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Frequently Asked Questions 

What is preterm birth?

Preterm birth is a birth that occurs 3 weeks or more before a baby’s due date.  A full term pregnancy is 40 weeks, so any baby born at less than 37 weeks is considered preterm.  Preterm babies have less time to develop in the womb which puts them at risk for medical and developmental problems.  In general, the earlier in pregnancy a baby is born, the more health problems it is likely to have.

Doctors use weeks instead of months to determine a baby’s due date.  A baby’s due date is 40 weeks after the first day of a woman’s last menstrual period, about 280 days. Pregnancies are actually longer than 9 months. The time frame of “9 months” can be misleading and a lot of women think 36 weeks (9 times 4) would be when the baby is “full term”.  However, a baby born at 36 weeks gestation is actually preterm and at risk for a variety of problems.  In fact, most premature babies are born between 34-36 weeks gestation.  These babies may seem like they are full term, but they are not yet finished developing and are at risk for problems.

Which women are at risk of having a premature baby?

Often, the causes of preterm birth are not clear. Three groups of women are at the greatest risk for having a preterm birth:

• Women who have already had a preterm birth
• Women carrying more than one baby (twins, triplets or more)
• Women with uterine or cervical abnormalities

Other risk factors are:

• Problems with the cervix or placenta
• Infections - most commonly in the urinary tract (e.g. UTI), amniotic fluid, or genital tract (e.g. STD)
• Smoking cigarettes, alcohol use, or illicit drug use during pregnancy
• Chronic health problems, such as diabetes, high blood pressure, and others
• Scheduling a birth by induction or cesarean section too early
• Poor nutrition
• Less than 6 months between pregnancies
• Stressful life events such as death of a loved one, domestic violence, or financial stress
• Physical injury or trauma

Preterm birth can happen to anyone. Almost half of women who have preterm labor and birth have no known risk factors.

How can I decrease my chances of having a premature baby?

The causes of preterm labor are not well understood. We know that there are certain things that increase your risk of having a preterm birth. There are steps you can take to lower your risk:

• Quit smoking and avoid alcohol or drugs
• See your health care provider for a medical checkup before pregnancy
• Plan your pregnancy so you can get healthy before you get pregnant
• Control diseases such as diabetes or high blood pressure
• Get prenatal care as soon as you think you may be pregnant
• If you are scheduling a birth by cesarean section or induction without medical reasons, the date for your baby’s birth should be scheduled near your due date, when you are at least 39 weeks
• Seek medical attention for any symptom of preterm labor (see below)

What are warning signs of preterm labor?

Preterm labor symptoms should be reported to your health care provider right away.  You are the best judge of changes occurring in your body, so it is important to pay attention to these symptoms - even months before your due date.  If you experience any one or more of these symptoms, contact your healthcare provider or go to the hospital:

Uterine contractions:   Abdomen tightens and becomes hard.  Irregular contractions occur normally during pregnancy, but if they become regular and occur every 10 minutes or closer they may be preterm labor.  These contractions may be painful or you may not feel any pain with them.
Cramps that feel like your period:   The cramping may come and go in a pattern or it may be constant.
Low, dull backache:  May move to the sides or front.  Changing positions does not make it go away.
Pelvic pressure:  Feeling that the baby is pushing down. Or you may feel pressure in your pelvic area, low back or thighs.
Change in vaginal discharge:  Leaking fluid or blood from your vagina. It may be watery or mucous-like.  The color may change – pink, light brown, or green.
Abdominal cramps:  This may occur with or without diarrhea.
Something’s not normal:  Many women with preterm labor have a feeling that “something isn’t right”.

CALL YOUR DOCTOR OR GO TO THE HOSPITAL immediately if you have any of the following EMERGENCY SITUATIONS:

• Large gush or steady stream of bright red bleeding from the vagina
• Gush of fluid or steady trickle of water from the vagina.
• Severe abdominal pain that is sharp or constant; may occur with or without contractions or bleeding

How many babies are born preterm? Isn’t prematurity rare?

