What Happens After a Premature Birth

Who is in the room

A preterm birth is attended by two teams. The maternity team looks after you. A separate neonatal team — usually a doctor or advanced neonatal nurse practitioner and one or two neonatal nurses, more if the gestation is very early — arrives beforehand and sets up in a corner of the room. What they set up is the thing people remember: a flat warmed platform under a heater, a hat, a plastic wrap or bag, an oxygen blender, a mask and a small bag or T-piece for giving breaths.

It looks like preparation for a disaster. It is preparation for a preterm birth, and it happens whether or not anything goes wrong.

The cord

NICE guideline NG25 says to wait at least 60 seconds before clamping the cord of a preterm baby, unless there are specific maternal or fetal conditions that need earlier clamping, and to position the baby at or below the level of the placenta while waiting. Extra blood from the placenta in that first minute helps a preterm baby's blood pressure and blood count.

Some units do this with the baby on your abdomen or a warmed surface beside you, sometimes with a nurse drying and warming them where they lie. If you notice a pause before anybody appears to do anything, that is usually what is happening, and it is deliberate.

Warmth comes before almost everything

A very preterm baby can lose a dangerous amount of heat within minutes. The hat, the plastic wrap and the warmed platform go on immediately, often before any breathing help. A cold baby uses up energy and does worse in every measurable way, so what looks like fussing about temperature is one of the most important things happening.

Breathing

NICE guideline NG124 says that when stabilising preterm babies who need respiratory support soon after birth and before admission to the neonatal unit, teams should use CPAP where clinically appropriate rather than invasive ventilation. In the room this usually looks like a small mask held gently over the nose and mouth, delivering steady pressure while your baby's own breathing establishes.

Some babies need a tube passed into the windpipe and surfactant, the treatment that replaces the substance keeping tiny air sacs from collapsing. NG124 says to give surfactant to preterm babies needing invasive ventilation for stabilisation, and, in babies who do not need it, to use a minimally invasive technique. Both routes are normal and neither is a verdict on how the pregnancy went.

Will I see my baby

Usually yes, briefly, before they are taken to the unit — often through the side of a transport incubator rather than in your arms. Ask to see them and to touch them if it is possible. If you were under general anaesthetic, or if your baby had to be moved immediately, ask for photographs to be taken at the cot side; most units do this as a matter of course and will bring them to you.

It is common to feel nothing much in that moment. Shock, anaesthetic, blood loss and the sheer speed of it all flatten the response people expect to have. That is not a failure of bonding and it does not predict anything.

The transfer to the unit

Your baby is moved in a transport incubator, sometimes only along a corridor. The first hour on the unit is about lines, monitoring, warmth and, often, an X-ray. It is usually the busiest hour of the admission, which is why you may be asked to wait a short time before coming in. Ask for a time to be given rather than left open.

The first phone call and the first visit

Bliss notes that units keep parents up to date on their baby's care in the first few hours, and that you can call the unit at any time, day or night, for an update. Ask for the unit's direct number before you need it, and ask what name your baby has been admitted under if you have not chosen one yet.

If you cannot get to the unit because of your own recovery, NICE NG124 says information for hospitalised mothers who cannot visit their baby should be delivered by a senior healthcare professional, face-to-face wherever possible. That is a standard you can hold people to.

If you were transferred before the birth

Being moved to another hospital before delivery, sometimes a long way from home, is a common part of preterm care rather than a sign that something has gone badly. Babies do better when they are born in a hospital with the right level of neonatal care attached, so moving the mother before birth is preferred to moving the baby afterwards.

Your own recovery is not a footnote

Preterm birth is often also a difficult birth: a caesarean, blood loss, pre-eclampsia, an infection. You may be recovering seriously while trying to be at a cot side. Ask for a wheelchair. Ask for pain relief that lets you sit up and express. Ask for your postnatal checks to be brought to you rather than skipped. Bliss suggests preparing practical things in advance where you know a neonatal admission is likely, including how you will travel to and from the unit — and if there was no warning at all, that is what the family support worker on the unit is for.

Expressing starts sooner than feels reasonable

Within the first hours, before you feel remotely ready, somebody will suggest hand expressing colostrum. It is the single most useful physical thing you can do in the first day, and drops are worth collecting. If nobody has offered by a few hours after birth, ask.