About 1 in 10 babies worldwide is born prematurely — that is, before 37 weeks of pregnancy. For most families, this comes unexpectedly, and it can be frightening. But the more you know about the signs, risk factors, and what actually happens at the hospital, the more prepared you can feel.

This guide is about the birth itself — preparation, what to expect, and the first days afterward. Looking for information about life with a premature baby after the birth? See our guide to premature babies and the first weeks at home with a premature baby.

What Is Premature Birth?

A birth is considered premature when the baby is born before completing 37 weeks of pregnancy. Around the world, this happens in approximately 10 percent of all births — about 15 million babies each year.

Premature birth is divided into categories based on how early the baby arrives:

Category	Gestational Week	Share of Premature Births
Late premature	Weeks 34–36	Approx. 70%
Moderately premature	Weeks 32–33	Approx. 15%
Very premature	Weeks 28–31	Approx. 10%
Extremely premature	Before week 28	Approx. 5%

Most premature births occur in the final weeks before the due date. Babies born after week 34 generally have good outcomes, even if they need some extra support.

Signs of Premature Labor

Recognizing the signs of threatened premature labor can be crucial. Early treatment can sometimes delay labor by days or weeks — which makes a significant difference for the baby's development.

Signs to Watch For

Regular contractions — more than four per hour before week 37, not relieved by rest
Change in vaginal discharge — increased amount, watery, or blood-tinged
Pressure in the pelvis — a feeling of the baby pushing downward, heavier than usual
Back pain — constant, dull pain in the lower back that does not go away
Abdominal cramps — cramping that feels like menstrual pain
Water breaking — leaking amniotic fluid, either as a steady trickle or a sudden gush

Call your labor and delivery unit immediately if you have regular contractions before week 37, experience your water breaking, or have vaginal bleeding. Do not wait and see — early contact can make a big difference.

The Difference Between Braxton Hicks and Real Contractions

Many pregnant women experience Braxton Hicks contractions (practice contractions) in the later part of pregnancy. Here is how to tell them apart from real labor:

Braxton Hicks	Real Contractions
Irregular	Regular and increasing
Relieved by rest or changing position	Continue regardless of what you do
Felt mostly in the abdomen	Often start in the back and radiate forward
Do not get stronger	Gradually get stronger and more frequent
Last 30–60 seconds	Last 30–90 seconds, at regular intervals

If you experience regular contractions that are increasing in strength and frequency before week 37, contact your hospital.

Risk Factors for Premature Birth

Some women have an increased risk of delivering early. This does not mean it will necessarily happen, but it may affect the follow-up care you receive during pregnancy.

Medical Risk Factors

Previous premature birth — the strongest single risk factor
Multiple pregnancy — twins, triplets, or more
Short cervix — often detected on ultrasound around weeks 18–20
Preeclampsia — may mean labor needs to be induced early
Infections — urinary tract infections, bacterial vaginosis, or other infections
Gestational diabetes — in some cases
Uterine abnormalities — unusual shape of the uterus
Placenta problems — placenta previa or placental abruption

Lifestyle Factors

Smoking and tobacco use — significantly increases risk
High stress levels — prolonged stress can affect pregnancy
Poor nutrition — inadequate nutrition during pregnancy
Short time between pregnancies — less than 18 months between birth and new pregnancy

Factors You Cannot Control

Age — under 17 or over 35
Ethnicity — some groups have statistically higher risk
Genetics — family predisposition

Even if you have one or more risk factors, it is important to remember that most women with risk factors carry their baby to term. Talk to your doctor or midwife about what applies to your situation.

What Happens at the Hospital?

When you arrive at the hospital with suspected premature labor, a series of examinations and interventions are quickly initiated.

Examinations

CTG monitoring — your baby's heart rate and your contractions are measured continuously
Cervical length measurement — ultrasound to measure the length of the cervix
Fetal fibronectin test — a test that can help assess whether labor is imminent
Blood tests — to check for infection and other conditions
Urine sample — to rule out urinary tract infection

Treatment to Delay Labor

If possible and medically appropriate, doctors will try to delay labor. Every extra day in the womb is valuable for the baby's development.

Tocolytic medications: Drugs that can slow or temporarily stop contractions. These are usually used to buy time — often 48 hours — so that other important treatments can be given.

Lung maturation with corticosteroids: If labor threatens before week 34, the mother receives injections of corticosteroids (usually betamethasone). These mature the baby's lungs and reduce the risk of breathing difficulties after birth. Treatment is typically given as two injections 24 hours apart.

Magnesium sulfate: If delivery is threatened before week 32, magnesium sulfate may be given to protect the baby's brain from injury.

Antibiotics: If the membranes have ruptured prematurely, antibiotics are given to prevent infection.

When Is Labor Allowed to Proceed?

Not all premature labors can or should be delayed. Labor is allowed to proceed when:

The mother's or baby's health is at risk
There are signs of infection
Placental abruption
Severe preeclampsia
Labor has progressed too far to be stopped

The Premature Birth Itself

A premature birth can happen either vaginally or by cesarean section, depending on the situation.

Vaginal Premature Birth

Many premature births happen vaginally, especially when the baby arrives after week 32. The birth process resembles a regular birth, but with some differences:

More specialists present — a neonatologist and neonatal nurses are often in the room
Continuous monitoring — the baby is closely monitored throughout labor
Careful progress — doctors and midwives are extra attentive to the fact that premature babies are more vulnerable
Incubator ready — equipment to warm and stabilize the baby is prepared

Cesarean Section

A cesarean may be necessary for:

Breech position (baby bottom-first)
Placenta problems
Severe preeclampsia
Fetal distress
Very early birth where vaginal delivery is considered too risky

The First Moments After Birth

What happens right after birth depends on how early the baby is and how they are doing.

