Premature birth: common causes and how to prepare

Updated April 2024 | 5 min read
Expert contributor Dr Penny Sheehan, head of the Preterm Labour Clinic, The Royal Women's Hospital, Victoria; Terri Barrett, Midwifery Director Statewide Obstetric Support Unit at Department of Health (WA Health)
Words by Joanna Webber

Here’s what you may need to know if you or someone close to you experiences a premature birth.

The neonatal intensive care unit (NICU) at Melbourne’s Royal Women’s Hospital looks much like any other hospital ward. It’s not until you notice the tiny cots surrounded by a tangle of tubes and medical equipment that you realise you’re looking at newborn babies.

According to the Miracle Babies Foundation, today one in 10 babies in Australia is born preterm (before 37 weeks gestation), and approximately 15% of all babies require some form of extra care at birth. This means that for a growing number of parents-to-be, the pregnancy is cut short. Mum, Lee, had her twins at 28 weeks and they were in the NICU for 102 days. "It was very scary to start with because I didn't know anything about having a premature baby. It wasn't even really something I considered, even though it was a high-risk pregnancy. It was all a bit of a blur and quite a confusing time," says Lee. Lee shares more about the challenges of seeing her babies in the NICU in our Navigating Parenthood podcast.

What is a premature birth?

Premature birth, also referred to as preterm birth, is usually an unplanned event during pregnancy that leads to the delivery of the baby before 37 weeks gestation. While most premature Aussie babies born between 32 and 36 weeks don’t have any serious long-term problems, very premature babies may be at a higher risk of developmental problems. Many babies who are born before 32 weeks and/or those weighing less than 2.5kg and need help breathing may be cared for in the NICU.

Common causes of premature birth

The Australian Preterm Birth Prevention Alliance explains that some premature births can be caused by problems with the foetus, the mother or both. Certain events, like placental abruption, incompetent cervix, hormonal changes or infection, can also cause the onset of premature labour for women.

Other factors that can cause a premature birth include:

• previous premature births
• pregnancy with multiple babies
• infection
• age
• drug or alcohol use
• obesity or underweight
• chronic conditions like diabetes and high blood pressure.

“Women are at higher risk of early labour if they’ve had pre-eclampsia or preterm delivery in a previous pregnancy, multiple miscarriages, a shortened cervix or if they’re pregnant with twins or triplets,” says Dr Penny Sheehan, head of the Preterm Labour Clinic at The Royal Women’s Hospital in Victoria.

“Diabetes or a urogenital infection like a yeast infection or UTI can also increase the risk, but many women experience spontaneous labour preterm without having any of these risk factors.”

Premature birth facts

The good news is that medical advances mean preterm babies have a greater chance of survival than ever. Sadly for babies born earlier than 24 weeks (towards the end of the second trimester), lungs and other vital organs are unlikely to be developed enough to survive without intervention. Before ventilators (machines that breathe for your baby) came along, the survival rate for babies born under 1kg was approximately 6%.

Today, the Better Health Channel says, two thirds of babies born at 24 weeks gestation who are admitted to a NICU will survive to go home and 98% of babies born at 30 weeks gestation will survive.

“In the long term, very premature babies are at a higher risk of chronic lung problems, decreased hearing and vision, and cognitive and motor skills impairment,” says Dr Sheehan. “But many babies have no long-term problems associated with their early birth at all.”

The Better Health Channel advises that if your contractions begin ahead of schedule, a series of measures can delay labour. If you’re not in active labour, you may be given medication to delay contractions for as long as possible and transferred to a hospital with a NICU, if needed.

“A woman at higher risk may be admitted to hospital during pregnancy so she and her baby can be monitored daily for any changes,” says Dr Sheehan. “We have tests which can predict the likelihood of a woman giving birth in the following two weeks, and if that comes back positive, we can provide steroids to help her baby’s lungs develop quickly, which is crucial to the baby’s survival and long-term health.”

Midwives also play a key role in assessing women for the risk of preterm labour and ensuring paediatric support is available at birth. Terri Barrett, Midwifery Director Statewide Obstetric Support Unit at Department of Health (WA Health), knows how frightening it can be for parents whose newborns are admitted to the NICU.

“It’s a stressful time for parents, and providing emotional support is an essential aspect of midwifery care throughout the labour and postnatal period,” says Terri. “Having a caregiver with whom you already have a relationship is important and very helpful.”

Visiting your premature baby in hospital

After delivery, it may be weeks – or even months – before preterm infants are ready to go home. The NICU becomes a home away from home, where teams of specialists work around the clock and parents quickly familiarise themselves with the unit’s equipment and care processes.

“Spending as much time as possible in the NICU ensures that parents and baby stay connected,” says Terri. “Touching, holding and massaging can help baby to feel cared for and supported.”

Breastmilk is the best food for preterm babies, says Terri, adding that in the case of tiny newborns
who may not be well enough to breastfeed, mothers can express breastmilk.

According to Pregnancy, Birth and Baby, as well as breathing problems, other health problems for premature babies may include heart and digestive tract issues, jaundice, anaemia and infections.

Terri says visitors are often limited to two at a time in the NICU and small children are sometimes not allowed to enter, which can make organising care for other children difficult.

“If parents know that their baby will be born prematurely, there are practical things they can do to
be organised,” she says. But preterm birth often occurs with little or no warning, so it helps if friends and family can offer support.

The costs associated with premature births

The average cost of having a baby in a private hospital as a private patient in Australia is approximately $8,500, but for a preterm baby who needs extra hospital care, the costs can reach as high as $3,000 a day. There may also be significant transport and accommodation costs if you live far away from hospital, and the financial strain can be tough if you’ve had to finish work earlier than expected. 

If you’re a public patient in a public hospital, most costs would be covered by Medicare.

If you’re a private patient, you may not be covered if you have a preterm baby within the 12-month
waiting period, so it’s worthwhile getting a pregnancy policy ahead of time if you can.

As a private patient you may get to choose your own doctor and are more likely to have a private
room.

You can find out more about the potential costs involved for vaginal and caesarean births using our cost estimators.

For more information on premature births, call the Miracle Baby 24-hour support line on 1300 622 243.