A milestone for expectant mom: 24 weeks

The long awaited 24 weeks is here – now what? Moms look forward to this mark in their pregnancy journey because at 24 weeks the baby now has the ability to be born and survive. It would be an early pregnancy, which could be followed by some challenges, but the baby is now at a size where he or she could make an entrance into the world.

Lots of questions and even concerns may come into a mom’s head at this point in the pregnancy, which is why we chatted with Dr. Brooke Chalk, of Novant Health Coastal OB/GYN & Midwifery - New Hanover for some answers.

Why is the 24-week mark considered a milestone?

For many years, 24 weeks has been considered the threshold of viability where if your baby is delivered now, there's a good chance of survival. That timeline has moved a little bit earlier over the last couple of years in some hospitals.

What would you say are some of the important things for women to know at this stage?

This would be the stage where it would be important to let their doctor know if they started to feel any sort of contractions, or leaking fluid or premature labor symptoms. It’s uncommon that labor happens this early, but because the baby is at a point where he or she could survive, we really want to know and intervene early if something like that is going on.

How would expecting mothers know if they're experiencing Braxton Hicks or truly going into labor?

Braxton Hicks for most women are mostly crampy, nuisance contractions rather than truly painful. Braxton Hicks I would describe as just a tightening of the belly. You feel it, but it doesn't necessarily take your breath away or give you really significant pain. A lot of times with Braxton Hicks, maybe you have them every 15 minutes for an hour or two, but for most women, if they rest and hydrate, that can go away. Whereas with true preterm labor contractions, you may rest and hydrate and those aren't getting better or going away.

Would you say there's any physical signs or symptoms women should be worried about at 24 weeks?

Really anything in pregnancy that seems different or concerning can be a worry. I would always encourage a woman to contact their provider if they are concerned. There are so many changes that happen in our bodies during pregnancy and there's such a wide range of what is normal.

Even for me, I do this for a living, and I've had two pregnancies and they were completely different. During my first pregnancy, I felt my baby move at 16 or 17 weeks. During my second pregnancy I didn’t feel movement until 24 weeks because of where my placenta was located. That was a lesson for me. I remember thinking “OK, this is why women call and say, ‘I'm not feeling my baby move, is that OK?” I get why someone who doesn't do this for a living would think that that was not normal or would be worried.

If someone has their baby at 24 weeks, what are some of the challenges or dangers of having a child that early on?

The good news is at our hospital, we have a fantastic NICU (neonatal intensive care unit) and they can take care of babies that young and they can really have good long-term outcomes. The short term is really, really hard for a baby that premature. They will be in the hospital for a few months, honestly.

One of the biggest challenges is breathing. The lungs are really just starting to form around that 24-week mark, which is why that is the big milestone for survival. We have ways to help those babies breathe and support their lungs. And, some babies born severely prematurely can have substantial physical and developmental challenges that may last a lifetime.

Because very premature babies are so small, they don't have a lot of fat, and it's hard for them to keep their temperature up, so temperature regulation is a big one. Feeding is another big challenge – they have a tiny mouth, a tiny stomach. They can use a lot of their energy to try to breathe, and then they're burning calories and not growing.

Are there ways to delay an early delivery?

Sure. So let's say you're 24 weeks pregnant and your water breaks or you are experiencing contractions and preterm labor. There are things that we can do to help prolong the pregnancy as long as we can. Mom getting a course of steroid injections can help a lot particularly with the baby’s lungs and that can help also reduce some other complications that happen in these very early preemie babies.

There are also medications that we can give to try to help stop contractions. They're not perfect. Sometimes we can stop preterm labor for days or weeks, and sometimes that isn’t possible. The best treatment for preterm labor is prevention and reducing those risk factors.

What are the risk factors for an early delivery?

Stillbirths can happen at 24 weeks. Are there warning signs for stillbirth?

Yes they can, and those are really hard. Thankfully, it's something that we don't see frequently. You know, one time is too many. Often, there may not be a warning sign. There are certainly risk factors for people that we know have a higher chance to have a stillbirth, but many stillbirths are unexpected, and it can happen in women who may not otherwise have risk factors. A big thing is once a pregnant woman has started to feel regular fetal movement, if they're noticing a difference in that at all, don’t ignore that. Call or come in. That's a really important thing. Just basic overall, self-care is important.

I know that sounds kind of silly, but so often in life, we don't take great care of ourselves. A lot of times as women, we're taking care of other people and pregnancy is really not the time for that. Really make sure that you're resting and hydrating and doing all the things that you're supposed to do. Those things really matter when you're pregnant.

The risk of gestational diabetes becomes possible at this stage, correct?

Between 24 and 28 weeks is when we test all pregnant women for gestational diabetes. We screen every pregnant woman for gestational diabetes and in most women that involves a glucose solution that they drink, and then an hour later, we check their blood sugar. In all pregnant women the placenta makes a hormone that makes it harder for the body to process glucose. That happens in every single pregnant woman. In some women, that becomes so difficult that they can get gestational diabetes, where their body is just not able to keep blood sugar normal. So every woman should have a screening for gestational diabetes.

What else should a woman keep in mind at 24-weeks?

I think it's never too soon to start thinking about options for a pediatrician. You have to plan and even if you’re not going to have a baby for four months, go ahead and prepare for things like that. Also, at any point in pregnancy, we recommend the flu vaccine during flu season and also COVID vaccines. Whether you're in that age near 20 week or 24 weeks or sometimes even earlier than that, we recommend vaccination because we know that pregnant women can get sicker with both the flu and COVID than non-pregnant women.