Premature babies and neonatal care

What does premature mean?

When a baby is premature, it means that they are born before the pregnancy has reached 37 weeks. This is also called preterm.  Around 8 out of 100 babies are born prematurely (NHS, 2024a).

If a baby is born prematurely, they can be vulnerable. They may also need extra care. The earlier they are born, the more care they might need immediately and in later life (NHS, 2024a; NICE, 2015a).

Occasionally, doctors might recommend starting a labour or having a caesarean birth before 37 weeks if it’s in the best interests of mother or birthing person and baby (NHS, 2024a).

Twins and multiples are often born before 37 weeks (NHS, 2024a).

Bliss is a charity which provides information and support for parents and families whose babies are born premature or sick.

When labour starts early

Most premature labours start on their own (NHS, 2024a; NICE, 2015a). If the waters break before 37 weeks it is called preterm pre-labour rupture of membranes (P-PROM) (NHS, 2024a). In any event, the pregnant woman or person is advised to contact the midwife or maternity unit (NHS, 2024a; NICE, 2015a).

Our article on the first signs of labour can help you recognise when labour is starting.

Can you delay a premature labour?

Sometimes when labour starts early it can be paused or stopped (NICE, 2015a). 

If it is thought that labour will happen early, or if there are concerns about the mother or pregnant person, or baby, doctors will discuss the reasons and options. They will give the mother or pregnant person the information they need to make an informed decision about their care (NICE, 2015a).

There are two options for reducing the chance of labour starting early (NICE, 2015b):

• A tablet of the hormone progesterone can be placed in the vagina
• The cervix might be closed with a stitch until birth

If premature labour is suspected a doctor will discuss these with you.

The mother or birthing person may be admitted to a hospital with a neonatal unit (NHS, 2024a). A neonatal unit is where babies are cared for if they need medical care after they are born.

If premature labour is suspected, it should be possible to visit the neonatal unit and talk to a neonatologist before the baby is born. A neonatologist is a doctor that specialises in newborn and premature babies (NICE, 2015b).

If you have done an NCT Antenatal course, the local NCT course leader or volunteers may be able to give you more information about the neonatal unit and local support.

What care will I receive if I am in premature labour?

Antenatal corticosteroids

The doctor might suggest corticosteroids (cor-tick-o-stair-oids). These are steroids the mother or pregnant person is given to help the baby’s lungs develop before birth (NICE, 2015b). This information from RCOG explains more.

Depending on the circumstances, a second course of corticosteroids may be offered (NICE, 2015b).

These aren’t usually given if the baby is older than 36 weeks, as it is thought they can breathe properly on their own by that time (NHS, 2024a).

Antenatal corticosteroids can delay the arrival of mature breastmilk.

Magnesium sulphate

If it seems the baby might be born early, the doctor might discuss using magnesium sulfate. This is to protect the baby’s brain, including reducing the risk of cerebral palsy (NICE, 2015b).

What happens during the birth?

Depending on the situation, the doctor may discuss with the parents how the baby will be monitored during labour (NICE, 2015b).

The doctor will discuss how the baby could be born. They should explain the benefits and drawbacks of both vaginal birth and caesarean birth, so the parents can make an informed decision (NICE, 1015b).

The mother or birthing person will be offered antibiotics. These are to protect the baby from infection after birth (NICE, 2021).

When the baby is born, the cord will be left for at least a minute before it is cut, unless there is a medical reason not to wait (NICE, 1015b).

Place of birth

If you are less than 28 weeks pregnant, you may be transferred to a different hospital which has a Neonatal Intensive Care Unit (NICU) onsite, if your local hospital does not have one.

What are special care, neonatal care and NICU?

There are wards in hospital that a baby can go to if they need special care. These are called neonatal units. Depending on a baby’s needs, they will go to the appropriate level of neonatal care (NHS, 2024b; Bliss, no date a). 

Special care baby unit (SCBU or SCU) – Level 1

This is appropriate for babies born after 32 weeks of gestation and who don’t need intensive care (Bliss, no date a). For example, they might be observed for a few hours after birth to confirm they’re stable and well.

Local neonatal unit (LNU) – Level 2

Babies in the LNU are often born between 27-32 weeks and require a higher level of medical support, but not intensive care (Bliss, no date a).

Neonatal intensive care (NICU) – Level 3

The highest level of care is for babies born before 28 weeks, or with a serious medical condition and needing intensive care support for more than 48 hours (Bliss, no date a).

Transfers

Because not all hospitals have all levels of care, it is common for babies to be transferred to a unit at a different hospital for appropriate care (Bliss, no date a).

A parent should be able to go with them when they transfer, and parents should be given information about the neonatal unit their baby is being transferred to as early as possible (Bliss, no date a).

Care for twins and multiples 

If there is a lack of available spaces in neonatal care, twins and multiples might be separated and go to different hospitals. Hospitals will try and keep them together when they can, but this is not always possible. 

Which babies need neonatal care? 

There are different reasons why babies have neonatal care. 

Premature or very small babies

Babies can survive if they are born after 22 weeks, but will need lots of medical support (NHS, 2024a).  

Premature babies and babies who are very small will be kept in an incubator rather than a cot, so they stay warm (NHS, 2024b). RCOG has parent information on having a small baby. 

