About Preterm Labour & Birth

I am the mother of two perfect preemies. One of them survived. One of them did not. Such is the tragic unpredictably of prematurity. 

My son, Max, was born at 23 weeks gestation after I went into spontaneous preterm labour, for no identifiable reason. Whilst survival rates of babies born prematurely have increased dramatically over the last couple of decades, unfortunately, for babies born before about 24 weeks, the chances of survival are still extremely poor. Research shows that this is the real 'threshold of viability', before which babies cannot be expected to survive outside the womb, no matter the interventions provided.

Preterm birth is unfortunately more common than you'd think. According to Australia's National Health and Medical Research Council, every year over six percent of pregnancies in Australia end in preterm birth, defined as less than 37 weeks gestation. It is well established that being born too early is the single largest cause of death and illness for newborn babies, but exactly what causes preterm birth is still largely unknown.

Survival rates of babies born prematurely have increased dramatically over the last couple of decades. Unfortunately, for babies born before 24 weeks, the chances of survival are still extremely poor. Research shows that this is the real 'threshold of viability', before which babies cannot be expected to survive outside the womb, no matter the interventions provided. My own obstetrician is of the opinion that it is unlikely the outcomes for such babies born earlier than 24 weeks will improve much in the future because major organs are still so underdeveloped at this stage.

The Medical Journal of Australia reports the following guidelines for perinatal care for babies, like Max, born on the borderline of viability:

Table taken from: http://embryology.med.unsw.edu.au/Child/birthpremature.htm#Preterm_Birth_Factor

For the very small number of babies born before 24 weeks who do survive (and there a handful of famous cases), most will have significant disabilities that would severely impede their ability to live a life of any reasonable quality and independence. Active resuscitation of babies at Max's gestation is therefore discouraged because the expected outcomes are so very dire. 

As was the case with Max, palliative care is instead recommended in these situations. Max was a very strong little boy - he lived for six hours and we were able to hold him for every minute of that time. Had resuscitation been initiated, he would have been rushed away from us to NICU, and most likely would have died alone and attached to multiple machines before we ever had the chance to know him. Though it is very confronting to have doctors tell you they can't help your baby - that the best thing for him is to do nothing - we remain very glad that he got to spend his whole life in our arms, and that he passed away peacefully with his mummy and daddy at his side. 

Researchers at the Royal Women's Hospital where Max was born, and elsewhere at specialist clinics around the world, are conducting research that aims to identify the mechanism that causes preterm labour so that it can be more adequately predicted, and as a consequence, prevented. 

Thanks to this research, and the incredibly hard work of the specialist preterm labour clinic at this hospital, I experienced a successful subsequent pregnancy, bringing home my beautiful daughter, Alice. I knew that a previous preterm birth was one of the most significant predictive factors of it happening in another pregnancy, and I was monitored fortnightly from 14 weeks gestation.

At 26 weeks I tested positive for fetal fibronectin, indicating that there was a fair chance I could go into labour at that point. Alice was born prematurely, but at the opposite end of the spectrum to her brother. She held out until 35 weeks, an amazing feat, ensuring she was well and strong at birth, and in need of only a ten day stay in Special Care for treatment of her jaundice, feeding issues and weight loss.