What happens if I'm told I am at risk of premature (preterm) birth?

Monitoring and tests

Treatments to prevent premature labour

Threatened preterm labour

Going into spontaneous premature labour

Planned premature birth

Looking after your mental health

Premature birth, also called preterm birth, is when a baby is born before 37 weeks of pregnancy.

Premature birth may happen spontaneously, which means that a premature labour starts on its own, naturally. It’s not always possible to predict who this will happen to. But you may be told ​you are at higher risk​. If you are, your healthcare team will monitor you closely. They ​will aim to ​prolong your pregnancy for as long as ​safely ​possible. This will give your baby more time to develop in the womb.

The care you’ll be offered to reduce your risk of giving birth prematurely ​​will depend on why you are at risk. Read more about the causes of preterm birth and things you can do to reduce your risk.

Sometimes a premature birth may need to be planned because it’s the safest thing to do for your health or your baby’s health.

Monitoring and tests

When you first see a midwife at your booking appointment, they will assess whether you are someone who would benefit from extra monitoring, such as scans to check your cervix. This monitoring will be offered by midwives and doctors who are specialists in looking after people who are at increased risk of having a premature baby or other pregnancy complications.  

You may be told you are at ‘high risk’ or ‘intermediate risk’ of preterm birth, depending on your medical history. This will help guide how often you are offered monitoring. You might not need treatment, but it can be reassuring to know your team is keeping a close eye on you and your baby through your pregnancy.

If your midwife or doctor thinks you may go into labour early, they may offer you some tests. 

Having a cervix shorter than 25mm has been linked to increased risk of preterm labour and birth. You may be offered a vaginal ultrasound scan to measure your cervix, usually between 16 and 24 weeks. This can be helpful for decisions about possible treatment.

You might also be offered tests for possible infection and to check your baby’s heartbeat.

Treatments to prevent premature labour

You may be offered treatment to help prevent preterm labour if:

• you've given birth at less than 34 weeks pregnant before
• you've had a miscarriage after 16 weeks pregnant before
• your waters have broken before 37 weeks in previous pregnancies
• your cervix has been injured in the past, such as through surgery
• your cervix is shorter than expected (measured with a vaginal ultrasound scan).

Your treatment may depend on why you are at risk of premature birth and your previous pregnancy history.

You may be offered a choice between cervical stitch or vaginal progesterone. Your healthcare team may recommend one over the other, but your preferences will be important.

Putting a stitch into your cervix (a cervical stitch) can help keep it closed and reduce your risk of having a preterm birth. The stitch is removed before you have your baby, usually at 36 to 37 weeks if you haven’t gone into labour sooner. Read more about having a cervical stitch.

Treatment with vaginal progesterone involves putting a progesterone medication into your vagina, usually up until 34 weeks of pregnancy.

There is no evidence to show that one of these two treatments is better than the other.

Your midwife or doctor will discuss with you the risks and benefits of treatments. Your circumstances and your preferences will be important.

Read more about treatments to prevent preterm birth. 

Threatened preterm labour

Threatened preterm labour is when you have contractions before 37 weeks but your cervix hasn’t started to get shorter and thinner ready for your baby to be born. Most people with threatened preterm labour do not go on to have a preterm labour and birth. If you think you may be going into premature labour, call your hospital or your maternity unit straight away for advice. They will usually tell you to go straight to hospital, and they may send an ambulance for you or tell you to call one.

Read about the signs and symptoms of preterm labour. 

Going into spontaneous premature labour

If you go into labour before 34 weeks, you may be offered a medicine to try to slow down the labour or delay the birth. 

Your midwife or doctor will discuss possible treatments with you. They will consider:

• how many weeks pregnant you are
• whether it might be safest for your baby to be born without delay
• what neonatal care facilities are available
• your preferences.

You may also be offered medicine to:

• prevent your baby getting an infection
• help protect your baby’s brain and nervous system
• help your baby’s lungs develop.

Planned premature birth

Sometimes a premature birth may be planned and induced (started artificially) because it’s safer for the baby to be born early. This could be because of a health condition you have (such as pre-eclampsia) or that your baby has (such as fetal growth restriction). Read more about the causes of premature birth. 

Your midwife and doctor will discuss with you the benefits and risks of continuing with the pregnancy versus your baby being born premature. If you are offered an induction, or a c-section, your healthcare team should discuss with you the reasons why they are offering it and what the risks, benefits and alternatives are.  

You will be able to talk to them about what you would like to happen and make a birth plan. It is your decision. You should always be given the information you need to make a choice that feels right for you and your baby, based on your own situation. Read more about making decisions in pregnancy.  

​​They should talk to you about:​

• risks to your baby and their chances of survival
• what care your baby will need and where they will be cared for
• how preterm babies grow and develop.

You should also be able to speak to a doctor specialising in the care of preterm babies (a neonatologist) or a children’s doctor (paediatrician) and visit the neonatal unit where your baby will be cared for.

Read more about inducing labour.  

Looking after your mental health

Being told you are at risk of giving birth early can be overwhelming. Don’t be afraid to tell your healthcare professional how you feel. They won’t judge you and are there to support you.  

Read about mental health in pregnancy and sources of support.

You can also talk to a Tommy’s midwife for free from 9am–5pm, Monday to Friday on 0800 0147 800 or email them at [email protected]. Tommy’s Midwives also run a specialist Black and Black-Mixed Heritage Helpline too – you can book a call with them.