body fat,
they often need extra help to stay warm.
At first your baby will likely
receive fluids and nutrients — known
as total parenteral nutrition (TPN) —
through an intravenous catheter, and later
start milk feedings through a tube that has
been passed through his or her nose. Like many
premature infants, your baby may not yet have
developed a sucking reflex or may be too weak
to suck. When your baby is stronger, you'll
likely be able to feed him or her by breast-feeding
or with a bottle. The antibodies in breast
milk are especially important for premature
Sensors may be taped to your
baby's body to monitor blood pressure, heart
rate, breathing and temperature. Caregivers
may also use ventilators to help your baby
breathe. This high-tech equipment may seem
overwhelming at first, but it's all designed
to help your baby.
In a hospital neonatal (newborn)
intensive care unit, babies are often first
watched unclothed on a warmer bed. Later your
baby will probably be kept in an incubator,
an enclosed plastic bassinet.
As the parent, you play an important
role in your baby's life, even though he or
she is in the NICU. Your baby's caregivers
will help you learn how to touch and eventually
hold your baby in ways that are calming and
not overstimulating. Talking or singing softly
to your baby, or just providing quiet company,
will give great support and comfort. When your
baby is ready to eat on his or her own, the
nurses will help you learn how to feed your
Babies are ready to go home when
they no longer have medical problems that require
continuous hospital care, when their body temperature
is stable and when they can nurse well enough
to gain weight. Your baby need not reach a
specific weight or age before going home.
Before you take your baby home,
your doctor will provide guidelines on how
to care for him or her. Ask questions about
any care issues or concerns.
Preemies are more susceptible
than other newborns to serious infections,
and their illnesses progress more quickly.
That's why it's important that they be examined
often. A follow-up visit will likely be scheduled
soon after you take your baby home so that
your doctor can examine the baby and answer
any of your new or ongoing questions.
Some research suggests that hydroxyprogesterone
caproate, a synthetic progestin hormone, may
prevent premature labor in women at high risk.
Although this treatment has been shown effective
in preventing a recurrence of premature labor,
more research is needed to confirm this approach
before such treatment is widely accepted and
used. The risks and complications of this treatment
Previous experimentation with
hormone treatment to prevent premature birth
occurred with the use of diethylstilbestrol
to prevent miscarriage. This treatment has
proven ineffective, and caused reproductive
problems in daughters of women who used it.
These risks didn't become apparent until more
than a decade after treatment was carried out.
Caring for a premature infant
can be a great challenge. You'll face many
challenges that don't exist for women who have
delivered a full-term baby. Like many parents,
you may have tremendous anxiety about your
baby's health and the long-term effects of
early birth. You may also feel angry, guilty
All of these feelings are normal,
and you'll likely find they change from day
to day. Sometimes you may also experience the
anxiety and sadness of postpartum depression
— the result of sudden changes in your
hormones after pregnancy. You may also find
it hard to establish milk production if your
baby is too small or too sick to breast-feed
In addition, you may need more
time to recover physically than you might think.
This, combined with your desire to be at the
hospital caring for your baby if he or she
is in a neonatal intensive care unit, can lead
to a great deal of fatigue.
Some of these suggestions may
help during this difficult time:
Learn everything you can about your baby's
condition. In addition to talking to your
doctor and your baby's caregivers, read
books on premature birth and look for
information on the Internet.
Take care of yourself. Get as much rest
as you can and eat a healthy diet. You'll
feel stronger and better able to care
for your baby.
Seek good listeners for support. Talk to
your partner or spouse, your friends,
family or your baby's caregivers. If you're
interested, your nursing staff or social
worker may be able to suggest a support
group in your area. Many parents find
it particularly helpful to talk to other
parents who are caring for a preemie.
Accept help from others. Allow friends
and family to help you. They can care
for your other children, prepare food,
clean the house or run errands. This helps
you save your energy for your baby.
Keep a journal. Record the details of your
baby's progress as well as your own thoughts
and feelings. Include pictures of your
baby, so you can see how much he or she
is changing. Photos will also help you
feel close when your baby is still in