Preventing Premature Births: Hospital Protocols And Practices

Hospitals have various methods to prevent early delivery and ensure the health of the mother and baby. Treatments to prevent premature birth include antibiotics to prevent infection, steroids to aid lung development, progesterone to delay contractions, and magnesium sulfate to reduce the risk of cerebral palsy. Hospitals also provide vitamin K injections to newborns to prevent bleeding, and eye ointment to prevent infection. The length of stay in the hospital after birth has been decreasing over the years, with mothers being discharged as early as 6 to 12 hours postpartum, which can affect the bonding experience and breastfeeding rates.

Hospitals administer antibiotics to prevent infection

Hospitals employ various methods to prevent early delivery, including the administration of antibiotics to prevent infection in both the mother and the baby.

Antibiotics to Prevent Infection

Hospitals administer antibiotics to prevent or treat infections in the mother and the baby. Antibiotics are crucial in preventing tearing of the cervix, which can cause severe hemorrhaging. Additionally, antibiotics can help prevent postpartum infections in the mother, which are common adverse outcomes of childbirth.

Other Methods to Prevent Early Delivery

In addition to antibiotics, hospitals use other methods to prevent early delivery. Steroids are administered to help the baby's lungs and other organs develop in case of early birth. Medicine is also given to delay labor, providing time for the steroids to take effect and for the mother to be transferred to a hospital with a neonatal intensive care unit (NICU) if necessary.

Magnesium sulfate may be given to reduce the risk of cerebral palsy in case of preterm birth. Furthermore, hospitals monitor vital signs and the baby's transition to life outside the womb, ensuring stable health for both mother and child before discharge. In some cases, a hearing specialist may visit for a hearing screening, and a pediatrician will see the newborn in the days following birth.

Early Hospital Discharge

There is an international trend towards shortening the postpartum length of stay in hospitals due to cost containment, bed availability, and a movement towards the 'demedicalization' of birth. However, early discharge may impact the detection and treatment of infant and maternal morbidity, breastfeeding problems, and maternal confidence. The benefits of early discharge include more positive experiences in the first few days postpartum, improved bonding, and higher breastfeeding rates.

Steroids are used to aid lung development

Hospitals use a variety of methods to prevent early delivery, including antibiotics, magnesium sulfate, medicine to delay labor, and steroids. This answer will focus on the use of steroids to aid lung development in premature babies.

Steroid shots, such as betamethasone, dexamethasone, and antenatal corticosteroids (ACS), are often used to speed up the development of a baby's lungs, increasing their chances of survival if born prematurely. These steroids are typically recommended for pregnant individuals between 24 and 34 weeks who are likely to deliver prematurely, especially if they are experiencing symptoms of preterm labor or have conditions such as preterm premature rupture of membranes (PPROM) or preeclampsia.

The steroids work by prompting the cells in the lungs to produce a chemical called surfactant, which helps accelerate lung maturation. Surfactant production typically occurs during the mid-to-late third trimester, and its presence prevents neonatal respiratory distress syndrome (RDS), a serious complication of preterm birth that affects a baby's breathing and can lead to early neonatal mortality and disability.

The maximum benefits of steroid injections occur when the baby is born two to seven days after receiving the first dose. Treatment becomes less effective if delivery occurs within 24 hours of the first dose or more than seven days after. Babies who are delivered before receiving the second dose still show better outcomes than those who receive no treatment.

While the long-term effects of ACS treatment are still being studied, current research indicates no adverse effects on the growth or development of babies or children whose mothers received a single course of ACS before 34 weeks of gestation. However, a temporary rise in blood sugar (glucose) may occur, requiring insulin dosage adjustments for individuals with diabetes or gestational diabetes.

Medicine can delay labour

Doctors will not attempt to stop contractions if the baby is more than 34 weeks along and the lungs are developed, or if there are concerns about the health of the mother or baby. In the case of multiple births, medicine cannot prevent early labour.

Mothers who think they are in labour or are experiencing contractions should contact their doctor or midwife immediately. If there is any bleeding or the water breaks, it is important to go to a hospital right away, preferably one with a NICU. These units specialize in treating preterm babies.

Doctors may recommend treatments such as progesterone, which can be given as a shot or inserted vaginally, to prevent early labour. Antibiotics can also be used to treat or prevent infections in the baby and mother.

Progesterone can be given as a shot or vaginally

Progesterone is a hormone that can help prevent early delivery. It can be administered in two ways: as a shot or vaginally. Progesterone shots are typically injected into the muscle of the arm or thigh. This method delivers the hormone directly into the bloodstream, allowing it to circulate throughout the body. The dose and frequency of the shots will be determined by a medical professional, who will consider factors such as the patient's weight, age, and medical history. Vaginal progesterone, on the other hand, is administered directly into the vagina, either as a suppository or a cream. This method allows the hormone to be absorbed through the vaginal walls, which are rich in blood vessels. Vaginal progesterone is often recommended for women with a history of preterm births or those at risk of preterm labour due to a short cervix. It is thought that vaginal progesterone helps to strengthen and prolong the effectiveness of the cervix, thus reducing the likelihood of early delivery. The decision to administer progesterone vaginally or as a shot will be made by a doctor, taking into account the patient's individual needs and preferences.

Hospital stays are recommended to prevent morbidities

For example, mothers can experience excessive bleeding, infections, and problems with breastfeeding after giving birth. By staying in the hospital under the supervision of healthcare professionals, these issues can be promptly detected and treated, reducing the risk of complications and readmission rates. In the case of a C-section, the hospital stay may be longer, typically ranging from three to four days, to monitor the mother's recovery and ensure proper wound healing.

Additionally, the hospital stay allows for the administration of medications and treatments to prevent early delivery and potential complications. This includes antibiotics to prevent infections, steroids to aid in the development of the baby's lungs and organs, and magnesium sulfate to reduce the risk of cerebral palsy in cases of preterm birth. The hospital stay also facilitates monitoring of vital signs, such as heart rate and blood pressure, which can help identify any potential concerns or deviations from normal parameters.

Furthermore, the hospital stay provides an opportunity for education and support for new mothers. Nurses and lactation consultants can provide guidance on newborn care, breastfeeding, and other aspects of postpartum care. This support can help increase maternal confidence and satisfaction with postnatal care, which is crucial for both the physical and mental well-being of new mothers.

While the length of stay in the hospital after childbirth has decreased in many countries, there is no standard definition of early postpartum discharge. The average length of stay varies significantly between countries, ranging from 1.5 days in the United Kingdom to 5.2 days in Hungary. Decision-makers introducing earlier discharge policies need to carefully consider the potential impact on neonatal and maternal health outcomes and ensure that appropriate support is in place for new mothers transitioning to home-based postpartum care.

Frequently asked questions