Anticipating or Planning a Preterm Birth, What to Expect

You and the midwives/doctors looking after you are likely to know in advance that preterm birth is going to happen, but how soon it will happen is very variable. This may be anticipated by signs and symptoms of spontaneous preterm birth, so it is really important you know what these are and tell your midwife straight away if you have any of them. Or preterm birth may be planned if a provider-initiated preterm birth is required instead. Having as much time as possible to prepare for preterm birth is really valuable.

All pēpi born preterm need some extra support after they are born, and being born early may have some effect on their long-term health and wellbeing. Whether pēpi is coming early due to spontaneous or provider-initiated preterm birth, there are some treatments and interventions that can be considered to help pēpi survive and survive well. 

These treatments are shown in the diagram below. Clicking on the links will take you to our Whanau Information for each treatment option. These information sheets have been designed to be read in kōrero/conversation with your midwife or doctor. You and your whānau will also have time to ask questions. You might also find them helpful to read through on your own and with whānau.

Preparing for preterm birth 

When preparing for the possibility of preterm birth, these steps can help your pēpi to survive and be healthy and well.

Stay in hospital for care and monitoring for you and pēpi

Ensure pēpi will be born in hospital, the safest place for preterm pēpi

Transfer to a hospital with the right level of neonatal intensive care

Pēpi who are born in a hospital with the right level of neonatal care for their gestation and needs (inborn pēpi) have better outcomes than pēpi who are born elsewhere and then transferred after birth (outborn pēpi)

Antenatal corticosteroid injections if you are expected to give birth before 35 weeks of pregnancy
Corticosteroids are given as two injections into your buttock of arm muscle, 24 hours apart and work best when they are given at least 48 hours before birth and within seven days.

Improve the chance of survival for pēpi
Lower the chance of pēpi having breathing problems, bleeding in the brain and inflammation of the gut /intestines.
Help with childhood development without evidence of longer-term harm

At the time of preterm birth

Around the time of preterm birth, these steps can help your pēpi to survive and be healthy and well.

Magnesium sulphate infusion if you are expected to give birth before 30 weeks of pregnancy
Magnesium sulphate is given as an infusion through a drip in one of your veins, at least 20 minutes before birth and within 24 hours

Lower the chance of pēpi having cerebral palsy and bleeding in the brain

Antibiotics (usually Penicillin, or an alternative if you have an allergy) if you are having a vaginal birth (not required if you have a planned Caesarean section)
Antibiotics are given as an injection into one of your veins and are given once you are in labour and continued at regular intervals until pēpi is born

Lower the chance of pēpi getting an infection called Group B Streptococcus which can make preterm pēpi particularly sick

Monitoring to listen to your pēpi heartbeat throughout labour

Provide information about how pēpi is coping with labour, which helps to ensure they are born as healthy as possible

A vaginal birth is usually the safest option for birthing preterm pēpi. Occasionally a caesarean section may be recommended

Your midwives and doctors will talk to you about the benefits and risks of each mode of birth and what is best for your birth

Waiting for one minute to clamp the pito/umbilical cord

Improve the chance of survival for pēpi
Lower the chance of pēpi having bleeding in the brain or needing a blood transfusion

Wrapping pēpi in a plastic sheet/wrap at birth

Help to keep pēpi warm and prevent hypothermia, preterm pēpi find it hard to control their own temperature

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Having a team of midwives and doctors present when pēpi is born

Allows pēpi to be cared for in the safest way possible
They may bring extra equipment to support your pēpi transitioning from your womb to the outside world

There are lots of extra things that should happen before, during and at the time of birth for preterm pēpi. Sometimes it can feel like this changes your experience of birth but many of the usual things can still happen.  Please talk to the midwives and doctors looking after you about your birth plan, including whānau that you would like to be present in your birth and any cultural birthing practices that are important to you. 

Care for pēpi after preterm birth