Premature Birth

Doctors use weeks instead of months to determine a baby’s due date. A baby’s due date is 40 weeks after the first day of a woman’s last menstrual period (about 280 days). Because of this, full-term pregnancies are actually longer than "9 months". 

Unless there are medical reasons to deliver earlier, the best time for a baby to be born is 40 weeks. If a woman goes into labor before 37 weeks of pregnancy, it is called preterm labor. Babies born too early may have more health problems or need to stay in the hospital longer.

Signs of Preterm Labor:

• Contractions that make your belly tighten up like a fist every 10 minutes or more often
• Change in the color of your vaginal discharge, or bleeding from your vagina
• The feeling that your baby is pushing down (pelvic pressure)
• Low, dull backache
• Cramps that feel like your period
• Belly cramps with or without diarrhea.

Call your health care provider even if you have only one sign of preterm labor. Your provider may tell you to:

• Come into the office or go to the hospital
• Stop what you’re doing
• Rest on your left side for 1 hour
• Drink two to three glasses of water or juice. Do not drink coffee or soda.

If the signs get worse or don’t go away, call your provider again or go to the hospital. If the signs do go away, take it easy for the rest of the day.

By knowing the signs of preterm labor, you will be helping your baby.

Prematurity is the number one cause of neonatal death and disability. In 2006, in the United States, over 4 million babies are born each year – 543,000 (over half a million) of these babies are born too early. The rate of preterm births has greatly increased in the last 20 years.

In Oklahoma, nearly 1 in 7 babies is born too early.  That means that in an average week in Oklahoma almost 151 babies are born preterm.  In 2006, 13.9% of babies were born preterm in Oklahoma, compared to 12.8% of U.S. births. This is a significant problem for our babies and their families.

Preterm labor and delivery can happen to any pregnant woman, but some women are more likely than others to have preterm labor and delivery. 

Even if a woman has one or more risk factors, it does not mean that she will have preterm labor. However, all women should learn the signs of preterm labor and what to do if they have any of them.

Three groups of women are at greatest risk of preterm labor and delivery:

• Women to have had a previous preterm birth
• Women who are pregnant with twins, triplets or more
• Women with a uterus and/or cervix that may not be normal

Other factors may put a pregnant woman at risk for preterm labor:

• Late or no prenatal care
• Smoking
• Drinking alcohol
• Using illegal drugs
• Domestic violence
• Lack of social support
• Stress
• Long working hours with long periods of standing
• Being exposed to some medications

Some medical risks may also increase a woman’s chances of having preterm labor:

• Some infections, including sexually transmitted diseases
• Diabetes
• Obesity
• High blood pressure
• Short time period between pregnancies (less than 6-9 months between birth and the next pregnancy)

Studies suggest that there may be four main routes or pathways leading to preterm labor:

• Maternal or fetal stress – mental or physical stress may trigger premature delivery
• Infections – the body’s natural immune response to certain infections may lead to premature delivery
• Bleeding – the uterus may bleed due to certain conditions
• Stretching – the uterus may become overstretched with the presence of two or more babies

Click here to learn more.

A woman may be able to reduce her risk of preterm labor and delivery by getting healthy before getting pregnant. Once pregnant, a woman should get early and regular prenatal care. A visit to a healthcare provider before getting pregnant is especially important for women with medical disorders such as diabetes or high blood pressure. When a woman receives good care before and during pregnancy, problems often can be found and treated early, helping to reduce the risk for preterm birth.

To increase the chances of a healthy full-term pregnancy, a woman should:

• Avoid alcohol, smoking and illicit drugs beginning before pregnancy and during pregnancy
• See your healthcare provider for a medical checkup before pregnancy
• Try to reach a healthy weight before pregnancy and gain the recommended amount of weight during pregnancy
• Control diseases such as diabetes or high blood pressure
• Get screened and treated, if needed, for infections including sexually transmitted diseases
• Start prenatal care as soon as you think you may be pregnant
• Reduce stress
• Have plenty of social support
• If you are scheduling a birth by cesarean section or induction without a medical reason, the date for your baby's birth should be scheduled near your due date when you are at least 39 weeks
• Seek medical attention for any symptom of preterm labor
• Allow 18 months between pregnancies

Preterm labor symptoms should be reported to your health care provider right away. You are the best judge of changes occurring in your body, so it is important to pay attention to these symptoms - even months before your due date.  If you experience any one or more of these symptoms, contact your healthcare provider or go to the hospital:

• Uterine contractions:  Abdomen tightens and becomes hard.  Irregular contractions occur normally during pregnancy, but if they become regular and occur every 10 minutes or closer they may be preterm labor.  These contractions may be painful or you may not feel any pain with them.
• Cramps that feel like your period:  The cramping may come and go in a pattern or it may be constant.
• Low, dull backache:  May move to the sides or front.  Changing positions does not make it go away
• Pelvic pressure:  Feeling that the baby is pushing down. Or you may feel pressure in your pelvic area, low back or thighs.
• Change in vaginal discharge: Leaking fluid or blood from your vagina. It may be watery or mucous-like.  The color may change – pink, light brown, or green.
• Abdominal cramps: This may occur with or without diarrhea.
• Something’s not normal:  Many women with preterm labor have a feeling that “something isn’t right”.

CALL YOUR DOCTOR OR GO TO THE HOSPITAL immediately if you have any of the following EMERGENCY SITUATIONS:

• Large gush or steady stream of bright red bleeding from the vagina
• Gush of fluid or steady trickle of water from the vagina.
• Severe abdominal pain that is sharp or constant; may occur with or without contractions or bleeding

In the hospital you will be evaluated for contractions, cervical changes, medical history, and laboratory results.  Your baby’s heart rate will be monitored.  This evaluation may take thirty minutes to several hours.

You may be started on one or more medications to stop contractions (called tocolytics), antibiotics, and steroids to help your baby if she is born early.

For most women these treatments are effective.  If these treatments can delay preterm delivery for even 2-7 days, this can allow time for the steroids to work to help the baby’s lungs and brain to mature.  Steroids may help your baby to have fewer problems with breathing and bleeding into the brain after delivery.  For some women the tocolytic medications do not stop their labor, or their individual situation makes it necessary to deliver the baby early (uterine infection, bleeding, certain diseases or abnormalities in the mother or baby).

Premature means the baby is born before it has had time to fully develop or mature, which may require special care after they are born. Doctors, nurses and respiratory therapists that specialize in premature babies care for these babies in neonatal intensive care units (NICU).

The earlier a baby is born, the greater the chance that the baby will have serious health problems or not survive. 

Late preterm birth happens when a baby is born between 34 and 36 weeks. Even a few weeks before term, the baby’s major organs including the brain have usually not had enough time to mature, which can put the newborn at risk for serious health problems. A baby’s brain at 35 weeks weighs only two-thirds of what it will weigh at 40 weeks.

While in the hospital

• Preterm babies have difficulty staying warm and are placed on special warming beds or in incubators.
• Immaturity makes feeding difficult. Babies cannot suck, swallow and breathe at the same time. This means that they might need to be fed through a tube in their stomach or an IV until they can feed from the breast or a bottle.
• Because premature babies’ organs are not fully developed, they might have complications with their lungs, brain, intestines, heart and liver. Premature babies might not be able to breathe without a machine. They are also at a higher risk for a collapsed lung, jaundice, bleeding into the brain, anemia and infections throughout the body. Premature babies can also have dangerous problems with the intestines or heart that may be corrected with medication or may require surgery.
• Most babies born after 32 weeks gestation (8 weeks too soon) have fewer complications than babies born before 32 weeks gestation. But, babies born just a few days or weeks early may have more health problems at birth or even later in life than those babies born full term or before 39 weeks.

After taking baby home

• Premature babies are more prone to illness.
  • Wash your hands frequently. Insist others around your baby do the same.
  • Keep your baby away from sick family and friends. Do not take your baby around large crowds of people until your doctor says it is alright. 
  • Make sure your baby gets regular checkups and shots.
• Sudden infant death syndrome (SIDS) is more common among premature babies. Lower the chances of SIDS by following safe sleep practices.
• Premature babies are more prone to jaundice (yellowing of the skin). Although rare, severe jaundice can lead to brain damage.
  • Breastfeeding your baby every 2-3 hours is the best way to help prevent jaundice.
  • If you leave the hospital before the baby is 5-7 days old, frequently observe the baby for jaundice. If you notice any yellowing of the skin or whites of the eyes, notify your doctor immediately.
  • Keep all doctor appointments you have scheduled for the baby.

While medical improvements have helped increase the survival of premature infants, complications can still occur immediately after the birth and later in the child’s life. Premature birth results in permanent health problems in as many as 1 in 4 babies. According to the March of Dimes, babies born early:

• have more learning and behavior problems in childhood than babies born at 40 weeks
• are more like to have feeding problems because they can’t manage sucking, swallowing and breathing as well as full-term babies
• are likely to have breathing problems like Apnea (when a baby stops breathing)
• are more likely to die of sudden infant death syndrome (SIDS).