Jaundice

Newborn babies often develop jaundice, where their eyes and skin appear yellow. For babies with Black or Brown skin, jaundice might be easier to see in the whites of the eyes, inside the mouth and on the palms and soles of feet. 

Jaundice does not usually need additional care. However, a few babies have severe jaundice, which needs specialist care and is treated with phototherapy. This is where the baby is exposed to bright light in a cot or incubator (NHS, 2024b). 

Sick babies

Sick babies might include those with a congenital condition, who experienced a difficult birth or surgery, or who have picked up an infection and need antibiotics (NHS, 2024b). 

Traumatic birth or surgery 

A baby who experienced a difficult labour and birth may need special care. And a baby expecting or recovering from surgery will need additional care (NHS, 2024b). 

What happens when my baby goes into neonatal care? 

The baby will be in an incubator to keep them warm. This might have an open top, or holes in the side so the parent can touch them. Parents can take them out of the incubator to hold and have skin-to-skin time (NHS, 2024b).  

Some babies might have wires attached to them. They might have a tube to feed them (NHS, 2024b). This is likely to feel unsettling for a parent. 

The nurse will explain what the equipment is for, and what parents can do. Parents will be asked to wash and dry their hands carefully each time before they touch their baby (NHS, 2024b). 

What is Family Integrated Care? 

Family Integrated Care (FIC or FICare) makes families the primary carers for their baby, supported by the clinical team. It takes into account the family’s needs and availability (Bliss, no date b).  

FIC means the parents can develop confidence and bond with the baby, for example by washing and changing, skin-to-skin contact and feeding or breastfeeding. This also helps the baby’s development (Bliss, no date b).  

Bliss has more information on caring for a baby when they are in a neonatal unit. 

How is the baby fed?

You may not be able to feed your baby how you intended to right away, or your feeding plans might change. This can feel difficult, and our Breastfeeding Counsellors can support you. Call 0300 330 0700 every day, from 8am to midnight, to speak to them.

Premature birth can delay the production of mature breastmilk, and antenatal corticosteroids may mean a longer delay. Parents who wish to breastfeed their premature baby should be offered additional support with feeding. Some parents may be offered medicine to boost milk production (Henderson et al, 2008; Asztalos et al, 2019).

Some babies will be well enough to feed from the breast or bottle, and others will be fed via a tube. The tube goes through the nose or mouth into the stomach and doesn’t hurt the baby (NHS, 2024b).  

If the mother or birthing parent intends to breastfeed, then expressed milk can be given by this tube (NHS, 2024b).  Even if not planning to breastfeed, expressing colostrum will be encouraged as it is especially beneficial for premature babies, reducing the chance of infections (NHS, 2022). 

Sometimes, hospitals can provide donor milk (NHS, 2022).

Some babies need to be fed directly into the bloodstream, and this is called Parenteral Nutrition (NHS, 2022).

How long do babies spend in special care? 

Some babies will spend only a few hours in the neonatal unit. Others may spend several days, weeks or months.

If there isn’t a specialist unit locally, this may mean transferring the baby or babies to a hospital with more facilities. In those cases, one parent may be able to stay with their baby. 

Sometimes the mother or birthing person remains on the postnatal ward for their own additional care. They don’t need to ask permission, but may need support to go to special care to be with their baby or babies. 

At other times, the mother or birthing person is discharged, and they come to be with their baby in hospital. 

Can other family members visit? 

Each unit will have a different visiting policy, and family members can usually visit. However, there might be set visiting hours and limited numbers for anyone other than the parents (Bliss, no date a). 

What’s it like having a baby in the neonatal unit? 

Parents are not considered visitors to neonatal units. It’s important that they can be with their baby whenever they want to be, for as long as they want to be, 24 hours a day (Bliss, no date a). 

Some parents aren’t sure what they are ‘allowed’ to do. But they shouldn’t feel as if they need to ask permission to do anything. The health professionals want to meet the needs of both parents and baby (NHS, 2024b).  

Hospital staff will explain the care they are providing. They will ask the parent’s consent for any treatment. If parents are not sure about anything or if something hasn’t been explained, they can speak to a nurse or ask for an appointment with the doctor (NHS, 2024b). 

Any of these experiences can feel very difficult. Having a support network to help with travel, looking after siblings, meals, laundry and pet care can be invaluable. Hospitals may have their own support services too. This can include a social worker to help with practical costs (NHS, 2024b). 

It is normal to feel a sense of numbness, loss or grief. This might be for the pregnancy ending so early, the expected happy postnatal days, or misplaced anxiety that the parent did something wrong. There is excellent support available from organisations such as Bliss. 

Tips to help you look after yourself 

It can be hard to think about yourself when you’re worried about your baby. But taking care of yourself can mean you have more energy and feel able to look after your baby.  

Bliss has some self-care tips (Bliss, no date b): 

• If you’re staying in the unit, go outside for some fresh air and natural light.
• Write a diary or start a memory book. 
• Let yourself go home for a meal or a sleep in your own bed, and let the care team look after your baby.
• Make notes of questions you’d like to ask your care team.  
• Ask the care team about how you can get involved in your baby’s care. This will help you get the most out of your time together. 

Further information

You can order a free card from Bliss with practical tips on how to support your mental health during your neonatal journey.

Mind has an online community for peer support. 

We have information on what happens when sadly, a baby dies.

We also have articles on mental health and wellbeing. 

This article was kindly reviewed by our friends at Bliss.