Premature birth

Dr. rer. nat. Daniela Oesterle is a molecular biologist, human geneticist and trained medical editor. As a freelance journalist, she writes texts on health topics for experts and laypeople and edits specialist scientific articles by doctors in German and English. She is responsible for the publication of certified advanced training courses for medical professionals for a renowned publishing house.

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In the case of a premature birth, the child sees the light of day before the 37th week of pregnancy. If the doctor recognizes the physical signs of an imminent premature birth, he will either delay the birth or initiate it quickly, depending on the cause. Read more about premature birth and how parents can help themselves and their premature baby.

When do we speak of premature birth?

One speaks of a premature birth if the child is born before the end of the 37th week of pregnancy (SSW). Doctors divide premature babies into three groups either according to the length of pregnancy or birth weight:

Extreme premature babies: 27 weeks gestation completed or weight less than 1000 grams
Very early premature babies: completed 30 weeks of gestation or weight less than 1500 grams
Moderately premature babies: completed 36 weeks of gestation or weight less than 2500 grams

In Europe, around six percent of all births are premature.

Signs of premature birth

The maternal body induces a premature birth through premature labor, premature rupture of the bladder and / or an early shortening of the cervix with simultaneous softening and widening of the cervix (cervical insufficiency).

It is normal for the uterus to contract slightly in the last few weeks of pregnancy. She prepares for the birth with practice and sinking pains. Sometimes, however, it is also a matter of premature labor, i.e. premature labor! You can recognize this by the fact that it occurs at short intervals (more than three times an hour) and over a longer period of time. In such a case there is a suspicion of a premature birth - consult a doctor quickly!

Causes of premature birth

There are many causes and risk factors for premature birth, but they cannot always be clearly identified. Experts assume that it is a so-called multifactorial event, i.e. that several factors together can lead to a miscarriage.

Maternal causes and risk factors for miscarriage include:

General illnesses such as (vaginal) infections or hormonal diseases
Malformations of the uterus or fibroids (growths) of the uterine muscle layer
pregnancy-related diseases such as high blood pressure, preeclampsia or gestational diabetes
Inefficiency of the placenta (placental insufficiency)
socially or economically difficult circumstances, psychological stress
maternal age under 20 or over 35 years
high consumption of nicotine or alcohol
previous miscarriages

Children's causes of premature birth are:

Deficiency development
Chromosomal disorders
Malformations
Multiple pregnancy

Premature Birth Prevention: General Measures

The risk of premature birth can be reduced if women avoid alcohol and nicotine, avoid underweight and overweight as well as stressful situations. If everyday working life is too stressful for the pregnant woman, as a precautionary measure, rest work up to and including a ban on employment can be prescribed. Regular medical examinations also reduce the risk of premature birth.

Prevention of premature birth: Medical measures

Which medical measures are taken in the event of an impending premature birth depends on the length of pregnancy and the possible risks for mother and child. Whenever possible, attempts are made to maintain the pregnancy, because it is better for the development of the child if the child can remain in the womb longer as intended.

Premature labor

Premature labor is treated with certain medications called tocolytics (labor inhibitors). This saves time, for example to give the mother cortisone, which supports the lung maturity of the unborn child (usually 23 to 34 weeks of gestation). If premature birth threatens before the 34th week of pregnancy, the pregnant woman can be transferred to a perinatal center that specializes in premature and newborn babies before the birth thanks to contraceptive agents.

Premature rupture of the bladder

In the event of premature rupture of the bladder, the doctor will weigh up the dangers of infection for mother and child and the risk of premature birth. Depending on this, he initiates the birth or tries to delay it a little. The precautionary administration of antibiotics (against possible infections) makes sense. If the mother has a fever, the aim is to give birth quickly.

Premature birth: introduction

If a premature birth can no longer be stopped, delivery is initiated. The length of pregnancy and the position of the child determine the type of delivery (vaginal or caesarean section). During a vaginal delivery, a perineal incision is often made to protect the child's still very soft head from excessive pressure.

Basically: All premature births before the 34th week of pregnancy should take place in a perinatal center. They specialize in the delivery and care of premature babies.

After the premature birth

Usually, the premature baby is placed in an incubator in the intensive care unit soon after birth. In it, temperature, humidity and oxygen content are regulated in such a way that the child can develop as best as possible. It is also attached to many cables that monitor breathing and heartbeat. Medicines for breathing problems, for example, are administered by infusion. Since premature babies cannot yet drink themselves, they receive the necessary nutrients via a gastric tube.

Premature babies are examined and, if necessary, treated with regard to the following risks:

Immaturity of breathing
Immaturity of the central nervous system
Immaturity of the eyes
Immaturity of the skin
Immaturity of the kidneys
Immaturity of the intestine

How can parents help their premature baby?

Mostly unprepared parents have to learn to deal with the new situation: the child is born much too early and it lies vulnerable, connected to many cables and hoses, in an incubator.Strict hygiene regulations, the large number of medical devices and a clinical environment make the situation difficult for parents who want to give their child as much security as possible. Worries about the premature baby's state of health are also stressful. Last but not least, the visits to the hospital, which usually last for weeks, require a lot of organization from the parents.

But even if the situation is difficult and the parents feel helpless - there is still a lot they can do for their child.

Emotional and physical closeness are good

Spend a lot of time with your child, tell them stories, read to them. A lot of closeness and loving care help them develop healthy and well.

You can build up a particularly intense emotional bond using the so-called kangaroo method and thus compensate for the early "separation". The premature baby, only wearing a diaper, is placed on the mother's or father's bare chest for a few hours. It hears your heartbeat, smells your skin, hears your voice. The child feels secure.

The often very delicate skin of premature babies is particularly sensitive to skin contact. It is therefore possible that the very small premature baby will find caressing uncomfortable. It is better to hold the child's head gently with your hand or place your hand on their back or around their feet. This also gives the little one a feeling of security.

Breastfeeding attempts are desirable

With the "kangaroo" you can start your first breastfeeding attempts as a young mother, even if the child cannot really drink yet. Little by little it starts to suck. And breast milk is ideal, especially for premature babies, as it is easy to digest and helps the premature baby to build up the intestinal flora and protect the immune system.

Don't forget yourself

After all those visits to the hospital, don't forget to think about yourself too. Allow yourself plenty of time to relax and recharge your batteries. Because if you are relaxed and rested, it will carry over to your child.

Limits of Medicine

Medical care has achieved a lot in the last few decades. The earlier the child leaves the womb, the lower the chances of healthy development or even survival. Because the child's organs are not yet fully developed when born ahead of time.

Unfortunately, premature babies born before the 22nd week of pregnancy usually have no chance of survival.

Children born before the 23rd week of pregnancy can sometimes survive with considerable consequential damage to their health. The decision for life-sustaining or death-accompanying measures is made jointly by parents and the treating physician.

Children born before the 24th week of pregnancy have a 50 percent chance of survival. However, some of these children later suffer from serious health problems that may require lifelong care. Depending on many factors such as weight, gender, single or multiple pregnancy as well as lung maturation, the parents of these children, together with the treating physicians, make the difficult decision about life-sustaining or death-related measures.

Premature babies born before the 25th week of pregnancy have a good chance of survival. Life support measures are therefore the rule. Only in the case of the most severe health disorders do the parents have to decide on life-sustaining or death-accompanying measures.

Difficult decision for parents

It is very stressful for parents to let go of a premature baby due to serious health problems or expected consequential damage and to go the path that accompanies death together. The trained clinic staff can support the parents or recommend professional help. Because grief work after a premature birth and the common dying situation is important and necessary in order to ultimately develop a new zest for life.

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