All you need to know about delivering a preterm baby
Discovering you are pregnant is one of the most exciting times in your life, but it can also be fraught with worry and doubt. Going into labour early can be a very real possibility, especially if you have a high-risk pregnancy. While there are a number of factors associated with preterm births, there’s also a lot of support out there for families with premmie babies, too. M&B spoke to Associate Professor Craig Pennell from the University of Western Australia’s School of Women’s and Infants’ Health about potential risk factors, developmental delays and taking care of a baby who is born so little and so young.
Q HOW EARLY IS CONSIDERED PREMATURE?
Craig says: “A baby born premature is anything less than 37 weeks gestation.”
Q WHAT DOES ‘CORRECTED AGE’ MEAN?
Craig says: “The best way to describe corrected age is by using an example. So, if a baby was born at 30 weeks gestation, when they are 12 weeks (or three months) old, it would be the equivalent of 42 weeks gestation. The corrected age therefore would be two weeks old. We do that because of milestones. For example, a baby should be smiling at around six weeks; but a baby who is born at 28 weeks won’t be smiling when they get to six weeks old.”
Q WHO IS AT A HIGHER RISK OF BIRTHING A PREMATURE BABY? IS THERE ANYTHING THAT MAKES PARENTS’ RISK FACTORS HIGHER?
Craig says: “Preterm birth occurs in about eight per cent of pregnancies. The strongest risk factor is genetics. If the parents of the baby were born pre-term, or have siblings that were preterm, there is a higher chance they will give birth earlier. There are also a number of other factors, including the age of the parents (less than 18 or more than 35), if mum smokes or is taking drugs and alcohol during pregnancy or if the baby is a product of IVF. Maternal conditions like diabetes, high blood pressure, autoimmune and blood clotting diseases may also lead to a preterm birth, as well as previous cervical surgery, so if you’d had abnormal Pap smears or biopsies, or surgery to remove precancerous cells. Also, women with uterine abnormalities like a double or half uterus, or different structural anomalies are all associated with increased risk of preterm birth.”
Q WHAT ABOUT MULTIPLE BIRTHS? IF I AM PREGNANT WITH MORE THAN ONE BABY, WILL I GIVE BIRTH EARLIER THAN OTHERS?
Craig says: “Yes. For twins, you’re looking at delivering around the 34-37 gestation week mark, for triplets, most are delivered around the 34-week mark, and with quads, they’re delivered at around 30 weeks gestation.”
Q AM I AT A HIGHER RISK OF HAVING A PREMATURE BABY SECOND TIME AROUND IF MY FIRST BABY WAS PREMATURE?
Craig says: “If you’ve had a preterm baby before, your risk is generally doubled.”
Q IF I HAVE A PRETERM BABY, WHEN SHOULD I GET THEM VACCINATED?
Craig says: “The paediatrician will give you individualised advice about that, but generally it’s done on corrected age.”
Q SHOULD I BE CONCERNED ABOUT THEIR DEVELOPMENT LATER IN LIFE?
Craig says: “The risk of developmental problems increases the earlier the baby is born. For example, if you were to look at a baby born at 24 weeks gestation, they have the largest number of issues, including possible learning delay difficulties all the way through to blindness, deafness and cerebral palsy. As you get further along in pregnancy, the risk lessens. By the time you get to 32 weeks, most of the severe conditions are no longer a problem, but there still can be learning issues or the risk of development delays up until around 37 weeks. We always try to get everyone to 40 weeks, or as close to it as possible.”
Q HOW DO MEDICAL PROFESSIONALS HELP GET THEIR PATIENTS TO FULL TERM?
Craig says: “We start with preconception counselling, to make sure high-risk women with underlying medical conditions can have their condition stabilised and whatever can be done to minimise the risk of preterm birth can be done before pregnancy.
Education also plays a big part. We advise people not to have kids before 18 and if you can, try to have them before 35. If you do choose to have them after 35, you need to be aware preterm birth is a risk. We also tell patients to avoid smoking, taking drugs and drinking alcohol during pregnancy, as that increases risk of a premature birth by about 40 per cent.
Once you are pregnant, the most common thing we do is check the cervical length when we do an anatomy scan. If it’s short, we offer treatment, which could be progesterone medication or sometimes the cervical stitch. We also increase the surveillance of those who are at greater risk and keep low-risk pregnancies as normal as possible. Also, if we know someone is going to be delivering early we want to make sure they’re located close to a tertiary hospital – it’s not ideal to have your baby at 26 weeks out in the country.”
Q HOW YOUNG CAN A PREMATURE BABY BE BORN?
Craig says: “At 23 weeks gestation the best survival data is about 46 per cent. At 24 weeks it goes up to 76 per cent. At 28 weeks, it’s 96 per cent. By 34 weeks, it’s quite similar to term babies.”
Twins are usually delivered around the 34-37 gestation week mark
Q CAN I STILL BREASTFEED MY PREMATURE BABY?
Craig says: “Breastfeeding is good for all babies, but it is really important for preterm babies, especially because of the immune benefits. In the hospital once your baby is born, you are helped to express breastmilk via pumps. Once babies are at the point where they are able to tube feed, with a tube down the nose into the stomach, they will be given expressed breastmilk. Babies are essentially fed through a drip for the first part of life when they’re really little, but certainly bigger babies are able to have expressed breastmilk. As soon as they are big enough and don’t need respiratory help, the aim is to transition the baby onto the breast.” That typically doesn’t happen until around 2.5kg, as before that, they might just have a few sucks and fall asleep.”
Q IF MY BABY REQUIRES CARE, CAN I STILL HAVE SKIN-TO-SKIN CONTACT?
Craig says: “For late preterm births, around 35 and 36 weeks, they can usually have some skin-to-skin time in labour ward or in the operating theatre before they go to the nursery. But for really small babies who are 600800g, once they’re stable in the nursery they tend to have ‘kangaroo care’. This is when mum sits in a recliner chair and the baby lies on its stomach, with their legs and arms to the side, lying on mum’s chest. They can even have that while having ventilated support. Mums can have that contact and care with baby from very early on.”