During your pregnancy, you may be told that your baby will likely be born too early. When it is safer for you or your baby, a premature birth may even be planned. For many expectant parents, however, the early arrival of a potentially ill baby comes as a shock. Sometimes, despite a straightforward pregnancy, you go into labour early unexpectedly. Whatever your circumstances, it is helpful to find out as much as you can about the birth and what is likely to happen immediately afterwards.

The Neonatal Unit (NNU)

If there is time before the birth, try to visit the Neonatal Unit (NNU) where your baby will go for extra help. The term ‘Neonatal Unit’ refers to the unit as a whole. It is divided into an intensive care section, NICU and a less intensive, step down section called the special care baby unit or SCBU.

In the United Kingdom, there are three levels of NNU.

Level one, sometimes called the Special Care Baby Unit (SCBU), cares for less sick or least premature babies. Most will be in open cots. Care might include a mattress that monitors your baby’s breathing. He may be getting oxygen through the nose and being fed by nasogastric (NG) tube, but if he is here, he does not need ventilation.

Level two is for babies who require intensive care and most hospitals where a lot of babies are delivered will have a level 2 unit. These units can treat the majority of prem babies. These babies may need support with their breathing and feeding and may be in open or closed incubators.

The level three NNU caters to the extremely premature and other very sick babies such as those needing surgery. There are fewer of these across the UK. Sometimes a baby will have to be transferred to a level 3 unit for intensive care. Transfers are done by an expert neonatal team. Despite all the high-tech equipment, it is still essential to interact with your baby as much as possible. Techniques such as comfort holding or kangaroo care can be used, so always ask your baby’s nurse about how to interact.

Visiting the NNU before the birth

A doctor or nurse can show you around and give you a good idea of what you can expect, including what your baby may look like and how small he may be. You can look at the equipment that may be used to support your baby and ask about how long he or she may have to stay.

If you can’t visit the unit, the doctor who will be looking after your baby will likely come and see you on the labour ward and tell you what to expect. She will try to be as reassuring as possible while being very honest about your baby’s chances if he is likely to be born extremely early or with a condition so serious he may not live.

Whether in the unit or on the ward, it’s always best to have your partner or another loved one present, both for support and to help remind you of everything that was said. Often, there won’t be a straightforward answer to your questions, or the answers will only become clear when your baby arrives. For some lucky parents, the anxiety about a predicted premature delivery proves unnecessary, and the baby arrives at the right time. However, even if this is not your case, conversations with staff should reassure you that mum and baby are in safe hands.

What happens when your baby is born early?

If your baby is premature, there will usually be a neonatal nurse and one or two paediatricians on hand with a resuscitaire—a special cot with heating, suction, oxygen, and monitoring equipment—at the ready. The moment your baby is born, a timer is started to record the heart rate, colour, oxygen requirements, and breathing at precise times. If the baby is not making any obvious breaths, he will have a mask attached to a small plastic bag attached over his mouth and nose, and air will be squeezed in. This will hopefully get him to start breathing by himself.

Very premature babies may require ventilation, with an endotracheal tube being passed down through the trachea, between the vocal cords, and into the lungs, where it administers air. The baby is kept warm throughout this process.

Arriving at the unit with your baby

Once a baby is stable, the resuscitaire is wheeled into the neonatal unit, and he is placed on a scale to be weighed. The mother’s partner can go with the baby, watch him being weighed, and take a quick photo to show mum. Then the baby is placed in an incubator for warmth, and the monitoring and treatment phase begins.

What will the neonatal unit be like?

Unii's Premature Baby Journey covers the NNU, where so many preterm babies go for extra care.