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Hospital Delivery

What If I Give Birth Before My Due Date?

It’s such a scary unknown. Will she survive? Have health problems? At what week will she be perfectly fine?

Photo: Thinkstock

You’re much more likely to give birth right before or after your due date than to go very early. But still, more than 12 percent of babies born in the US are premature (meaning they’re born before the 37-week mark), according to the Centers for Disease Control (CDC). So if you’re part of that group, there’s no cutoff in the number of weeks baby’s born prematurely that guarantees a good or not-so-good outcome, but in general the longer you’re pregnant, the more time baby has to develop important organ systems. “The most acute issues occur in babies born at less than 26 weeks, and less than 750 grams birth weight,” says Loren DeLuca, DO, a neonatologist at Englewood Hospital and Medical Center in Englewood, New Jersey.

Preemies, Week by Week

Every preemie’s health varies, but here’s a snapshot of what’s usually in store when baby’s born early.

Under 26 weeks: Micro-preemie
These tiny babies will need breathing support, probably for a significant amount of time. About half of babies born before 24 weeks will survive.

27 to 28 weeks: Very Premature
These babies have a greater survival rate than micros, but are still at risk for serious issues such as blindness and brain damage.

29 to 30 weeks: Premature
Slightly larger, these preemies often look a lot like full-term babies, but smaller (thanks to the loss of lanugo, the fine coating of hair most much younger preemies have).

31 to 32 weeks: Moderately Premature
These babies are more apt to catch up quickly in the NICU, though they will need varied levels of support with breathing, feeding and staying warm.

33 to 34 weeks: Preterm
Lung development is still a problem for even these preemies, since the lungs’ air sacs only fully develop late in pregnancy.

35 to 36 weeks: Close to Early Term
These babies will go home most quickly barring unforeseen problems; their main job is to gain weight.

(In 2013, ACOG revised its definition of “term pregnancy;” 37 to 38 weeks is considered early term, and 39 to 40 weeks is considered term.)

If baby arrives early, “he’ll be evaluated by a special pediatric team right in the delivery room,” says Jeffrey Ecker, MD, chair of The American College of Obstetricians and Gynecologists’s (ACOG) obstetric practice committee. “What happens next will depend on how your baby is doing. Some babies born at 31 weeks are breathing on their own and don’t need intubation and spend less time in the NICU, while some babies born at 35 weeks are sicker,” he says. These are the most common issues preemies are faced with:

Temperature Regulation

The earlier baby is born and the smaller she is, the harder time she’ll have keeping herself warm (though every preemie, no matter her size, will be immediately placed on a warmer while she’s evaluated, DeLuca says). The combination a lack of body fat and a larger skin-to-body-weight ratio leaves preemies susceptible to hypothermia. Baby will stay in a warming Isolette in the NICU until she can regulate her temperature on her own.

Breathing

Because of immature lung development, most preemies have some kind of breathing issue, says DeLuca, and will be helped immediately, either with an oxygen mask, prongs in the nose or -- for the youngest, smallest infants -- intubation (where a tube will help her breathe). Often babies born even at 35 weeks don’t have enough surfactant, a substance in the lungs that keeps tiny breathing sacs open. Preemies are treated with surfactant replacement to avoid respiratory distress syndrome (RDS), most common in babies born before 30 weeks, and less common thereafter. Apnea of prematurity, or when baby stops breathing intermittently, is another prematurity problem, most common in babies born before 34 weeks.

Feeding

Babies born before 32 weeks will almost certainly need feeding help, either from a feeding tube or an IV. That’s because the coordination baby needs to suck and swallow doesn’t normally kick in until 32 to 34 weeks, DeLuca says. Mothers are encouraged to pump breast milk right away to establish a milk supply; breast milk is good for all babies, but especially helpful for preemies who can use the extra-immune-system boost. If you can’t pump or have trouble, baby will receive a special preemie formula in the NICU that’s higher in calories, fat and protein than regular infant formula.

Infection

A preemie’s immune system is immature, leaving her prone to infection, either from the birth process itself or from any procedures done in the NICU. One dangerous infection that may arise in the weeks after birth: necrotizing enterocolitis (NEC). “An immature gut may allow transit of bacteria from the intestines into the body,” DeLuca explains. “We don’t know exactly what causes NEC, but we do know that breast milk is slightly protective against it.”

Heart

Some preemies may have patent ductus ateriosus (PDA), which is an opening between blood vessels leading to and from the heart. It can close on its own (by naturally shrinking) or may need treatment with medication, a catheter-based procedure and/or surgery.

Brain

Brain bleeding (intraventricular hemorrhage, or IVH) is most likely to be an issue in very early babies (delivered before 28 weeks) and has different grades of severity. Some bleeds are mild and resolve on their own; others can lead to serious brain damage. Unfortunately, there’s no way to pinpoint the outcome of IVH until baby develops further.

Vision

All babies born at less than 30 weeks or 1,500 grams will be screened for a condition called retinopathy of prematurity (ROP). Immature blood vessels in the eye can lead to detached retinas and may cause blindness if not treated. The preemie should also be screened by a pediatric ophthalmologist after she goes home, DeLuca says.

The big question: When can baby go home? “Most hospitals don’t have weight and age cutoffs to go home,” DeLuca says. “Usually, we look for the time when your baby can keep himself warm in a regular bassinet, when he’s gaining weight, and when he can feed, suck and swallow without any changes in his vital signs.”

Plus, More from The Bump:

Top 10 Labor and Delivery Fears

What Happens at the Hospital When You Deliver

Tool: Birth Plan


-- Denise Schipani

See More: Labor and Delivery