Giving birth to your premature baby

Find out what to pack for labour and birth.

What is premature labour like?

Planned premature labour

In some cases, pre-term labour is planned because it's safer for the baby to be born sooner rather than later. This could be because of a health condition in the mother (such as pre-eclampsia) or in the baby (such as fetal growth restriction).

If your healthcare team know you need to give birth early, you may be offered an induction or caesarean section. 

If this is the case, you may have some time to prepare for your birth experience. You may want to think about things like:

• if you would like any music playing while you give birth
• how you would like to deliver the placenta 
• how you would like to feed your baby after birth
• who you want as your birth partner 
• what positions you’d like to use during labour
• what type of pain relief you want to use during labour.

If you are having a c-section, find out more about how you can prepare. 

Giving birth to multiple babies     

The National Institute for Health and Care Excellence (NICE) recommends that all women carrying multiple babies should plan to give birth earlier than women carrying single babies. This helps to reduce the increased risk of complications, such as stillbirth. Your doctor should help you plan for delivery.     

This means that even if you don’t go into spontaneous premature labour (when labour happens naturally), you will be advised to give birth before your due date. Where you give birth is up to you and you should be supported in your choice. However, you will be advised to give birth in hospital so you have access to medical facilities and doctors if you need them. It’s sometimes called a delivery suite or an obstetric unit.

You will be able to talk to your midwife and doctor about your options for giving birth. In a twin pregnancy, this will depend on several things, including the position of the first (presenting) baby, the position of the placenta, their growth and how your pregnancy is progressing. 

Both vaginal birth and caesarean section have benefits and risks. Your doctor or midwife should explain these to you so you can make an informed decision about how you would prefer to give birth.

Find out more about giving birth to multiple babies.

If you go into spontaneous premature labour

Most preterm births happen spontaneously (on its own, without medication or medical intervention). 

“Don’t be afraid to speak up if there is something you’re not sure of or need help with, premature birth can be a scary and worrying time. Sometimes just talking to the healthcare team can lessen some of the worry.”

Victoria

Premature birth may change your birth plan

Many women don’t go to antenatal classes until around week 30, so if you have your baby unexpectedly before this, you may not have made a birth plan or even thought about how you wanted to give birth.

If you have written a birth plan, having your baby prematurely may mean you’ll probably have to do things differently from what you originally planned. For example:     

• you will need to go to hospital rather than having the baby at home or in a midwife-led unit
• if your hospital of choice does not have specialist facilities for premature babies, you may need to be transferred to one that does
• if there are any complications, for example, if your doctor or midwife is concerned about your health or your baby’s, you may need help such as an emergency c-section. 

Medications

If you are in labour, you may be offered:

• tocolysis, which is a medicine to help slow down labour (this is not suitable if you are having more than 1 baby) 
• steroid injections to help your baby’s lungs develop in case they are delivered early
• magnesium sulphate to protect your baby’s brain development.  

Find out more about preparing your baby for a premature birth. 

Having a caesarean section (c-section) if you go into premature labour

You may have already planned to have a caesarean section. But sometimes doctors may recommend a vaginal birth instead of a caesarean section for very premature births. This may be because the womb is too small for a standard horizontal cut, which means your doctor will have to make a vertical cut. This increases the chances that you will need to give birth by caesarean in future pregnancies.   

Even if you had planned a vaginal birth, you may be advised to have a caesarean section if:

• your healthcare team is worried about your health or your baby’s health and your baby needs to be delivered as quickly as possible
• labour isn’t progressing
• your baby is not head down (is breech). 

Your doctor should clearly explain the general risks and benefits of having a caesarean section before you give your consent (permission).

Having a vaginal birth in preterm labour

The main difference between preterm labour and full-term labour is that preterm labour may be faster. The healthcare team will also be monitoring you and the baby more closely and will check the baby’s position. Breech babies are more common in earlier pregnancy. Most babies turn naturally into the head-first position by 36–37 weeks.  

Your healthcare team will also be ready to perform emergency procedures, such as an emergency caesarean section, if necessary.

The stages of labour

Before labour gets going: the latent phase

The latent phase of labour is when your cervix becomes soft and thin as it gets ready to open up (dilate) for your baby to be born. Your contractions during this stage may be infrequent, mild or irregular.

Labour is usually described in 3 separate stages:

Stage 1 – The first stage of labour is also known as established labour. This is when your cervix opens (dilates) to at least 4cm and your contractions become stronger and more regular. 

Stage 2 – The second stage starts when your cervix is fully open (dilated) and the muscles of your womb are tightening and loosening to push the baby down and out. 

Stage 3 – The third stage of labour begins when you’ve had your baby but need to deliver the placenta. Your midwife will speak to you during your pregnancy about the different options for delivering the placenta and the pros and cons of each.

Assisted birth

You may need help to deliver your baby if there are any concerns about your or your baby’s wellbeing, or if they are not coming out as expected. 

If this happens, your healthcare team may recommend that you have an assisted birth. This is where the doctor uses special instruments (forceps or ventouse) to help deliver the baby during the last stage of labour.

Forceps are smooth metal instruments that look like large spoons or tongs. They are curved to fit around your baby’s head. The doctor will carefully put them around your baby’s head, wait until you have a contraction and then ask you to push while they gently pull to help deliver your baby.

A ventouse (vacuum extractor) uses suction to attach a soft or hard plastic or metal cup on to your baby’s head. The doctor will wait until you are having a contraction and then ask you to push while they gently pull to help deliver your baby.

Ventouse and forceps are both safe and effective. The ventouse is not suitable if you are less than 34 weeks pregnant as the baby’s head is softer, which can increase the risk of hurting the baby. 

Your doctor or midwife will always ask for your permission to use forceps or ventouse to help deliver your baby     

Find out more about assisted birth.

Pain relief

If you have a vaginal birth, you may need pain relief. Your midwife should offer you gas and air, or an epidural if you need stronger pain relief.

You may be advised against pethidine, diamorphine or other opiate drugs if you are already in advanced labour. This is because these may affect your baby’s breathing if your baby is born soon after the drugs are given, which could affect them more if they are premature. 

Find out more about pain relief during labour and birth. 

Delayed cord clamping

In the minutes after your baby has been born, the umbilical cord continues to transfer blood, oxygen, and stem cells to your baby while they adjust to being outside the womb.

This blood has many red cells needed to transfer oxygen from the lungs to the heart and brain. It also has many stem cells to repair damaged tissues. Clamping the cord too quickly prevents these from getting to your baby. 

The healthcare team should do everything possible to delay clamping the cord until at least 1 minute after the birth. 

Delayed cord clamping has been shown to reduce death in preterm babies by nearly a third. 

Read more about delayed cord clamping.

After your baby is born

After your premature baby is born, the healthcare team will immediately assess your baby's health and start treating them if necessary. What level of care they need will depend on how prematurely they were born and their health.

If your baby needs immediate care, you may not be able to hold them straightaway after they are born. This can be a very difficult time, but you will be given precious time to bond with your baby as soon as it is safe and possible. 

Find out more about skin-to-skin contact with your premature baby – known as kangaroo care.

Your mental health

Every parent hopes for a healthy, uncomplicated pregnancy, labour and birth. It can be very upsetting when this doesn’t happen. Don’t be afraid to tell your healthcare professional how you feel. They won’t judge you. It is common for a parent’s mental health to be affected after having a baby and your healthcare professionals are aware of this. 

You can also talk to a Tommy’s midwife for free from 9am–5pm, Monday to Friday on 0800 0147 800 or email them at [email protected]

Find out more about coping with a premature birth.