Premature birth: when baby arrives early

Published July 2018 | 5 min read
Expert contributor Dr Penny Sheehan, lead at the Preterm Labour Clinic, Royal Women’s; Terri Barrett, president of the Australian College of Midwives
Words by Joanna Webber

Here’s what you need to know if your baby is born ahead of schedule.

The neonatal intensive care unit (NICU) at Melbourne’s Royal Women’s Hospital looks much like any other hospital ward. It’s not until you notice the tiny cots surrounded by a tangle of tubes and medical equipment that you realise you’re looking at newborn babies.

Today, 10% of babies in Australia are born preterm (before 37 weeks gestation), compared with nearly 7% in 1991. This means that for a growing number of parents-to-be, the pregnancy is cut short.

Mum Lee had her twins at 28 weeks and they were in the NICU for 102 days.

"It was very scary to start with because I didn't know anything about having a premature baby. It wasn't even really something I considered, even though it was a high-risk pregnancy. It was all a bit of a blur and quite a confusing time," says Lee.

Lee shares more about the challenges of seeing her babies in the NICU in our Navigating Parenthood podcast.

Why some babies are born early

Dr Penny Sheehan leads the Preterm Labour Clinic at the Royal Women’s and is a researcher into the causes and preventions of preterm labour and miscarriage.

She lists many reasons for a rise in premature births, including:

• Higher rates of obesity and diabetes.
• More women having babies when they’re older. An extensive 2018 Canadian study found women over 40 were more likely to have preterm babies, not because of assisted reproduction technologies or early labour induction as previously thought, but because they were more likely to have risk factors for early delivery including high blood pressure and obesity.
• Rising rates of multiple pregnancies associated with IVF and with migrants from countries where the rate of twins is much higher, such as West Africa.
  

“Women are at higher risk of early labour if they’ve had pre-eclampsia or preterm delivery in a previous pregnancy, multiple miscarriages, a shortened cervix or if they’re pregnant with twins or triplets,” says Dr Sheehan.

“Diabetes or a urogenital infection, like a yeast infection or UTI can also increase the risk, but many women experience spontaneous labour preterm without having any of these risk factors.”

Early arrival facts

The good news is that medical advances mean preterm babies have a greater chance of survival than ever. Sadly for babies born earlier than 24 weeks (towards the end of the second trimester), lungs and other vital organs aren’t developed enough. Before ventilators (machines that breathe for your baby) came along, the survival rate for babies born under 1kg was approximately 6%. Today, two thirds of babies born at 24 weeks gestation who are admitted to a neonatal intensive care unit (NICU) will survive to go home. Ninety eight per cent of babies born at 30 weeks gestation will survive.

“In the long term, very premature babies are at a higher risk of chronic lung problems, decreased hearing and vision, and cognitive and motor skills impairment,” says Dr Sheehan. “But many babies have no long-term problems associated with their early birth at all.”

If your contractions begin ahead of schedule, a series of measures can delay labour. If you’re not in active labour, you can be given medication to delay contractions for as long as possible and transferred to a hospital with a neonatal intensive care unit (NICU), if needed.

“A woman at higher risk may be admitted to hospital during pregnancy so she and her baby can be monitored daily for any changes,” says Dr Sheehan. “We have tests which can predict the likelihood of a woman giving birth in the following two weeks, and if that comes back positive, we can provide steroids to help her baby’s lungs develop quickly, which is crucial to the baby’s survival and long-term health.”

Midwives also play a key role in assessing women for the risk of preterm labour and ensuring paediatric support is available at birth. Terri Barrett, president of the Australian College of Midwives, knows how frightening it can be for parents whose newborns are admitted to the NICU.

“It’s a stressful time for parents, and providing emotional support is an essential aspect of midwifery care throughout the labour and postnatal period,” says Barrett. “Having a caregiver with whom you already have a relationship is important and very helpful.”

Visiting your premmie baby in hospital

After delivery, it can be weeks – or even months – before preterm infants are ready to go home. The NICU becomes a home away from home, where teams of specialists work around the clock and parents quickly familiarise themselves with the unit’s equipment and care processes.

“Spending as much time as possible in the NICU ensures that parents and baby stay connected,” says Barrett. “Touching, holding and massaging can help baby to feel cared for and supported.”

Breastmilk is the best food for preterm babies, says Barrett, adding that in the case of tiny newborns who may not be well enough to breastfeed, mothers can express breastmilk.

As well as breathing problems, other health problems for premature babies include heart and digestive tract issues, jaundice, anaemia and infections.

Barrett says visitors are often limited to two at a time in the NICU and small children are sometimes not permitted, which can make organising care for other children difficult.

“If parents know that their baby will be born prematurely, there are practical things they can do to be organised,” she says. But preterm birth often occurs with little or no warning, so it helps if friends and family can offer support.

What about the cost?

The average cost of having a baby in a private hospital as a private patient in Australia is approximately $8,500, but for a preterm baby who needs extra hospital care, the cost can reach as high as $3,000 a day. There are also significant transport and accommodation costs if you live far away from hospital, and the financial strain can be tough if you’ve had to finish work earlier than expected.

If you’re a public patient in a public hospital, most costs would be covered by Medicare.

If you’re a private patient, you may not be covered if you have a preterm baby within the 12-month waiting period, so it’s worthwhile getting a pregnancy policy ahead of time if you can.

As a private patient you may get to choose your own doctor and are more likely to have a private room.

You can find out more about the potential costs involved for vaginal and caesarean births using our cost estimators.

For more information on premature births, call the Miracle Baby 24-hour support line on 1300 622 243.