As your pregnancy progresses, you may think you have loads of time to prepare for your little one. After all, pregnancy takes 9 months, right? Well, sometimes. Although the majority of babies are born near the end of 40 weeks of pregnancy, the Center for Disease Control and Prevention (CDC) reports that up to 1 in 9 babies in the United States every year will be born prematurely, or before 37 weeks. And according to the CDC, premature labor and resulting preterm deliveries are becoming more common as more women are using assisted reproductive technology, like in-vitro fertilization, to become pregnant.
You may be well-prepared for life with a newborn that involves no sleep, lots of caffeine, and a colorful variety of burp cloths, but are you prepared for the possibility of a preterm labor and delivery?
"The definition for a preterm delivery is every delivery before 37 weeks of gestation," explains Dr. Doerthe Brueggmann, an OB/GYN at Keck School of Medicine. And although any delivery during that timeframe is considered "preterm," the differences in terms of the baby's health can be vast:
Babies born before 25 weeks are what Dr. Erica Song of Englewood Hospital and Medical Center in New Jersey claims are "critically" premature. Babies born less than 23 weeks often have very slim chances of surviving. "At 23-24 weeks, that's the point of pushing the limits when the baby can survive outside of the uterus," she explains. And although Dr. Brueggmann states that even babies born around 24 weeks of gestation can have up to a "60 percent chance of survival," many babies born so early still face severe medical complications at birth and throughout life. At this stage in the game, parents with premature infants 25 weeks and under can expect a full-blown admission to a Level IIIc or even a Level IIId NICU (which provide the most intensive level of NICU care available, including heart surgery) to receive around-the-clock care, including intubation for breathing, feeding tubes, and incubators to maintain body temperature.
The percentage of premature babies that are born--and continue to live without any disabilities--jumps drastically even from 24 to 25 weeks gestation. The major medical complications for preterm babies, which drastically increase the younger the baby is, include learning disabilities, behavioral challenges, growth restrictions, respiratory problems (due to immature lung development in the womb), and cerebral palsy, according to EPIcure, a long-term population study on prematurely-born infants. Babies born up to 27 weeks can still expect to receive intensive care in the high-level NICU.
"Although every extra day and every extra week can make a big difference, 28 weeks seems to be a good mark," says Dr. Song. And after 30 weeks, newborn survival rates increase steeply, to more than 96 percent, according to Dr. Brueggman. Babies born within this time frame generally require care in a Level III NICU, depending on the severity of their problems.
While she concedes that even at 34 weeks, "some babies don't do well," for the most part, Dr. Song feels that after 34 weeks, most babies have a good chance of delivery without any major complications, even though the baby is still considered "early term" if it's born between 37 and 38 weeks. Infants born at 32 weeks or above may receive care in a Level II or "specialty care" hospital that provides supportive care for mild immaturity issues, such as feeding problems that aren't considered life threatening.
First of all, be aware of the signs of premature labor, which include:
- Contractions (which may seem like an obvious sign, but can be hard to distinguish early on during the pregnancy; they may feel more like a backache or cramps)
- Any leaking of fluid
Because the early signs of labor can be difficult to distinguish, especially early on the pregnancy, Dr. Stone advises women who aren't bleeding but just feel "crampy" or uncomfortable to first try slowing down, drinking some water, and resting. If symptoms persist, she should call her physician to be seen. "Usually it's best to go to the doctor's first, because most of the time, these are not labor signs and can be treated easily," explains Dr. Stone.
In many cases, the reason for preterm labor is largely unknown; In other instances, preterm labor can be caused by a variety of different factors, including infection, an "incompetent" or weak cervix, twins or multiples, or problems with the baby's growth or placental development, so treatment will depend on the cause, if it can be determined. Sometimes the hormone progesterone can be administered to try to delay the labor, or treatments like bed rest or cervical cerclage, wherein the mother's cervix is stitched closed, may be recommended.