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Premature labour and birth

Newborn baby
Photo credit: istock.com / cdwheatley

Premature or preterm is the term given to your baby if they are born before 37 weeks. Premature babies are small and might have complex health needs depending on when they were born. For example, if your baby is born at 23 or 24 weeks, they will have a very different level of treatment compared to being born at 34 to 36 weeks. Find out about the symptoms of early labour, why premature birth happens and how your preterm baby will be cared for.

What does premature or preterm birth mean?

Your baby will be premature if they arrive before you're 37 weeks pregnant.

Once you reach 37 completed weeks of pregnancy, your baby is what’s called "term" or "full-term". That's why premature babies are also described as "preterm".

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What are the symptoms of premature labour?

Call your midwife or maternity unit if you’re less than 37 weeks pregnant and you have any of the following symptoms:

  • Regular contractions. Find out what contractions feel like.
  • Tightenings across your belly, or period-type aches and pains.
  • A heavy, dull backache that's not usual for you.
  • A "show" in your pants or when you go to the toilet. The show is when the mucus plug that seals your cervix comes out.
  • A gush or trickle of fluid from your vagina. This could mean your waters are breaking. (NHS 2020).


After talking to you over the phone, your midwife will ask you to go into hospital if they think you're in premature labour. Ask someone to drive you there, or if that isn’t possible, call the hospital and ask for an ambulance.

Read more about the symptoms of early labourOpens a new window on the NHS website.

Why does premature birth happen?

It's very common for there to be no explanation for why a baby has arrived early (NICE 2015, Robinson and Norwitz 2019). Most preterm births happen when labour starts by itself, without your waters breaking (RCOG 2013, Robinson and Norwitz 2019, Romero et al 2014).

Sometimes, though, there's a reason why your baby may need to be born early. Between a quarter and a third of premature births happen because they've been planned that way (RCOG 2013, Robinson and Norwitz 2019).

You may need an early induction of your labour, or a scheduled caesarean, if your unborn baby isn't thriving, or has a condition that needs treatment after birth, or if you develop complications harmful to your health (RCOG 2013, Robinson and Norwitz 2019).

If you're expecting more than one baby, you're at higher risk of premature birth. More than half of twins or more are born early (NHS Digital 2020, NCCWCH 2011a).

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How likely am I to have a premature birth?

If you're healthy and your pregnancy is going well, you're unlikely to have a premature baby. Most mums give birth when their baby is full-term, between 37 weeks and 42 weeks (NHS Digital 2020).

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In the UK, about 1 birth in 13 is premature (NHS 2020, NHS Digital 2020, NICE 2015). Most of these births happen between 32 weeks and 37 weeks (ISD Scotland 2018, NHS Digital 2020), and these babies have a good chance of doing well and growing up to be healthy.

That’s because the further on in your pregnancy you are, the more likely it is that your baby will thrive (Pike and Lucas 2015). Their organs will be more mature, their lungs better prepared for breathing, and they'll have more strength for sucking and feeding (NHS 2018).

Just two per cent of babies in England are born very early, before 32 weeks (NHS Digital 2020). There can be longer lasting effects for these babies (NHS 2018), including learning and behavioural difficulties (Johnson and Marlow 2017, NCCWCH 2015, RCOG 2014).

Babies born even earlier, before 28 weeks, are especially vulnerable to a range of complex health problems, including cerebral palsy (Johnson and Marlow 2017, RCOG 2014).

However, specialist healthcare for extremely early babies has improved dramatically, and survival rates are much better than they used to be (Johnson and Marlow 2017, NCCWCH 2015, RCOG 2014).

What makes me more likely to have a premature birth?

There are certain factors that make you more likely to have a premature labour and birth. Remember though that even if you are more likely, your risk is still low.

Health conditions or factors linked to premature birth include:

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Your ethnicity

Unfortunately, you have a higher risk of a preterm labour if you’re Black or have Asian ethnicity. Sadly, it’s one of the reasons for a higher rate of deaths among mums and their newborns (MBRRACE-UK 2021).

The reasons behind your increased risk of preterm birth are complex. Factors may include the fact you’re at higher risk of health conditions that are linked to premature birth.

But experts also point to wider social issues that are more likely to affect you, such as barriers to health and maternity care and stressful work and home lives.

You’re also more likely to report not being taken seriously by health professionals. It’s very important that you feel listened to and supported by your midwife or GP during pregnancy. Research shows that it leads to better birth outcomes.