Knowing what to expect can help prepare for caring for a preterm baby. Click here for more information on caring for premature infants.

Yes! Breast milk may help premature babies develop and may even reduce some illnesses. However, they may need extra support. 

Learn more about Breastfeeding

Babies born very early may not have the ability to feed directly from the breast soon after birth. They may have difficulty coordinating sucking and swallowing, get tired easily, and may have other medical problems, such as breathing difficulties, which make it too hard for the baby to breastfeed. But your baby will still need the nutrition that only your breast milk can provide.

The breast milk of mothers who deliver prematurely is best at meeting the special needs of the premature baby. Besides providing milk that is more easily digested, breast milk contains white blood cells, antibodies and other valuable immunities that may help a premature baby resist infection.  

Premature babies fed breast milk also learn to feed better, have higher mental function scores, and may have a lower risk of long term intestinal disease and allergies.

You can use a breast pump to collect your milk. In the hospital, your milk can be fed to your baby through a tube until she is mature enough for direct breastfeeding. This is a special gift only you can provide to your baby. The nurses at the hospital can assist you in getting a pump and teaching you how to use it. You should begin using the pump as soon as you can after the baby is born, ideally less than three hours after the delivery.

Before going home your baby will transition to taking feedings either directly from the breast or from a bottle. Either your baby’s nurse or a lactation consultant can help you and your baby accomplish your goal.

Discuss with your healthcare provider getting a second opinion or a consultation from a specialist. Women who have already had a premature baby are at the highest risk for having another preterm birth.  Some of these women may be treated with the hormone progesterone to try to prevent them from having another preterm baby. 

Maternal –fetal medicine doctors have received special training to care for women who have complicated pregnancies. If you have had a preterm birth, pregnancies complicated by medical problems, or are having problems with this pregnancy, talk with your healthcare provider.

"Catch-up growth" generally occurs in the first 2 to 3 years of life. The smallest of premature babies may take longer to catch up. It may take anywhere from 8 years through adolescence to reach their full growth potential. 

Babies born prematurely experience higher rates of learning disabilities, cerebral palsy, vision and hearing loss, breathing and respiratory problems, and feeding and digestive problems. Some babies who were born premature do not ever catch up and may have developmental and learning disabilities or serious health problems for the rest of their lives.

Yes, although the reasons are not well understood.  

In Oklahoma, for the years 2004-2006, preterm birth rates were highest for African Americans (18.3%), followed by Native Americans (13.1%), Asians (13.1%) whites (12.7%) and Hispanics (11.7%). (1)  These differences may be due to many different things:  genetic conditions  passed on to the baby, the mother’s health behaviors, living environment, social circumstances, and/or access to and quality of health care.

Some researchers believe the increased risk is related to higher levels of stress hormones caused by life stressors.  These constant high levels of stress hormones may lead to preterm labor.  

Other research shows preterm birth may be related to a different type of response to inflammation in some women.  Women of different races may be more likely to suffer from constant stress or may have different types of responses to stress or inflammation. More research is currently being done to get a better understanding of why certain groups of women have a higher risk for preterm birth.

The March of Dimes Foundation is a primary partner dedicated to improving the health of babies by preventing birth defects, premature birth and infant mortality.

Down Syndrome Association of Central Oklahoma

Down Syndrome Association of Tulsa

There are many on-line resources and support groups for parents of premature infants.  Oklahoma Family Network, (OFN) Oklahoma’s Family to Family Health Information Center, staff members can visit you while your baby is still in the hospital.  They provide support and encouragement to those who have babies in a NICU.  They can help you meet another family who has a child a little older than yours who was born early also and/or they can help you find resources you may need. Most families feel parent-to- parent support is exactly what they need to make it through a hospital stay and going home with their baby.  OFN will provide support as long as you wish, even after your child goes to school.  Visit their web site at www.oklahomafamilynetwork.org or call them at 877-871-5072.    

Often parents that have babies in the NICU at the same time become a support for each other during their stay. The March of Dimes also has available resources.

• Video Emphasizes Importance of Reducing Elective Deliveries Before 39 Weeks of Pregnancy
• Television spot highlights importance of full-term birth-English
• Television spot highlights importance of full-term birth-Spanish
• Free educational materials online!