Approximately eight to nine percent of all babies are born prematurely, so-called “preemies” — but what exactly does “premature” mean? There is an endless amount of information about preterm births and their causes. In this article, we have summarized the most common risk factors for preterm birth, how you can help prevent it, and how to best support your prematurely born child.

When is a birth considered premature?

A baby is considered premature if it is born before the completion of the 37th week of pregnancy . Additionally, preterm infants are divided into three different groups based on their weight:

· Newborns with extremely low birth weight (under 1,000 grams)

· Newborns with very low birth weight (1,000 to 1,500 grams)

· Newborns with low birth weight (1,500 to 2,500 grams)

Only about one percent of all newborns weigh less than 1,500 grams. These babies have a significantly increased risk of complications. Long-term studies fortunately show that most preterm infants not only survive, but also go on to lead largely carefree lives.

Causes and Risk Factors of Premature Births

There are various risk factors that increase the likelihood of a premature birth. Over the past ten years, the number of children with low birth weight has nearly doubled. There are different reasons for this: for example, an increasing number of pregnancies resulting from fertility treatments due to conception problems, which can prevent the embryo from implanting optimally. Another factor is that more and more mothers are having babies at an older age. Additionally, multiple pregnancies also increase the risk of preterm birth, as they place greater stress on the cervix and placenta. Other possible risk factors include:

• Repeated miscarriages or preterm births

• Repeated surgeries on the uterus, such as curettages, myomectomy, and removal of parts of the cervix.

• Alcohol or nicotine consumption and drug use during pregnancy

• Maternal illnesses, especially vaginal infections, but also preeclampsia, HELLP syndrome, and diabetes mellitus

• Especially advanced or young maternal age

• Placental insufficiency , premature placental abruption or placenta previa

• Increased amniotic fluid production and overdistension of the uterus due to fetal malformations (for example, spina bifida)

Not least, premature labor can also be a warning sign from your baby — for example, due to a threatened undersupply through the placenta. Since so-called high-risk pregnancies are now closely monitored medically from the beginning, early births and miscarriages can be prevented more and more often. Only 9.2 percent of all births in Germany are premature. Some risk factors, such as the risk of infection, can be positively influenced by you in consultation with your doctor. In any case, regular check-ups during pregnancy are important. They allow potential causes of premature birth to be identified early and treated promptly, if necessary. Thanks to the intensive care and treatment available today, premature babies now also have the best chances of becoming healthy children.

Signs of a premature birth

A threatened premature birth is often signaled by premature labor or the bursting of the amniotic sac . In addition to these unmistakable symptoms, there may be other signs indicating that your baby could be on the way too early:

• Menstrual-like cramps

• Discharge (often foul-smelling and discolored) as a sign of infection

• Vaginal bleeding

• Loss of amniotic fluid

If you notice any of these signs, you should contact your gynecologist as soon as possible or go to the emergency room. Spotting in early pregnancy does not necessarily have to be alarming, but it’s better to be safe than sorry. Your doctor will examine you and check whether your symptoms indicate a threatened preterm birth. Depending on your week of pregnancy, your baby’s heartbeat will be monitored using a CTG, and your baby’s well-being will be assessed. Additionally, he or she will examine the position and structure of the placenta, the amount of amniotic fluid, and the length and opening of the cervix.

Depending on the results of the examination, treatment will then be initiated. In the case of an infection, for example, it can often be treated well locally. The natural immune flora can be supported or restored with antibiotics or antimycotics, as well as so-called lactic acid bacteria. Before the 34th week of pregnancy, your baby’s lung maturity can also be promoted through corticosteroid treatment if, after thorough testing, a birth is actually imminent. This is very important if a premature birth does occur. Most hospitals perform so-called fibronectin tests, which can predict or rule out a birth within the next 7–14 days with a high degree of certainty. Fibronectin is a protein and component of the amniotic membranes that can be detected very early in vaginal secretions, even before labor-relevant contractions begin or a rupture of membranes occurs. With the help of these tests, it can also be decided whether active labor suppression or treatment for lung maturity is necessary. This can be important if there are no objective criteria, such as a shortening of the cervix or a rupture of membranes, that make these treatments necessary. You may be prescribed bed rest or labor-suppressing medication to prevent an early birth. Or — if your little explorer is already far enough along — preparations for birth are made. In the case of a premature birth, delivery should, if possible, take place in a hospital with neonatology to ensure your baby receives the best possible medical care after birth.