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Assisted conception

You may be more likely to have a premature baby if you had assisted conception, even if you're expecting a single baby (Robinson and Norwitz 2019).

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Length between pregnancies

If you have a short gap between pregnancies, it may increase your chances of premature birth (Robinson and Norwitz 2019). Being very underweight or overweight can also raise your risk (Robinson and Norwitz 2019).

Lifestyle

Some lifestyle factors, such as smoking, or drug use (especially cocaine), carry an increased risk of premature birth (Robinson and Norwitz 2019).

What will happen if I go into premature labour?

You'll need to follow your midwife's advice and get to the hospital as quickly as you can. When you arrive, you're bound to feel anxious, and may feel unprepared for what's happening.

Try to ask plenty of questions. This will help you to understand what's going on, and make decisions about your care. Your midwife or doctor should tell you what's happening throughout. It's helpful to have someone with you who can listen to their advice and support you (NICE 2015).

Your doctor or midwife will ask you to describe what has happened, and whether anything like this has happened in a previous pregnancy (NICE 2015).

They'll offer checks to show whether your cervix is shortening and opening, ready for labour. The checks may include a vaginal examination using a speculum, and an ultrasound scan (NCCWCH 2015).

Your doctor or midwife may offer a fetal fibronectin test (NCCWCH 2015). A fetal fibronectin test checks for a protein secreted by your baby when your body is ready to give birth. This is a good way to tell if your early contractions or tummy pains are a false alarm, or if you're in premature labour (NCCWCH 2015).

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A fetal fibronectin test on its own isn't so useful for predicting premature labour if you're expecting twins or more (NCCWCH 2011a). You're more likely to go into premature labour anyway, even more so if you've already had a baby (NCCWCH 2011a).

If your waters have broken, your midwife will take a swab from your vagina to test for bacterial infection (NICE 2015), such as group B streptococcus (GBS) (NCCWCH 2015).

Even if you don't have an infection, your doctor is likely to recommend antibiotics anyway (NICE 2015). Antibiotics can help to prolong your pregnancy, giving your baby a healthier start to life (NCCWCH 2015, RCOG 2013).

If your waters haven't broken, and there are no signs that labour is about to start, you'll probably be able to go home again (NCCWCH 2015, NICE 2015). The symptoms of early labour often stop, in which case your pregnancy can continue for a while longer (van Baaren et al 2014).

If all the checks show that you are in labour, but your waters haven't broken yet, your doctor may give you medicine (tocolysis) to delay labour for a few days (NCCWCH 2015).

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This is most likely if you're between 24 weeks and 34 weeks pregnant. Having more time helps to prepare you and your baby for early birth (NCCWCH 2015).

You'll be able to have a course of steroids to protect your baby's lungs (NICE 2015). Steroid injections work best if your baby is born between 24 hours and seven days after your second dose (RCOG 2012). Or you may need the extra time so you can be transferred to a hospital that offers more specialist care (NICE 2015).

If there's time, you may have the chance to visit the neonatal ward and talk to a neonatologist or paediatrician (NICE 2015).

However, if you are really in labour it may not be possible (van Baaren et al 2014), or even desirable, to stop it. Sometimes, trying to stop labour may cause more harm than good (NCCWCH 2015). For example, if:

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  • your baby is not growing well
  • you're more than 4cm dilated
  • you're seriously unwell
  • you have an infection in your womb (NCCWCH 2015)
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Even if there's little time, your doctor will still give you steroids to give your baby's lungs as much protection as possible. You doctor may also offer you a medicine called magnesium sulfate to protect your baby’s brain (NCCWCH 2015, NICE 2015).

You'll have magnesium sulfate via a drip until your baby is born or for 24 hours (whichever comes first). You'll need regular tests, such as pulse and blood pressure checks, to check that you're receiving the right level of magnesium sulfate for you (NICE 2015). Women vary in the response to the drug, and too much can make some women ill (NCCWCH 2015).

You'll also be offered intravenous antibiotics during labour to reduce the risk of passing an infection, such as GBS, on to your baby (Hughes et al 2017).

Can I have a vaginal birth?

Yes. In fact, unless your baby needs to be born quickly, your doctor is likely to recommend that you try for a vaginal birth (NCCWCH 2015).

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Doctors prefer not to carry out caesarean sections in premature births because it may not be best for the mum in the long run (NCCWCH 2015). Usually, the womb is too small for a standard "bikini-line" horizontal cut, meaning your doctor will have to make a vertical cut. Having a vertical incision increases the chances that you'll need to give birth by caesarean in future pregnancies (NCCWCH 2015, NICE 2015).

