Tommy's PregnancyHub

My premature baby’s development in the womb – week 28

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

You’re now at the beginning of your third trimester. Your baby's heartbeat can now be heard through a stethoscope. Another person may even be able to hear it by putting an ear to your bump, although it can be difficult to find the right place. 

Your pregnancy symptoms

Bleeding

Bleeding after the first trimester can be a sign that there is a problem with the placenta, such as a low-lying placenta (placenta praevia) or placental abruption, which can both cause premature birth.    

Any bleeding in pregnancy should be investigated, even if you are not experiencing any other symptoms. If you are more than 12 weeks pregnant, go to your local A&E (in most areas, you’ll be told to contact your maternity unit rather than A&E) or contact the hospital maternity unit immediately so you can be checked, just in case. Find out more about bleeding in pregnancy

In the third trimester our advice is to go sleep on your side because research has shown that this is safer for your baby. This includes night sleep and daytime naps. Research has shown that in the third trimester (after 28 weeks of pregnancy) going to sleep on your back increases your risk of stillbirth. Try not to get overly anxious about this. 

We cannot control our position when we are asleep and a large bump is likely to be uncomfortable enough to prevent you from being on your back for long during the night. We also know that the position we go to sleep in is the position we spend the longest amount of time in during the night. If you wake up on your back, just settle back to sleep on your side. Find out more about safe sleep in pregnancy.

You will also have an antenatal appointment around this time. At this appointment, your midwife or doctor will: 

  • take some blood to check your iron levels
  • use a tape measure to measure the size of your uterus (womb)
  • measure your blood pressure and test your urine for protein
  • offer more screening tests
  • offer your first anti-D treatment if you're rhesus negative (a blood group) and it is deemed appropriate. 

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

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]

If your baby was born this week, they would be classed as very preterm (rather than extremely preterm). If your baby is born now, the medical conditions associated with severe prematurity become less serious. But they will still need specialist care in the neonatal baby unit. 

It is less likely that babies born now will have severe breathing problems requiring intubation (where a breathing tube passed through their mouth or nose and into their lungs) in the delivery room.

Some babies may not need a ventilator but will still need help with their breathing. Instead, they will have small prongs put into their nostrils or have a mask put over their nose connected to a machine (called ‘CPAP’) that provides air or oxygen with pressure to make the effort of breathing easier for them. Your baby may be given some medicine into their lungs, called surfactant, to help with their breathing. Find out more about breathing support for premature babies

The healthcare team will recommend caffeine treatment to help reduce or treat apnoea. Apnoea is a common condition where a baby may pause their breathing for a variable amount of time.  

Babies born at this stage are at risk of hypothermia (an abnormally low body temperature). When they are born, they will be placed into a clear plastic bag up to their neck to help keep them warm and protect their fragile skin. On the neonatal unit, they will be placed in an incubator that is humidified to keep them warm. 

They will need a thin tube passed through their nose or mouth into their tummy that milk can be given through. They will also need fluids or nutrition (a ‘drip’) through a thin tube into a vein (intravenous or IV line). This will often be into one of the veins in their umbilical cord. Find out more about feeding your premature baby in hospital

Babies born now may have low blood pressure so the healthcare team may also need to raise your baby’s blood pressure with extra fluids or medicines.  Your baby will also be tested and may be treated for infection. 

Your healthcare team will monitor your premature baby closely to make sure they receive the best possible care. 

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

NHS Choices. Vaginal bleeding in pregnancy. https://www.nhs.uk/conditions/pregnancy-and-baby/vaginal-bleeding-pregnant/ (Last published: 10 March 2021 Next review due: 10 March 2024)

Royal College of Obstetricians & Gynaecologists. (2018) Placenta praevia, placenta accreta and vasa praevia.
https://www.rcog.org.uk/en/patients/patient-leaflets/a-low-lying-placenta-after-20-weeks-placenta-praevia/

Platts, J., Mitchell, E.A., Stacey, T. et al. The Midland and North of England Stillbirth Study (MiNESS). BMC Pregnancy Childbirth 14, 171 (2014). https://doi.org/10.1186/1471-2393-14-171

NHS. Your antenatal appointments. https://www.nhs.uk/pregnancy/your-pregnancy-care/your-antenatal-appointments/ (Page last reviewed: 2 September 2019 Next review: 2 September 2022)

Macdonald, Sue (2017) Mayes’ Midwifery. London, Elsevier Health Sciences UK

NICE (2019) Specialist neonatal respiratory care for babies born preterm. NICE guideline 124. National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/ng124

Moschino L et al. (2020) Caffeine in preterm infants: where are we in 2020? ERJ Open Res. 2020; 6(1): 00330-2019.

Ballout RA et al. (2017) Body positioning for spontaneously breathing preterm infants with apnoea. Cochrane Database of Systematic Reviews 2017; Issue 1. Art. No.: CD004951. DOI: 10.1002/14651858.CD004951.pub3.

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

BMJ Best Practice (2021) Premature newborn care. https://bestpractice.bmj.com/topics/en-gb/671/pdf/671/Premature%20newborn%20care.pdf