Preterm labor: Mode of delivery

For all deliveries regardless of whether they are Term or Preterm, the method of delivery is dependent on a variety of factors, and preterm labor in itself does not dictate this one way or the other.

As a general statement, in the absence of contraindicating factors, the aim will be for a vaginal delivery in preterm labor. If the baby is in the breech position, this general plan may have to be reviewed. This does not mean preterm breech babies are not delivered vaginally. It only means a careful evaluation on the best method of delivery needs to be made by the obstetrician.

Using forceps to deliver a preterm baby

Using forceps used to be regarded as essential in delivering a preterm baby. This was on the hypothesis that the forceps blades will be protective to the relatively fragile head. This is no longer considered to offer any advantage to the premature baby and will therefore be used only if there are any of the usual indications for using forceps.

The ventouse is not used, certainly not before 34 weeks, after which it can be used for the usual indications.

Potential maternal complications from preterm delivery

There is a slight increase in the risk of retaining the afterbirth, thus requiring surgical removal in the operating theatre.

Probably the potential problem which creates most concern among prospective or new parents is the interruption in the mother-baby bonding. The baby, if needing special care, will be transferred to the neonatal intensive care baby unit.

In some cases, if facilities are inadequate or unavailable at the local hospital, the baby may have to be transferred to another hospital further away. Efforts are usually made to maximize access of the parents to the baby.

Breast-feeding, when and if possible, is encouraged. If the baby is unable to suckle, the mother will be encouraged to express milk for the baby.

Challenges for the preterm newborn

Potential problems that the newborn will face depend mainly on the degree of prematurity: the lower the gestation, the more severe the potential complications. The immediate problem the baby faces is usually respiratory.

Infant respiratory distress syndrome (IRDS), also called "hyaline membrane disease" affects virtually all babies born before 26 weeks of gestation. Between 26 and 28 weeks of gestation, four out of five (80%) babies will be affected by this condition, but at 32 - 34 weeks, the figure falls to only about one in ten and is less severe.

Other short-term concerns include brain hemorrhage and bowel inflammation, both of which could lead to serious long-term handicap or even loss of the baby. The bowel inflammation, also known by the medical term ‘Necrotizing Enterocolitis (NEC)’ affects up to 10% of all the preterm infants weighing less than 1.5kg. Necrotizing enterocolitis can be further complicated by bowel perforation. This is a serious escalation.

Long-term, there is the potential of developing chronic lung disease, eye complications (which, in some cases lead to blindness) and general or localized handicap, resulting from brain hemorrhage. Again, the risk is higher the severer the degree of prematurity.

Of all the problems mentioned, the most frequent and greatest cause of illness and infant loss is the respiratory distress syndrome.