However, you may need to have a caesarean section if:

  • You have heavy bleeding (NCCWCH 2011b).
  • Your baby is in distress (NCCWCH 2011b, NICE 2015).
  • Your baby is in the breech (bottom first) position (NCCWCH 2015, NICE 2015).
  • Your doctor is worried that the baby's umbilical cord has slipped down your vagina in front of your baby (cord prolapse). Cord prolapse is more likely if your waters break early (NCCWCH 2011b, RCOG 2014).


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 (NCCWCH 2014, OAA 2016).

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You will be advised against pethidine and other opiate drugs if you are in advanced labour (NCCWCH 2014). Opiate drugs could affect your baby's breathing when they're born (NCCWCH 2014, OAA 2016).

Your doctor or midwife will monitor your baby's heartbeat. This may be either by continuous monitoring, or intermittent monitoring, depending on how you and your baby are doing (NCCWCH 2015, RCOG 2014).

What will happen after my premature baby is born?

A highly skilled medical team will care for your newborn. The level of treatment your baby needs will depend on the stage at which they were born. If your baby is born:

Extremely early (27 weeks or earlier)

Your baby will need to be cared for in a neonatal intensive care unit (NICU), which may mean they'll be moved to another hospital. They'll need to be kept very warm as they'll have a high risk of hypothermia, and will need dextrose to prevent low blood sugar. They will also be at risk of low blood pressure and infection, and will need help with their breathing.

Very early (28 weeks to 31 weeks)

Your baby is likely to be cared for in a special care baby unit (SCBU) or local neonatal unit (LNU). They will be stronger than younger babies but still at risk of hypothermia, low blood sugar and infection. They may need more specialised care at a NICU.

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Moderately early (32 weeks to 33 weeks)

Your baby may have problems with breathing, feeding and infection that require specialised care. They may be able to stay with you on a transitional care ward, or be taken straight to an LNU or SCBU.

Early (34 weeks to 36 weeks)

Your baby may not need any treatment. They may look small but still be able to go straight to the postnatal ward with you. Or they may be admitted with you to a transitional care ward. It will depend on how well they're feeding, and whether they have problems with blood sugar levels, blood pressure or infection (NHS 2018).
If your baby needs immediate care, you may only have a brief glimpse of them before they're whisked away. This can be frightening, and you'll need lots of support to help you cope with the separation at such a vulnerable time for you and your baby.

Once your baby is stable, you can see them as often as you like. There's lots that you can still do for them, such as change their nappy, stroke them and talk to them (NHS 2018). You may also be able to hold them skin to skin, give them a massage and feed them.

How unwell will my preterm baby be and what can I do to help them?

The further your pregnancy progresses, the better the chance your baby has (NCCWCH 2015, Seaton et al 2019).

Sadly, babies born before 22 completed weeks of gestation are unlikely to survive. A baby born at 23 weeks or 24 weeks does have a much better chance, but it depends on their birth weight and their health at birth (NCCWCH 2015).

Doctors will do their best to make sure that your baby is as comfortable as possible. They'll discuss with you whether actively trying to keep your baby alive, such as by using resuscitation, is the best course of action for your baby in the short term and in the long term (NCCWCH 2015, NICE 2015, RCOG 2014). Decisions like these are very hard for parents and doctors to make, which is why clear guidelines have been created (RCOG 2014).

Whatever the situation, your baby needs the special comfort that you and your partner can give them just as much as they need medical help.

Breastmilk is important for all babies, but even more so for premature babies (Cleminson et al 2016, NHS 2018), who are more vulnerable to infection (NHS 2018).

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Breastmilk gives your baby extra protection against infection, (Quigley and McGuire 2014) as well as all the nutrients they need (Bering 2018). Breastmilk has unique properties that can help your baby's brain develop too (Cleminson et al 2016).

It may be that your baby is too small to latch on to your breast, but your midwife will show you how to express your milk. Your baby may need feeding via a tube at first, as they may not be able to suck and swallow for themselves yet. The tube is soft and fine, and passes through your baby's nose down to their tummy (NHS 2018). Breastmilk can then be passed down the tube.

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The content in this article has been reviewed by Sandra Igwe, founder of The Motherhood Group.
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BabyCentre's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organisations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies.

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Jenny Leach is an editor and writer specialising in evidence-based health content.
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