Early Term birth. ‘Every week counts’.

What is this information about?

This information is about early term birth. A birth is called an early term birth if it happens between 37 and 39 weeks. 

This information explains: 

• why you may be offered an early term birth
• why the last weeks of pregnancy are important for your baby’s health
• what the risks of an early term birth may be for your baby when they are born, just after they are born (the neonatal period), and later in their life.

Why have I been given this information?

This information can help you decide whether to have an early term birth (an ‘early delivery’).  

This information tells you about the possible risks to you and your baby if you do, or do not, have an early term birth. When you know this information, you can make a decision knowing what might happen. This is called an ‘informed decision’.

What other information will I get to help me to decide whether to have an early term birth?

The maternity team (doctor or midwife) will explain the risks to you or your baby that you need to think about when deciding if your baby should be born before 39 weeks.  

They will also explain: 

• that deciding to have an early term birth means that you will need to have an induction of labour or caesarean
• what happens if you have either of these

When might I be offered an early term birth?

There are guidelines on when to offer early term birth which all maternity staff in England should follow (national guidance). This includes guidance from the National Institute of Clinical Excellence (NICE) and Saving Babies Lives (version 3). 

This national guidance aims to balance the rare chance of severe harm happening to a small number of babies against the chance of less severe harm happening to a relatively larger number of babies.   

Less severe harms might include, for example, a baby needing help to breath (having air through a breathing tube). These harms may only cause a problem that lasts for a few days or weeks. Other harms could last longer or even be for life. For example, having Special Educational Needs. 

Severe harm includes things such as brain injury, stillbirth, or your baby dying in the days or weeks after they are born.

Who decides whether I will have an early term birth?

You will decide.   

The guidance is based on what has happened in many other people’s pregnancies. It is not based on your own situation. You should consider both the guidance and your own situation before making an informed decision.

This is why the guidance says that although the maternity team must offer you an early term birth if they think that it is the best thing for you and your baby, the final decision is yours. You can say yes or no to the offer.

The maternity team will support you to help you to decide.

How likely is it that a baby will benefit or be harmed by induction of labour at 37 weeks?

If women and pregnant people with a low-risk pregnancy had an induction of labour at 37 weeks it would take 700 inductions to prevent one baby dying in the neonatal period. 

Those 700 inductions would result in ten percent (or seventy) babies having to stay in hospital (be admitted) for neonatal care.  

The chances that a baby will need to be admitted to a special care baby unit (SCBU) or neonatal unit after they are born gets less as the pregnancy gets closer to full term. A baby born at 37 weeks is twice as likely to need to be admitted to a special care baby unit or neonatal unit as one born at 38 weeks. 

Babies who need to be admitted for neonatal care stay in for an average of seven and a half days. This is an important time for you to bond with your baby and establish feeding. This can be more difficult if they are on the special care baby unit or neonatal unit.  

National guidelines only advise early birth when the benefits outweigh the risks.

What complications might there be if my baby is born between 37 and 39 weeks?

The last few weeks of pregnancy are very important for your baby’s health and development. 

Babies’ brain and lungs continue to develop throughout pregnancy. Early term birth (37 to 39 weeks) may mean a baby’s brain and lungs do not develop as well as if they had been born at or after 39 weeks.

When your baby is born before 39 weeks:

• it may be difficult: 
  • to keep their temperature at the right level 
  • to keep their blood glucose (blood sugar) at the right level 
• they may get jaundice 
• their body may not be as good at fighting infections 
• they may have trouble with breathing and need oxygen treatment.

How could early term birth affect how well my baby is able to breathe on their own

Your baby’s lungs keep growing and getting ready to breathe until your baby is born. If your baby is born early their lungs may not be fully developed. This can mean that your baby gets tired easily and that the effort of breathing causes them some distress. 

Some early term babies may need support with breathing (for example they may need to have oxygen through an oxygen mask) or need to be admitted to the Special Care Baby Unit or neonatal unit.

Research that has looked at babies who had an early term birth when they are older show that they may be more likely to:

• have a wheeze
• need an inhaler or antibiotics (medicines to fight infections).

Is there anything that can be done to reduce the chance that my baby may have respiratory (breathing) difficulties if they need an early term birth?

If your baby needs an early term birth, the maternity team may offer you steroid injections. These can reduce the chance that your baby will have respiratory problems or make the problems less severe.

Not everyone who is having an early term birth will be offered a steroid injection. This will depend on your situation and what type of birth is planned.

How could early term birth affect my baby’s brain development?

Brain development is very important for learning, movement, and co-ordination.

By 38 weeks gestation (early term), a baby’s brain is about 90% developed, so it still has 10% of its development to go.

Cognitive, language, and social skills of babies born early term may be affected. Cognitive skills are what the brain uses to think, pay attention, concentrate, process information, and remember things.

Some research has linked early term birth with children going on to have Special Educational Needs.

• One additional child will have SEN for every 60 inductions at 37 weeks.
• One additional child will have SEN for every 120 inductions at 38 weeks.
• One additional child will have SEN for every 250 inductions at 39 weeks.

The recent UK Millennium Cohort Study found that children born early term:

• may not do as well in primary school.
• do not appear to do any worse than other children at secondary school

We are still learning more from research about how being born early can affect babies in later life.

Who can I contact if I would like further information or support after I have read this information?

If you need further information or support, you can ask your community midwife or obstetrician at your next appointment or contact the Maternity triage line, phone: 01903 285 269.