In the last specialist maternity ward still in Ukraine’s control in the eastern Donbas region, the windows are packed with sandbags.

Rooms used for births at the Perinatal Centre in the city of Pokrovsk follow the two-wall rule, which says the safest parts of a building are separated from the outside by at least two walls.

“Sometimes we’ve had to deliver babies during shelling,” said Dr Ivan Tsyganok, the head of the centre. “Labour is a process that cannot be stopped.”

The centre, roughly 40km (25 miles) from the closest front line, gives a glimpse of the suffering the war is inflicting on pregnant women – their anxiety over where they can give birth, fears of the hospital coming under attack, and what doctors have observed to be an increased rate of early labour.

Tsyganok fears the stress of living under Russian attack has led to a spike in premature births, a fear borne out in initial data from the centre and observed elsewhere in conflict zones.

Katya Buravtsova’s second child, Illiusha, was among those born early, delivered at 28 weeks. He would have had “zero chance” at survival if not for the centre, Tsyganok said.

In 2021, about 12 percent of more than 1,000 babies born at the centre were born before 37 weeks of pregnancy, according to data Tsyganok shared with the Reuters news agency. This rate – compared with a Ukraine-wide average of about 9 percent, according to the WHO – was typical for previous years in the centre, he said.

Since the February 24 invasion, 19 of the 115 babies born at the hospital were premature, a rate of about 16.5 percent, he said. The total number of births was low since many women had fled, he added.

Tsyganok says the sandbags in the windows will not save the clinic and its patients in the event of a direct hit, like the one at a hospital in Mariupol in March.

There, at least three people died when a Russian missile hit the hospital, sending expectant mothers, some with shrapnel wounds, fleeing in hospital gowns, according to Ukrainian authorities and media photos.

Russia’s Defence Ministry denied having bombed the hospital and accused Ukraine of staging the incident.

With the Mariupol centre gone and another in nearby Kramatorsk closed, the Pokrovsk facility now serves the remaining population of the Ukraine-controlled Donetsk region, about 340,000 people, according to the regional governor.

Among those attending the centre in Pokrovsk was Viktoriya Sokolovska, 16, expecting a baby girl.

“The shooting is affecting my nerves,” she said late last month, while 36 weeks pregnant and trying her best to remain calm. She feared “all the nervousness will pass over to the baby.”

She has since given birth to a healthy daughter, Emilia.