Prematurity is the number one cause of neonatal death and disability. In 2006, in the United States, over 4 million babies are born each year – 543,000 (over half a million) of these babies are born too early.  In Oklahoma, nearly 1 in 7 babies is born too early.  That means that in an average week in Oklahoma almost 151 babies are born preterm.  In 2006, 13.9% of babies were born preterm in Oklahoma, compared to 12.8% of U.S. births. This is a significant problem for our babies and their families. (1)

If I have preterm labor can it be stopped so my baby can continue to grow and develop?

In the hospital you will be evaluated for contractions, cervical changes, medical history, and laboratory results.  Your baby’s heart rate will be monitored.  This evaluation may take thirty minutes to several hours.

You may be started on one or more medications to stop contractions (called tocolytics), antibiotics, and steroids to help your baby if she is born early.

For most women these treatments are effective.  If these treatments can delay preterm delivery for even 2-7 days, this can allow time for the steroids to work to help the baby’s lungs and brain to mature.  Steroids may help your baby to have fewer problems with breathing and bleeding into the brain after delivery.  For some women the tocolytic medications do not stop their labor, or their individual situation makes it necessary to deliver the baby early (uterine infection, bleeding, certain diseases or abnormalities in the mother or baby).

Do I need to see a special doctor if I have preterm labor or have had a premature infant in the past?

Discuss with your healthcare provider getting a second opinion or a consultation from a specialist. Women who have already had a premature baby are at the highest risk for having another preterm birth.  Some of these women may be treated with the hormone progesterone to try to prevent them from having another preterm baby.  Maternal –fetal medicine doctors have received special training to care for women who have complicated pregnancies. If you have had a preterm birth, pregnancies complicated by medical problems, or are having problems with this pregnancy, talk with your healthcare provider.

Is the rate of prematurity different among different races?    

Yes, although the reasons are not well understood.  In Oklahoma, for the years 2004-2006, preterm birth rates were highest for African Americans (18.3%), followed by Native Americans (13.1%), Asians (13.1%) whites (12.7%) and Hispanics (11.7%). (1)  These differences may be due to many different things:  genetic conditions  passed on to the baby , the mother’s  health behaviors, living environment, social circumstances, and/or access to and quality of health care.  Some researchers believe the increased risk is related to higher levels of stress hormones caused by life stressors.  These constant high levels of stress hormones may lead to preterm labor.  Other research shows preterm birth may be related to a different type of response to inflammation in some women.  Women of different races may be more likely to suffer from constant stress or may have different types of responses to stress or inflammation.  More research is currently being done to get a better understanding of why certain groups of women have a higher risk for preterm birth.

If my baby delivers early what can I expect while she is in the hospital?

Babies born too early have problems that require special care. Doctors, nurses and respiratory therapists that specialize in premature babies care for these babies in neonatal intensive care units (NICU).

• Preterm babies have difficulty staying warm and are placed on special warming beds or in incubators.
• Immaturity makes feeding difficult. They cannot suck, swallow and breathe at the same time. This means that they might need to be fed through a tube in their stomach or an IV until they can feed from the breast or a bottle.
• Because premature babies’ organs are not fully developed, they might have complications with their lungs, brain, intestines, heart and liver. Premature babies might not be able to breathe without a machine. They are also at a higher risk for a collapsed lung, jaundice, bleeding into the brain, anemia and infections throughout the body. Premature babies can also have dangerous problems with the intestines or heart that may be corrected with medication or may require surgery.
• Most babies born after 32 weeks gestation (8 weeks too soon) have fewer complications than babies born before 32 weeks gestation. But, babies born just a few days or weeks early may have more health problems at birth or even later in life than those babies born full term or before 39 weeks.

Once you take your baby home:

• Premature babies are more prone to illness.
     -Wash your hands frequently and insist that others around your baby do the same.
     -Keep your baby away from sick family and friends. Do not take your baby anywhere there are large crowds of people until your doctor says it is alright. Large crowds are more likely to have sick people that could pass germs on to your baby.
     -Make sure your baby gets regular checkups and shots to protect against serious illness.

