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Premature labour is a relatively common event, occurring in around 7 – 10% of all pregnancies. It is officially defined as labour which occurs before the baby reaches 37 weeks of gestation. Babies who are born early can develop a range of health related complications. However, advances in the management of prematurity have meant that survival rates are extremely high, particularly for babies who reach 30 weeks. Even before that stage, babies who are able to progress to 26 weeks gestation still have around a 25% chance of surviving without any long term effects.
It can be very difficult to identify why premature labour has occurred or why the membranes have ruptured. Many times premature labour is passed off as “one of those things”.
The answer is we don’t really understand the mechanisms involved in the onset of labour. It is thought that the baby is responsible for sending a hormonal message which acts as a catalyst for labour to commence. This may be generated from the baby’s lungs as a sign that they are ready to start breathing independently and they no longer rely on the umbilical cord to deliver to them, oxygenated blood. Another theory is that the placenta secretes hormones, or, that the mother’s vagina and cervix produce higher levels of a particular protein just before labour starts.
There is a range of factors which increase the likelihood of a baby being born premature, though these are not absolute. Even when no risk factors are present, babies can still be born early. Around half of the mothers who deliver their baby prematurely do not have any known risk factors.
Labour can be started in the maternity unit by the midwife or obstetrician artificially rupturing the membranes (ARM) and sometimes, starting a Syntocinon drip. This is a hormone which makes the uterus contract and initiates labour. Vaginal delivery follows in most cases, unless the baby becomes distressed or the labour fails to progress; in which case a caesarian section delivery of the baby occurs.
Caesarian section delivery may be planned before a baby reaches term. For example, when a mother is unwell, has Preeclampsia, diabetes or placental insufficiency then caesarian section can become the safest option, even if the baby has not yet reached full term.
During the delivery of a premature baby, where possible, a paediatrician is present. If breathing assistance or resuscitation is required, then time is an important factor. Ensuring the baby is well oxygenated, accurately assessing its Apgar score and giving medications which can initiate respirations are all factors which require immediate, specialist attention.
If a mother suspects she is going into premature labour, it is imperative that she contacts her midwife, obstetrician or the labour ward of the closest hospital. Labour can be halted in many cases, stopping it from progressing. However, if the membranes have ruptured and the cervix is already dilated, holding off labour is impossible. Steroid medication can be given to the mother to help with maturing her baby’s lungs. This helps to avoid the need for ventilation and supports the baby towards breathing independently.
Bed rest is another standard recommendation for threatened premature labour. Ideally, this is done at home with support provided by partners, friends and family. However, if the baby needs close monitoring and it is impossible for the mother to receive practical support at home, hospitalisation becomes necessary. Avoiding sexual intercourse is also important as this can initiate labour and contractions, particularly in women with a sensitive cervix.
Treatment for prematurity depends on the gestation of the baby. Very premature babies need help with their breathing and may need to be ventilated. This is because their lungs are immature and not capable of independently expanding and deflating.
Again, this depends on the extent of prematurity and the factors relating to why it occurred. Some babies need to remain in hospital for months following their premature birth, and others for only a few weeks.
Remember, in the majority of premature births, there is nothing a mother could have done to prevent it from occurring. Guilt has no part in coming to terms with having a premature baby.