Challenges of premature children

The earlier your baby is born, the less developed their organs and immune system are, and the more support they may need outside the protective womb. From the 23rd week of pregnancy, a baby is medically considered viable, and with each additional week, the risk of potential (late) consequences decreases. Birth weight also plays an important role in the health of premature infants: if a baby weighs over 2,500 grams at birth, their chances of survival are already 200 times higher than with a birth weight under 1,500 grams. Children born during this phase of pregnancy are examined especially intensively for neurological problems. Very small premature infants also receive particularly comprehensive medical care to help prevent seizures, visual and hearing impairments, chronic lung problems, and developmental disorders.

An important milestone, so-called lung maturity, is reached by babies after the completion of the 34th week of pregnancy; prior to that, it can be medically supported with corticosteroid administration in the case of threatened preterm labor ( RDS Prophylaxis ). In addition, prematurely born babies receive special care due to these potential secondary illnesses:

• Brain hemorrhages

• More frequent infections due to an immature immune system

• Intestinal inflammations, stomach pains, bleeding

• Retinopathy of prematurity (changes in the retina of the eye)

• Hyperglycemia (too low blood sugar level)

The goal of special monitoring is to diagnose these conditions early and, if possible, prevent them. You and your baby will be cared for especially closely by medical professionals in the hospital after a premature birth. Don't hesitate to ask your questions!

Prevention

First and foremost: Premature births can rarely be influenced by the mother’s behavior. The factors that trigger them are very diverse and highly individual. However, you should be strict about avoiding nicotine, alcohol, or other drugs — not only is there a proven, significantly increased risk of preterm birth, but also an increased risk of early or late miscarriages. Passive smoking is also among the known risk factors. If you have concerns or worries, talk to your midwife or your doctor about them. In many cases, they can reassure you. Regular check-ups are also very important so that risks can be identified early and treated if necessary. Especially if you have an increased risk — perhaps because you have experienced it before — you should discuss the possibility of more frequent check-ups with your doctor. Additionally, you can inform your midwife early about your fears and concerns and attend regular check-ups with her in parallel.

Many premature births are also linked to infections in the uterus or the vagina in the mother. Even though an infection can have various causes, there are some things you can do during pregnancy to help prevent it, primarily by maintaining good hygiene.
If you suspect that an infection might be present (for example, because your intimate area itches or you have unusual discharge), you should see your doctor as soon as possible for treatment. A robust immune system can also help defend against such infections. Balanced Nutrition and appropriate exercise are always beneficial — and your midwife and doctor will be happy to advise you. For recurrent infections, you should regularly treat the intimate area with lactic acid derivatives in suppository or cream form to stabilize the vaginal flora and help prevent local infections.
In some cases, surgical stabilization of the cervix, known as prophylactic cerclage, may be advisable. Especially if your cervix is shortened, you have had cervical surgery, or you suffer from cervical insufficiency or premature opening of the cervix, your doctor will consider this option. From the 16th week of pregnancy, your cervix can be surgically reinforced to help prevent premature opening.

In any case, information about possible risks is very important for the prevention of preterm births. You should adapt your daily routine as much as possible to your pregnancy and avoid risk factors. Of course, you don’t have to wrap yourself in cotton wool. Even while pregnant, you can continue to lead an active and colorful life. Talk to your trusted medical professionals about how you can manage this during pregnancy. In our magazine articles on the topics “ Pregnant – and now? ", “ Pregnancy Roadmap " and " What should be considered during pregnancy? "you will also receive helpful tips and tricks."

Myths about premature birth

During pregnancy, parents often worry a lot. When complications occur, these worries can turn into concerns or even self-blame. But we can reassure you: for many of the myths surrounding preterm birth, there is absolutely no scientific evidence. Some of them are listed here for you.

• Swimming: Swimming is generally very healthy for pregnant women. It is a joint-friendly way to stay active. The risk of infection is also not increased. If your doctor has no objections, there is nothing wrong with swimming a few laps in the pool.

