The Preterm Optimisation Pathway is an evidence based pathway of care for babies born preterm that looks at seven different elements to help support your baby.
Preterm Prevention Clinics
The Preterm birth prevention clinics aim to provide extra care for women who may be at an increased chance of having a baby born early.
There are a number of things that can make preterm birth more likely, such as:
- Previous birth before 34 weeks
- Previous late miscarriage
- The water (amniotic sac) have broken before 34 weeks in a previous pregnancy
- Previous surgery or loop biopsy to the cervix after an abnormal smear
- Previous cervical suture to your cervix in a previous pregnancy
- An unusually shaped womb (uterus)
- Previous caesarean section when your cervix was full dilated (10cm)
At your booking appointment, your community midwife will ask you about your history and whether you have experienced any of the above events.
Smoking doubles the risk of preterm delivery
If you are currently smoking, your midwife will refer you to Stop Smoking Service. If you stop smoking, you and your baby will benefit from a reduced risk of preterm birth, stillbirth, growth restriction and sudden infant death syndrome (known as cot death).
If you are at higher chance of delivering your baby early based on your history you will be referred to a Specialist Consultant led clinic where they will discuss your care will you and help to develop a personalised plan of care.
Your care will involve additional surveillance from as early as 16 weeks and will involve transvaginal ultrasound of your cervix. Evidence suggests that a shortening cervix may mean that there is a higher chance that you could deliver your baby early. You will be seen in the Specialist Clinic following the ultrasound to discuss your results and develop an individualised plan of care.
When to seek advice
Sometimes there may be signs that you are going into labour. Often the signs do not lead to preterm labour but it is important to let a midwife know if you are experiencing any so you can get advice and be assessed if required.
These signs may include
- Period-like pains, cramps or ‘tightenings’ across your abdomen which come and go
- Signs of your waters breaking/fluid leaking from your vagina
- Bleeding from the vagina
If you think you may be in labour, DO NOT wait for your next appointment in the Preterm Clinic. Call the Maternity Assessment Unit (MAU) or Labour Ward immediately.
What is the preterm optimisation pathway?
The Optimisation pathway is a care bundle that is made up of 7 different elements. Each one aims to improve the outcomes for babies born early with an aim to reduce the risk of long-term health and developmental problems.
Every pregnancy and every baby is individual, and all parts of the pathway may not be necessary. This will depend on how many weeks pregnant you are when your baby is born.
This information has been put together to support the recommendations from the BAPM Optimisation Toolkit
Place of Birth
When you found out you were pregnant you decided where you would like to have your baby. However, if your baby is born before 30 weeks pregnant they will initially need intensive care so it would be better for them to be born at a hospital where that specialist care is available.
Sometimes, if you are less than 30 weeks the staff looking after you may discuss transferring you to a specialist unit before your baby is born. However, if your baby is born before you are able to be transferred the neonatal team can care for your baby before they are transferred to the other Unit.
Information about the neonatal units in the North East and North Cumbria can be found on the Northern Neonatal Network website.
If you go into labour before 34 weeks of pregnancy you will be offered a course of steroid injections before your baby is born. Steroids will help to prepare your baby’s lungs and reduce the risk of long-term breathing problems for your baby. Ideally, we would like you to have two doses of steroids up to 24 hours apart. These are given by an injection, usually into your upper thigh or buttock.
Sometimes your baby may arrive so quickly that there is not time for steroids to be given. This is quite common, and the team will do everything they can to support your baby’s lungs if this happens.
Women who go into labour before 30 weeks of pregnancy will be offered a medication called magnesium sulphate.
This treatment is extremely effective in protecting your baby’s brain and can reduce the risk of cerebral palsy.
Intrapartum simply means during labour. Group B Strep (GBS) is a type of bacteria called Streptococcus. It is commonly carried by both men and women and most people who carry it do not know they have it. If a pregnant woman has GBS there is a risk that this could be passed on to baby during the delivery. In a small number of cases this can result in an infection and could make your baby poorly.
Babies that are born early are vulnerable to infections so, depending on the circumstances of the birth, to minimise the risk to your baby you may be offered a course of antibiotics. If the antibiotics are not given before your baby is born, please do not worry as they can also be given directly to your baby if necessary.
Find out more information about Group B Strep.
Optimal cord management
Optimal Cord Management (OCM) or Delayed cord clamping may improve the health of your baby by reducing the risk of brain haemorrhage or the need for a blood transfusion after birth. It allows time for extra blood to flow from the placenta to your baby. The extra blood flow increases the amount of iron transferred to your baby, which benefits their brain development. It may also improve your baby’s blood pressure which helps to protect their organs and can reduce problems with your baby’s gut that are common in babies born early.
Delayed cord clamping is completely safe and is recommended by the World Health Organisation (WHO). However, there may be some situations where delayed cord clamping may not be possible but the team looking after you will discuss this with you.
Babies born early tend to be smaller than a term baby and will have a lot less or no fat which makes it harder for them to maintain a normal body temperature. We do not want your baby to get cold as it can cause low blood sugars and breathing problems.
Staff will ensure your baby has a safe body temperature and, depending how many weeks pregnant you are when your baby is delivered they may be placed in a special plastic wrap to help protect their delicate skin and help to keep them warm. There are different ways to help maintain your baby’s temperature, including wearing a hat or through the use of a heated cot. If your baby’s condition allows, delivery room cuddles will be encouraged, this is a great way of keeping your baby warm.
Maternal breast milk
You and your partner may have already made a decision about how you would like to feed your baby or you may still be undecided. How you feed your baby is your choice and this decision will be supported by the team looking after you and your baby.
However, when your baby is born early, the safest and most protective milk to give your baby is the mother’s own breast milk. There are many benefits of your baby receiving early milk including protecting your baby from getting infections.
Even the smallest amount of milk given to your baby via a tube or mouth care, will make a huge difference to them by boosting their immune system. Therefore, even if you have made the decision not to breastfeed, expressing colostrum for your baby (this is the first milk immediately produced following the birth) is extremely important. Colostrum is ideally given within the first 24 hours after your baby has been born, but ideally within 6 hours.
If you choose to express milk for your baby, support will be given to hand express as soon as possible, ideally within two hours of birth. This may seem daunting at first but both the maternity and neonatal team have lots of experience in supporting you to express breast milk. Even just a couple of drops is incredibly beneficial in those first few hours.
The Breastfeeding Network is a great resource for information about expressing breast milk.
It is acknowledged there are nuances around birth and lactation in the LGBTQ+ community. Readers can look for specialised information in these contexts but a general overview can be found here.
Support for you
Having a baby in neonatal care can be a very stressful time for parents and families and it is often hard to think about looking after yourself. Sometimes talking to other people with lived experience of neonatal care can be really helpful.
The Unit where your baby is being cared for will advise what support is available locally for you and your family.
Support for parents and families of premature or sick babies.
Support email: [email protected]
Tommy’s exists to support, care for and champion people, no matter where they may be on their pregnancy journey.
Pregnancy support line: 0800 0147800
UNICEF work to ensure that children receive the support they need to reach their full potential.
The Breastfeeding Network (BfN) aims to be an independent source of support and information for breastfeeding women and others.
Dad Matters aims to help dads have successful relationships with their families, and to support dads with anxiety, stress and mental health issues.
Leo’s has supported the mental health and well-being of neonatal families since 2018.