• Sudden infant death syndrome (SIDS) is more common among premature babies. Lower the chances of SIDS by following these safe sleep practices:
     -Always put your baby on his back to sleep.
     -Do not have loose blankets, pillows, bumper pads, and toys in the crib.
     -Put your baby down to sleep alone in her own safe area – not on adult beds, waterbeds, cushions, sofas, or comforters.
     -Do not sleep with your baby on the couch or arm chair.
     -No one should smoke around your baby.

• Premature babies are more prone to jaundice (yellowing of the skin).
     -Although rare, severe jaundice can lead to brain damage.
     -Breastfeeding your baby every 2-3 hours is the best way to help prevent jaundice.
     -If you leave the hospital before the baby is 5 - 7 days old, frequently observe the baby for jaundice. If you notice any yellowing of the skin or whites of the eyes, notify your doctor immediately.
     -Keep all doctor appointments you have scheduled for the baby. If at all possible, do not cancel or reschedule the appointment. The baby’s doctor will check for jaundice.

Are there any long-term consequences for babies born premature?

Babies born prematurely have higher rates of learning disabilities, cerebral palsy, vision and hearing loss, breathing and respiratory problems, and feeding and digestive problems. These disabilities and health problems can follow a child throughout their lifetime.  

How long does it take a premature baby to catch up to a term baby?  

Catch up growth generally occurs in the first 2 to 3 years of life. The smallest of premature babies may take longer to catch up. It may take anywhere from 8 years through adolescence to reach their full growth potential. Some babies who were born premature do not ever catch up and may have developmental and learning disabilities or serious health problems for the rest of their lives.

Can premature babies be breastfed?

Yes! Breast milk may help premature babies develop and may even reduce some illnesses. However, they may need extra support. Babies born very early may not have the ability to feed directly from the breast soon after birth.  They have difficulty coordinating sucking and swallowing, get tired easily, and may have other medical problems, such as breathing difficulties, which make it too hard for the baby to breastfeed.   But your baby will still need the nutrition that only your breast milk can provide.  The breast milk of mothers who deliver prematurely is best at meeting the special needs of the premature baby.  Besides providing milk that is more easily digested, breast milk contains white blood cells, antibodies and other valuable immunities that may help a premature baby resist infection.  Premature babies fed breast milk also learn to feed better, have higher mental function scores, and may have a lower risk of long term intestinal disease and allergies.
You can use a breast pump to collect your milk. In the hospital, your milk can be fed to your baby through a tube until she is mature enough for direct breastfeeding. This is a special gift only you can provide to your baby. The nurses at the hospital can assist you in getting a pump and teaching you how to use it. You should begin using the pump as soon as you can after the baby is born, ideally less than three hours after the delivery.
Before going home your baby will transition to taking feedings either directly from the breast or from a bottle. Either your baby’s nurse or a lactation consultant can help you and your baby accomplish your goal.

Where can I find other parents who have delivered a baby prematurely?  

There are many on-line resources and support groups for parents of premature infants.  Oklahoma Family Network, (OFN) Oklahoma’s Family to Family Health Information Center, staff members can visit you while your baby is still in the hospital.  They provide support and encouragement to those who have babies in a NICU.  They can help you meet another family who has a child a little older than yours who was born early also and/or they can help you find resources you may need. Most families feel parent-to- parent support is exactly what they need to make it through a hospital stay and going home with their baby.  OFN will provide support as long as you wish, even after your child goes to school.  Visit their web site at www.oklahomafamilynetwork.org or call them at 877-871-5072.     Often parents that have babies in the NICU at the same time become a support for each other during their stay. The March of Dimes also has available resources. Visit their website at www.marchofdimes.com

(1) Centers for Disease Control and Prevention. National Center for Health Statistics. Health Data Interactive. www.cdc.gov/nchs/hdi.htm. [July 20, 2010].

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