An Overview of the Neonatal Intensive Care Unit (NICU) and Early Labor

Written By: Elissa Lauber on June 29, 2023

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For this post I'm going to do my best to summarize information I have learned about the NICU in the hopes of saving you time looking for answers across multiple websites, books, etc. I'll also write about my thoughts on what you should consider if you suspect you're in early labor.

The first thing to understand about the NICU is that there are different levels. The Rocky Mountain Hospital for Children does a nice job of explaining the 4 NICU levels.

Level I: Basic newborn care

Level II: Advanced newborn care

Level III: Sub-speciality newborn care Level IV: Highest level of neonatal care

But before I write about what level of care each level provides, it's important to understand which NICU level generally corresponds to which gestational age category.

The World Health Organization explains birth category by gestational age.

• extremely preterm (less than 28 weeks)

• very preterm (28 to less than 32 weeks)

• moderate to late preterm (32 to 37 weeks)

• full term (37 to 40 weeks)

Note. You may hear or read the term micro preemie, which typically is defined as a baby born between 22 and 26 weeks.

Applying gestational age to NICU Levels, I would say that generally:

Level I: Full-term babies (37+ weeks)

Level II: Moderate- to Late-term babies (32+ weeks)

Level III: Very or Extremely preterm babies (~25+ weeks)

Level IV: Critical Illness and/or born Very or Extremely preterm (22+ weeks).

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1. Why does NICU Level matter?

Put simply, if you suspect or know that you are about to give birth to a premature baby or babies, you will want to go to a hospital that will best accommodate you and the baby or babies. If, for example, your baby or babies is/are <32 weeks gestation, a Level II NICU will not be able to provide care. Instead, you will have to immediately be life-flighted to the nearest Level III or Level IV if active labor hasn't started, or immediately after labor.

Personal story: When I was 26w3d pregnant, I felt a little gush of fluid when I was walking around my apartment. Luckily, I had asked my ob-gyn at an office visit a few weeks prior how I would know if I were in pre-term labor, and she gave me great advice. Other than the more classic labor signs of contractions, bleeding, lower back pain, etc., she said if you suspect your water has broken prematurely (PPROM: Preterm Premature Rupture of Membranes), go to the bathroom and empty your bladder. If, when you then stand up and/or walk around you feel any fluid leaking, it is most likely amniotic fluid. So, I did exactly this. I emptied my bladder, walked around, and felt small gushes of fluid. I immediately called the ob-gyn office and spoke to the nurse, who told me based on my twins' gestational age that I needed to go directly to the hospital with a Level III NICU. The nurse explained that the hospital where my ob-gyn had delivery privileges, and where I had planned to deliver my twins, only had a Level II NICU, and would not be able to handle my twins if they were born before 32 weeks.

2. Labor may be starting or has started early. What should I do?

If you suspect you might be in early labor, please call your healthcare provider! Even after you speak to your healthcare provider, I recommend you also go directly to the hospital. I recommend doing this for a few reasons.

A. Your health needs to be assessed.

You need to give your healthcare provider every opportunity possible to determine if something is wrong. For conditions such as preeclampsia, eclampsia, preterm premature rupture of membranes (PPROM), etc., delaying getting to a healthcare provider can be life-threatening. In some cases, the treatment of an illness, such as antibiotics for a urinary tract infection (UTI), could prevent you from going into labor.

Even if you are in early labor, depending on your baby's or babies' gestational age(s), your healthcare provider may want to give you a course of magnesium sulphate, for example, to decrease the risk of brain injury to your baby or babies. *Note. Magnesium sulphate is a tocolytic, which is thought to decrease uterine contractions. You may hear people say that they were put on magnesium to "stop labor," but to my knowledge healthcare providers do not typically use magnesium for this purpose. As several doctors explained to me when I was admitted to the hospital for preterm premature rupture of membranes (PPROM), my twins might very well be safer being delivered pre-term than they would be remaining in utero (e.g., infection), which is why they would not try to "stop labor."

B. Your baby's or babies' health need(s) to be assessed.

Another reason why you should see your healthcare provider immediately if you suspect or know you are in pre-term labor is to make sure your baby or babies are okay. Your healthcare provider may want to perform a non-stress test (NST), for example, to check your baby's or babies' heart rate(s).

Remember: You are not bothering your healthcare provider if you ask for yourself and/or your baby/babies to be checked. You MUST be an advocate for yourself and your baby/babies! Any healthcare provider who dismisses your concerns should no longer be a member of your care team. Period.

To learn more about your risks for preterm labor, visit the March of Dimes website.