The Preterm (premature) Birth Service
The Preterm Birth team are based at the Lister Hospital but have clinics that run at the Lister and at Hertford County Hospital. The service is for women who have been identified as being at higher risk of having a preterm (premature) birth. We hope this webpage will be helpful in understanding the risk factors and how the Preterm Birth team will support you during pregnancy to try and reduce the risk of preterm birth.
What is preterm birth?
We normally expect babies to be born between 37-42 weeks of pregnancy. When babies are born before 37 weeks, this is known as a preterm (premature) birth.
About 8 out of 100 babies will be born prematurely before 37 weeks.
Premature babies have a higher chance of having health problems, particularly with breathing and feeding. They are also at increased risk of infection. The earlier a baby is born, the more vulnerable they are and they may need to be looked after in the neonatal unit. However, more than nine out of ten premature babies born after 28 weeks survive and only a small number will have serious long-term disabilities.
Please see the infographic on outcomes for babies born before 26 weeks.
What causes preterm birth?
The cause of preterm labour and birth is usually unknown. In most cases, doctors can not predict which women will go into labour early, but certain factors are known to increase the risk of premature labour and a combination of several of these factors can be involved.
If you have been identified as having any risk factors for premature birth then the midwife at your booking appointment will refer you to the Preterm Birth team. The Preterm Birth team will go through your referral and decide if you need an appointment and what type of appointment this may be. The team may also contact you to ask some questions to ensure you are given the right appointment at the right time.
What if you think you are in preterm labour?
If you think you are in preterm labour or that your waters have broken, please contact Lister Hospital:
- Less than 20 weeks pregnant, contact the Early Pregnancy Unit (EPU—Woodlands) on 01438 286190 (or attend the emergency department if urgent).
- Over 20 weeks, telephone the Maternity Triage on 01438 286168.
There are treatments which we can sometimes offer in an attempt to stop premature labour or to reduce the risk of complications to baby if you do give birth early. This all depends on the gestation that this occurs and also if there are any other complications such as infection. The healthcare team can discuss this with you at the time.
If labour is not confirmed, you should be able to go home assuming you are well and there are no other concerns for you or your baby. We will make arrangements to see you again if you need more assessments at a later date.
Pregnancy charity Tommy’s has created a useful resource for signs and symptoms of premature labour
Supporting you if you are in preterm labour:
If you are more than 24 weeks pregnant and we think that there is a very high chance that you may birth your baby within the next week, you will be advised to stay in hospital. You may also be offered some medications to help with your baby’s development and to reduce the chance of complications caused by being born early.
If your waters have been confirmed as broken (known as Preterm Prelabour Rupture of Membranes or PPROM), then we will advise that you stay in hospital for at least 48 hours as there is a chance that you could go into labour.
Please follow this link to the PPROM leaflet for more information on how we manage PPROM.
Right place of birth
Here at the Lister, the level two neonatal unit is best equipped to appropriately care for babies that are born over 27 weeks, (or over 28 weeks for twins) and babies who are estimated to weigh over 800g at birth. If your baby is less than 27 weeks, (less than 28 weeks for twins) or estimated to weigh less than 800g, then we will discuss with you about transferring you to a hospital that has a level three neonatal unit that is better equipped to provide the best care for your baby/babies. Ideally, if we do transfer you, this would occur before the birth so that preparations can be made to give them the best start. This is known as an in-utero transfer.
Neonatal Services at the Lister
If your baby is born prematurely, they may need to stay in the neonatal unit for some time depending on their gestation at birth.
The neonatal team will be able to support you on your journey. A Family Support nurse from the neonatal team would be happy to speak to you to answer any questions you have. They can even facilitate a virtual or face to face tour of the neonatal unit at the Lister. You can contact them via email on enh-tr.neonatalfamilysupport@nhs.net. They aim to respond within 3-5 working days.
Contacting the Preterm Birth team
Our preterm birth team are available by email pretermbirth.enh-tr@nhs.net. They aim to respond within 3-5 working days.
You can also contact the Preterm Birth Midwife by telephone on 07920 762047 (Monday-Thursday 9am-5pm and Friday 1.30-5pm). She can answer any questions you may have or direct you to other services.
Other useful resources
There are some webpages that can offer more information to support you:
Tommy’s – Pregnancy charity
https://www.tommys.org/pregnancy-information/premature-birth
Bliss Charity – Premature baby charity
https://www.bliss.org.uk/parents/having-another-baby
Little Heartbeats Charity for PPROM
https://www.little-heartbeats.org.uk/
Frequently Asked Questions (FAQs)
You are at higher risk of Preterm Birth if:
You went into labour naturally and had your baby between 24+0 and 33+6 weeks gestation in a previous pregnancy.