Babies born after weeks 34–36: Many of these babies can be placed directly on the mother's chest for skin-to-skin contact. They may need a little extra monitoring but often manage without intensive care.

Babies born before week 34: These babies are often quickly taken to the NICU for stabilization. Parents usually get to briefly see the baby before they are moved. Skin-to-skin (kangaroo care) starts as soon as the baby's condition allows.

Babies born before week 28: These extremely premature babies need immediate intensive care with a ventilator, temperature regulation, and close monitoring.

Even if it feels overwhelming to see your baby connected to tubes and machines, remember that each of these helps do a specific job. Ask the staff if you are unsure about anything — they are used to explaining.

The NICU — What to Expect

For many parents, the time in the NICU is an emotional rollercoaster. Here is what is useful to know:

Equipment You Will See

Incubator — keeps the baby warm and protected
Ventilator or CPAP — helps with breathing
Monitors — tracks heart rate, oxygen levels, and breathing rate
IV access — for fluids, nutrition, and medications
Feeding tube — for feeding if the baby cannot nurse on their own

Your Role as a Parent

You are not just a visitor in the NICU. You are the most important person in your baby's life.

Kangaroo care — skin-to-skin contact is one of the most effective treatments for premature babies
Care — you can participate in diaper changes and care as soon as the baby is stable enough
Breastfeeding and pumping — start pumping early to establish milk production
Talking and singing — your baby recognizes your voice and needs closeness

How Long Will the Baby Stay?

As a rule of thumb: babies typically stay in the NICU until around their original due date, but this varies. Babies born at weeks 34–36 can often go home after a few days to a couple of weeks. Very premature babies may need months.

Preparation — What Can You Do?

Even though a premature birth cannot always be predicted, you can prepare.

Practical Preparation

Pack your hospital bag early — pack your bag around weeks 28–30 instead of week 36
Baby clothes in small sizes — premature babies often need very small sizes (preemie or newborn)
Inform your workplace — let them know that parental leave may start earlier than planned
Insurance — check that your health insurance covers a potentially extended hospital stay

Mental Preparation

Talk about it — share worries with your partner, friends, or healthcare provider
Learn about the NICU — many hospitals offer tours for pregnant women with risk factors
Find support — look for organizations that support families of premature babies
Have a backup plan — think through what happens with older children, work, and other commitments

Birth Plan Considering Premature Birth

If you have risk factors for premature birth, it may be worth creating a birth plan that accounts for different scenarios.

Some questions to think through:

Who should be contacted immediately?
Who will care for any older children?
Do you want your partner to follow the baby to the NICU?
Do you want to try breastfeeding, pumping, or a combination?

Emotional Reactions

A premature birth often triggers strong emotions in both parents. It is completely normal to experience:

Shock and disbelief — even if you knew it could happen
Guilt — many mothers wonder if there was something they could have done differently
Grief — for the birth you had imagined but did not get
Fear — for your baby's health and future
Helplessness — seeing your baby in an incubator and not being able to do more
Anger — directed at your body, the system, or the situation

All of these feelings are normal. Talk with the NICU staff, your partner, or a therapist. Many hospitals have parent support services available.

Rights and Parental Leave

Parents of premature babies have specific rights:

Family and Medical Leave — check whether you qualify for FMLA or similar protections to care for your hospitalized baby
Extended parental leave — the leave period may be adjusted to account for early birth
Short-term disability — the mother may qualify for additional leave
Workplace rights — your employer may need to make accommodations

Contact your HR department or a social worker at the hospital early to clarify your rights. A hospital social worker can also help you navigate insurance claims and paperwork.

What Comes Next?

After the initial acute phase, a new phase begins. Here are some resources:

Read our guide to premature babies and development
Prepare for the first weeks at home with a premature baby

Frequently Asked Questions About Premature Birth

What Are the Signs of Premature Labor?

The most common signs are regular contractions before week 37 that are not relieved by rest, change in vaginal discharge, pelvic pressure, persistent back pain, abdominal cramps similar to menstrual pain, and water breaking. Contact labor and delivery immediately if you experience these symptoms.

Can Premature Labor Be Stopped?

In some cases, tocolytic medications can slow contractions temporarily. The goal is often to buy 48 hours so that lung maturation can be given. Not all premature labors can be delayed, and doctors always assess what is safe for mother and baby.

What Are the Risk Factors for Premature Birth?

The most important risk factors are previous premature birth, multiple pregnancy, short cervix, preeclampsia, infections, and smoking or tobacco use. Age under 17 or over 35, short time between pregnancies, and genetic predisposition are also factors.

When Does the Baby Get Lung Maturation Treatment?

Lung maturation with corticosteroids is typically given when there is a risk of birth before week 34. The treatment consists of two betamethasone injections given 24 hours apart.

How Long Will a Premature Baby Stay in the Hospital?

It varies widely. Babies born at weeks 34–36 can often go home after a few days to a couple of weeks. Babies born before week 32 may need several weeks to months.

Can I Breastfeed a Premature Baby?

Yes, breast milk is especially important for premature babies. Babies who are too small to nurse can receive breast milk via a feeding tube. Start pumping as early as possible after birth to establish milk production.

Do Parents of Premature Babies Have Special Leave Rights?

Yes, many countries and employers have provisions for parents of hospitalized newborns. Contact your HR department or a hospital social worker to clarify your rights and options.

Sources

WHO. "Preterm birth." who.int
AAP. "Caring for a Premature Baby." healthychildren.org
CDC. "Preterm Birth." cdc.gov
ACOG. "Preterm Labor and Birth." acog.org
March of Dimes. "Premature Birth." marchofdimes.org