• Worries, arguments, and negative thoughts: Of course, it’s good to stay as relaxed as possible during pregnancy. But let’s be honest — it doesn’t always work that way. Hormones often play their part. And as long as you’re not under constant stress, your baby can handle it wonderfully. However, if you feel that you’re doing unusually poorly mentally, talk to your doctor. It happens, and there’s no reason to feel bad or even ashamed.

• Air Travel : Basically, you can fly without any problems during pregnancy. The changes in cabin pressure and the metal detectors at the airport do not pose a danger to your baby. You’ll be on the safe side if you discuss your travel plans with your gynecologist — in special cases, flying during pregnancy is actually advised against.

• Sex during pregnancy: In a complication-free pregnancy, you are allowed to do what you enjoy. Your baby is well protected in the amniotic sac. If you have experienced a miscarriage or other pregnancy complications, you should consult your doctor here as well. Condoms are not necessary for prophylactic infection protection. However, if a known infection is present in one of the partners, the infection should be treated before resuming sexual activity.

• Need to eat more during pregnancy: Of course, you should not go on an active diet during pregnancy, but eating more to adequately nourish the baby is absolutely not necessary. Consuming significantly “more than necessary” can even increase the risk of supply issues such as diabetes or high blood pressure — and therefore the risk of a premature birth.

Postpartum and Maternity Leave

The period after a premature birth is full of challenges for your baby, you, and your partner. Your little explorer is probably lying in a warm bed, possibly connected to some devices, and is closely monitored by doctors and caregivers to observe or regulate his/her bodily functions and to treat or prevent potential complications. But even if you might feel a little helpless during this time — you can do a lot for your baby!

• Body contact:
  An important factor for your baby’s development is body contact. Therefore, many hospitals place great importance on your baby spending as much time as possible with you or your partner — best skin to skin . This is called "Kangarooing" , and it means hours of cuddling with your baby — sounds great, doesn’t it? This way, you give your little explorer warmth and security and also become more confident in handling your baby. Additionally, it has been proven to strengthen your little explorer’s vital functions and help them get the best possible start in life.
  

• Breast milk:
  Preterm infants often cannot digest milk properly yet and are therefore initially given preterm formula made of sugar and water, sometimes via a tube if they lack the strength to suck. Once your little explorer is able to digest milk, expressed breast milk can be beneficial for them. Colostrum and milk from mothers of preterm infants contain important nutrients in particularly high concentration . It also helps build your baby’s gut flora and immune system. You will be advised on this in the hospital if necessary.
  

• Preemie clothing and diapers:
  Preterm babies are often very small. Most diapers in the smallest size are suitable for babies from 2 kilograms of weight, including the LILLYDOO diapers . For smaller babies, there are special preemie diapers available at the hospital. Clothing for premature babies is now also available in retail stores. You should opt for natural, minimally processed materials to avoid irritating your little explorer’s skin. There are also very special preemie clothes online, featuring small pockets and openings for medical devices and tubes, and they can be easily opened and closed with Velcro fasteners.
  

• Help and Support:
  The medical staff at the hospital are experienced in caring for premature infants. Even on the ward, you will be prepared for the care and nursing of your baby at home. Use this time to build as much confidence and security as possible.
  
  Even after your hospital stay, a midwife can support you. You have a legal entitlement to this for at least twelve weeks, and if needed, even until the end of breastfeeding. With a corresponding certificate, many health insurance providers also cover a household help, and you could be entitled to an extended Mutterschutzfrist have.

Additionally, good medical care is important for premature babies, as potential long-term effects are often not immediately detectable. A good doctor will guide you and your little explorer safely and competently through childhood.

Life with preemies

The start of family life together may have gone differently than planned and perhaps wasn’t
very easy. But you are not alone in this. You can get (medical)
support, and it’s completely okay to accept it and
make use of it. Check with your health insurance provider to see which treatments and
support services are covered. Almost all neonatology
units have a so-called “Early Help Program” in cooperation with social pediatric
centers. Here, prematurely born children are supported by experts over the course of years
so that they can develop in the best possible way.

Your little explorer will certainly not miss out on love, warmth, and affection,
but don’t forget about yourself and your partner, too. The mother’s postpartum period
should not be neglected either. When family or friends offer support, listen to yourself
and accept what feels good for you. And if you like, talk about your experiences
with the premature birth — whether with your midwife, friends,
family, or in a self-help group. Sharing can
help. We wish you all the best for the future with your little
explorer!