Tommy's PregnancyHub

My premature baby’s development in the womb – week 24

If you have been told you are at risk of a premature birth, you may be feeling anxious. Here’s some information about your baby’s development this week.

This information is for women who have been told that they are at risk of a premature birth

If you are not at risk of having a premature baby, we have information for you in our pregnancy calendar - our week-by-week guide to the stages of pregnancy.
 

Your baby's development this week

By 24 weeks it is thought that your baby can now recognise their parent’s voices. Try talking or singing to your unborn baby, which can help you bond. 

When your baby is born, they will recognise your voice, which will help give them comfort and reassurance. Knowing you are close and hearing your voice will release a hormone called oxytocin, which is important for your baby’s brain development. 

Your pregnancy symptoms

Swelling

You may have some swelling in your face, hands or feet. This is often caused by water retention. 

Tell your midwife or GP if you have any swelling so they can make sure you do not have pre-eclampsia. Pre-eclampsia is a combination of raised blood pressure (hypertension) and often protein in your urine (proteinuria) or problems with the kidneys or liver. 

Most cases of pre-eclampsia happen after 24 to 26 weeks and usually towards the end of pregnancy. Women expecting multiple babies have a higher risk of developing pre-eclampsia.  

A growing bump is the sign of a growing baby. Your midwife should start measuring your baby bump from 24 weeks to make sure they are growing at the right rate.

It is best to limit your caffeine intake as much as possible during pregnancy, as high levels have been linked to pregnancy complications. Find out your daily caffeine intake with our caffeine calculator.

Other symptoms

If you are at risk of giving birth early, it’s important to take care of yourself. There are also some things you can do to try and reduce the risk of giving birth early.

Tell your midwife or doctor if you have any symptoms that you are worried about. Do not worry if you've talked about it before and don't be concerned about whether you're wasting anyone's time. This is your pregnancy and it's important to trust your own instincts if you feel something isn't right.

You can also call the Tommy’s midwives on 0800 014 7800 (Monday to Friday, 9am to 5pm), or email us at [email protected]

Symptoms of early labour

Call your midwife or hospital maternity unit straight away if you think you are in early labour. It may be a false alarm, but it’s best to get checked out. Find out more about the symptoms of early labour

Your mental health

If you have been told that you are at increased risk of giving birth early, it’s important to try and reduce stress and take care of your emotional health. Find out more about coping with the idea of a premature birth.

What may happen if your baby is born this week

This information may be difficult to read. If you have any questions about your pregnancy or risk of premature birth please talk to your doctor or midwife.

You can also call the Tommy’s midwives on 0800 014 7800 (Monday to Friday, 9am to 5pm), or email us at [email protected]

Babies born before 28 weeks are described as being extremely preterm. Research shows that for babies born before 27 weeks of gestation it is best, whenever possible, to be born in a specialist maternity unit with a specialist Neonatal Intensive Care Unit. If you are in labour and aren’t at a hospital with these facilities, you may be taken to one as soon as possible. This is known as in utero transfer

Sadly, most babies born at this gestation will not survive labour and birth. At 23 weeks, this is known as a late miscarriage.
Approximately 6 in 10 babies don’t survive if they are born now, even if they are born alive and receive treatment to try and save their life. Of those who do survive, 1 in 4 babies born at this time will have a severe disability, such as cerebral palsy.

Up to 1 in 4 of children without a severe disability may have a milder disability, such as learning difficulties, behavioural problems or mild cerebral palsy. 

When talking about babies who have been born extremely prematurely, the term severe disability can include: 

  • not being able to walk or even get around independently (this includes conditions such as severe cerebral palsy) 
  • being unable to talk, or see or hear properly 
  • difficulties with swallowing or feeding safely 
  • having multiple health problems with frequent visits to hospital
  • needing to attend separate school for children with special educational needs 
  • being unable to care for themselves or live independently as they grow up. 

What does this mean for your premature baby? 

Every baby is different and it is important to talk with your doctors and midwife. They will give you specific information about your own and your baby’s condition.

The chances of your baby’s survival and long-term health will depend on several other factors, not just the week they were born. How much your baby weighs, their gender, and how well you and your baby are when you give birth will all have an impact.

Your doctors will talk to you about what your options are and help you make decisions about what’s best for you and your baby.

You and your healthcare team may decide that it will be best to provide palliative care to your baby, either because there is an extremely high risk that your baby will not survive or they are likely to suffer from life-long disability, even with the very best treatment. Palliative care means providing treatments that will make them as comfortable as possible until they pass away. 

You and your healthcare team may decide that starting neonatal intensive care would be best for your baby. Babies born at this time have the highest risk of breathing problems because their lungs have not matured and will need help to breathe.

The medical team will usually put a breathing tube passed through their mouth or nose and into their lungs (known as intubation), which is connected to a machine called a ventilator. This machine does most or all of the breathing for the baby. Your baby will also be given some medicine into their lungs (surfactant) to help with their breathing. 

Babies born now will not be able to feed independently and are at risk of complications such as hypothermia (when their temperature is low), heart and blood flow problems, low blood pressure, high or low blood sugar and infections. The medical team will monitor all these things and provide treatment when necessary.
 

Regan, Lesley (2019) Your pregnancy week by week, Penguin Random House, London

Unicef (2016) You and your baby. Supporting love and nurture on the neonatal unit. https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2015/08/neonatal_leaflet_online.pdf

NHS. You and your baby at 25 weeks pregnant. https://www.nhs.uk/pregnancy/week-by-week/13-to-27/25-weeks/ (Page last reviewed: 17 July 2018 Next review due: 17 July 2021)

NICE (2019). Hypertension in pregnancy: diagnosis and management. National Institute for health and care excellence https://www.nice.org.uk/guidance/ng133
  
NHS. Pre-eclampsia. https://www.nhs.uk/conditions/pre-eclampsia/ (Page last reviewed: 7 June 2018 Next review due: 7 June 2021) 
    
NHS. Foods to avoid in pregnancy. https://www.nhs.uk/pregnancy/keeping-well/foods-to-avoid/ (Page last reviewed: 16 April 2020 Next review due: 16 April 2023) 
  
British Association of Perinatal Medicine. (2019) Perinatal Management of Extreme Preterm Birth before 27 weeks of gestation British Association of Perinatal Medicine. https://hubble-live-assets.s3.amazonaws.com/bapm/attachment/file/182/Extreme_Preterm_28-11-19_FINAL.pdf
 
NICE (2019). Specialist neonatal respiratory care for babies born preterm. National Institute for health and care excellence. https://www.nice.org.uk/guidance/ng124

NHS Thames Valley & Wessex Operational Delivery Networks (2019) Too small too soon. Information for parents of babies born early around 22 to 24 weeks. https://www.royalberkshire.nhs.uk/patient-information-leaflets/maternity-preterm-birth-high-risk-or-22-to-24-wks-gestation.htm