Preterm delivery: Could it happen to you?
Any woman can deliver her baby preterm, but African-American women, women younger than 17 and women older than 35 are at greater risk. You are considered at high risk if you:
- expect twins, triplets or more
- had a previous preterm birth
- have certain cervical or uterine abnormalities, such as fibroids
Other risk factors include:
- a premature rupture of the membranes, or amniotic sac
- vaginal or urinary tract infections or sexually transmitted infections
- conditions such as diabetes, high blood pressure or clotting disorders
- being underweight before pregnancy
- less than six to nine months time between giving birth and getting pregnant again
- birth defects in the baby
- bleeding from the vagina
- late or no prenatal care
- smoking, drinking alcohol or using illegal drugs
- physical, sexual or emotional abuse
- lack of social support
- high stress levels
- long working hours with long periods of standing
Most pregnancies last about 40 weeks, with babies arriving near their due date. Sometimes, though, babies come into the world early and unexpectedly. These preterm babies, or those born before 37 weeks gestation, require extra special care. Much of their bodies—their lungs, heart, liver and digestive and immune systems—are underdeveloped or not fully functional, placing them at risk for mild to severe complications.
Babies born before 34 weeks are the most fragile. Not yet ready for life outside the womb, they can have severe problems such as lung disease, heart defects, bleeding in the brain, infections and vision or hearing loss.
Any woman can give birth to a preterm baby, yet some women are more at risk than others. (See “Could it happen to you?”) What can you expect if you give birth early?
Your baby will most likely receive highly specialized care in a neonatal intensive care unit (NICU) during recovery. He or she will rest in an incubator to maintain body temperature because premature babies have less body fat than full-term babies. The healthcare professionals caring for your baby will test and monitor your newborn for a number of medical complications. Common problems include:
This condition, in which a newborn’s skin has a yellow cast, occurs commonly in “preemies” because their immature livers cannot filter bilirubin, a waste product, from the blood. A jaundiced baby is placed under special lights (with little goggles to protect the eyes) that help break down the bilirubin until the liver is more fully developed.
During the last weeks of a full-term pregnancy, a baby’s lungs develop a substance called surfactant, which helps the air sacs become elastic and easier to fill with air. Without surfactant, the lungs collapse and the baby works harder to breathe. This condition, called respiratory distress syndrome, most commonly affects preemies born before 34 weeks. Giving artificial surfactant helps the baby recover, but he or she may still require oxygen, a ventilator or a treatment that delivers pressurized air to the lungs to aid breathing.
Many of the earliest preemies don’t have the coordination to suck, swallow and then breathe, preventing them from being able to breast or bottle feed. An infant with this problem will receive nutrients through a vein or a tube inserted into the stomach. As the baby matures, he or she will learn to feed normally. If your baby is too weak to nurse, you should pump your milk to give through tube feedings. Breast milk contains vital nutrients and antibodies especially important for a preemie.
The immune system of a preterm baby is inefficient at fighting off bacteria, viruses and other infections. Premature babies commonly suffer pneumonia, meningitis and sepsis (a blood infection). To help avoid exposing your baby to contagions, you’ll need to limit visitors, wash your hands frequently and have the whole family get flu shots. A highly contagious virus called respiratory syncytial virus, prevalent between October and May, also poses a risk, and your baby may receive injections to protect against the virus during these months.
Preventing preterm delivery
While you can’t change some risk factors, taking these important steps helps better your chances of having a healthy, full-term pregnancy and baby.
- Seek early prenatal care. See your doctor as soon as you suspect you’re pregnant and keep all your appointments for checkups and screenings. Be sure he or she knows your history, including obstetrical complications, surgeries, infections or conditions such as fibroids or diabetes.
- Strive for a healthy pregnancy. Follow your doctor’s advice about diet, exercise, weight gain and stress management. Avoid cigarettes, alcohol and illegal drugs. Tell your doctor about unusual symptoms such as burning or pain with urination or suddenly swollen feet.
- Know the signs of preterm labor. Call your doctor or go to the hospital if you have contractions every 10 minutes or more often (they may not be painful); clear, pink or brownish fluid leaking from your vagina; a feeling that the baby is pushing down; a low, dull backache; or cramping.
Despite a rocky start, 80 percent of babies born after 30 weeks suffer no long-term health or developmental problems. Once your little one recovers from any complications and can breathe, feed and maintain body temperature on his or her own, you’ll be able to welcome your baby home.