- You went into labour and had a late miscarriage between 16+0 and 23+6 weeks gestation
- Your waters broke between 16+0 and 33+6 weeks in a previous pregnancy. This is called preterm prelabour rupture of membranes (PPROM).
- You have had previous surgery on your cervix such as a LLETZ (large loop excision of the transformation zone) or cone biopsy to remove abnormal cells in the cervix
- You have had a previous caesarean section in labour when you were fully dilated
- You had a cervical cerclage (stitch) in a previous pregnancy
- Previous trachelectomy for treatment of cervical cancer
- You have a variation in the size and shape of your uterus, e.g. bicornuate, unicornuate uterus, uterine septum
- You have adhesions (scar tissue) in your uterus sometimes known as Asherman’s syndrome
You can contact the Preterm Birth Specialist Midwife by telephone on 07920 762047 (Monday-Thursday 9am-5pm and Friday 1.30-5pm). She can answer any questions you may have or direct you to the relevant service to support you in the pregnancy.
You can also contact the Preterm Birth Team by email pretermbirth.enh-tr@nhs.net. They aim to respond within 3-5 working days.
If you think that your waters have broken, telephone the Maternity Triage on 01438 286168. They will invite you in to be assessed by the healthcare team. They will check whether you are in labour or, if not, what is causing your symptoms.
If we confirm that your waters have broken or that you are showing signs that you may have your baby soon we will discuss admitting you to the Labour Ward for observation and treatment or transferring you to another hospital if you are below 28 weeks gestation.
If labour is not confirmed, you should be able to go home assuming you are well and there are no other concerns for you or your baby. We will make arrangements to see you again if you need more assessments at a later date.
Checks may include:
- A general examination and a check of your temperature, pulse and blood pressure.
- An examination of your tummy (abdomen).
- A check of your baby’s heartbeat – you will be put on a monitor to watch the pattern of your baby’s heart rate if you are over 28 weeks pregnant, which can show whether your baby looks tired or stressed. If you are under 28 weeks, a handheld Doppler will be used.
- Blood samples to check for signs of infection.
- A urine sample for testing for infection and protein (which could be due to pre-eclampsia).
- An ultrasound scan to check your baby’s well-being and which way he/she is lying.
- A vaginal speculum examination to look at whether there is fluid leaking through the cervix and if your cervix is opening. This may be followed by a vaginal examination by the midwife or doctor to assess if the cervix is shortening and opening if you are having regular contractions.
- A vaginal swab to check for infection.
- If you are less than 34 weeks pregnant, a type of swab called fetal fibronectin may be taken from the top of the vagina. Fetal fibronectin is a protein that acts as a ‘glue’ to keep the amniotic sac attached to the lining of the womb. If you are likely to give birth early, the protein may be released into the vagina, where it can be measured using a swab.
Here at the Lister Hospital, Level 2 Neonatal Intensive Care Unit (NICU) is best equipped to care for babies born over 27 weeks gestation (or over 28 weeks for twins). If your baby is below this gestation or estimated to weigh less than 800g, we may recommend that you go to a hospital with a Level 3 NICU before your baby is born.
This is known as in-utero transfer. This means transferring the baby while they are still in your womb. If you give birth in a hospital with a Level 3 NICU, your healthcare team will have immediate access to the right equipment and expertise that your baby needs.
For more information about in-utero transfer, please refer to our leaflet via this link.
If it looks like you may be going into labour and that your baby could come early, we may offer you some medications to reduce the risks of complications to your baby. This will depend on how many weeks pregnant you are. We may offer:
Steroids – to reduce the risk of breathing difficulties at birth, bleeding in the brain and bowel inflammation. This course of steroids is two doses of an injection into the muscle given over 12-24 hours.
Magnesium sulphate – to reduce the risk of cerebral palsy. This is a drip that is given in two parts. A larger starting dose given by the doctors, followed by an infusion which continues for 24 hours or until your baby is born. If you are to be transferred, the infusion will be stopped for the transfer.
Antibiotics – to reduce the risk of infection as this risk is higher in premature babies. If you are found to be in established labour then we will start antibiotics given through a drip.
If your baby is born prematurely, they may need to stay in the Neonatal Unit for some time depending on their gestation at birth.
The neonatal team will be able to support you on your journey. A Family Support nurse from the neonatal team would be happy to speak to you to answer any questions you have. They can even facilitate a virtual or face to face tour of the neonatal unit at the Lister. You can contact them by email on enh-tr.neonatalfamilysupport@nhs.net. They aim to respond within 3-5 working days.
