Pregnancy - premature labor

What is premature labor? Sometimes, babies arrive early#

It’s important to recognize premature labor, in case you and your baby need medical care. First, let’s look at what is ‘early’. Pregnancy usually lasts for 38 to 42 weeks. A premature birth is when a baby arrives before 37 weeks.

For premature babies, we talk about their ‘gestational age’. This means how long they have been growing in the womb. It is calculated from the first day of your last period. The words used to describe prematurity based on gestational age are: – 36–37 weeks.

When babies are born prematurely they are less developed than full term babies. Their gestational age is an indicator of what stage of development they have reached.

This, in turn, relates to what sort of medical support they will need#

The health professionals and equipment needed to look after premature babies are usually located in the (for babies who are a little stronger than those needing intensive care). Equipment in the NICU helps to support and monitor babies’ breathing, heart rate, feeding and temperature, and the workings of their stomach and bowels.

It is hard to predict whether you will go into early labor, particularly if you are healthy.

Most premature labors happen by themselves and are unexplained. The presence of certain germs in the urine (even without signs of an infection) seems to make premature labor more likely. Treating the infection seems to reduce the risk of premature labor.

Other risks for labor starting too early include: problems with the womb, such as fibroids. Some women will have labor deliberately started early by their doctor because it is safer for the baby to be born than to remain in the womb. Some of the reasons are: the baby is not growing.

Remember, if any or all of these risks apply to you, you may still have a full term pregnancy.

And, if you have none of the risks, you may still have a premature labor#

After 20 weeks of pregnancy, you may have a tight feeling in your womb.

These contractions are called Braxton Hicks contractions (also known as false contractions) – they are your body preparing for giving birth, not the start of labor.

If your pregnancy is your first, the feeling may be quite strong and even painful. Late in pregnancy, it can be hard to tell Braxton Hicks contractions from the real start of labor.

Look for these differences: Real labor pains become regular. They start to be more intense and more frequent. Braxton Hicks contractions usually happen only once or twice an hour, a few times a day.

And they usually last less than a minute#

Real labor pains become longer and more painful#

Braxton Hicks contractions may stop if you change what you’re doing – for example, they may go away if you’ve been walking and then you sit down, or if you’ve been resting and then you move about.

If you are not sure, call the health professional who will be delivering your baby. You may experience false labor before your real labor.

It tends to happen in late pregnancy, and more often affects women who have had a baby before. False labor contractions can be painful, so they may seem to be the real thing.

However, they are usually short (less than 45 seconds) and irregular, and they cause discomfort in different places – such as your groin, your lower abdomen or your back.

True labor contractions are usually regular and become longer and stronger. They cause pain that starts at the top of your womb and moves down to your pubic bone. You can feel the pain in your lower back and pelvis too.

False labor is not dangerous for your baby#

Premature labor needs immediate medical help#

If your waters break, or you start contractions before 37 weeks of pregnancy, call your midwife, doctor or hospital immediately (at any time of day or night).

You may also need help if you have any of the following symptoms#

Immediately talk to your midwife, doctor or hospital to work out whether your symptoms mean you’re in labor: blood or fluid coming from your vagina.

Other signs of labor can be that your baby stops moving, or moves less. Or maybe you just don’t feel right.

If you experience any of these labor symptoms before 37 weeks, see a midwife or doctor as quickly as possible.

After you speak with your midwife or doctor, you will probably have to go to the hospital. Don’t drive yourself.

If no-one can drive you, call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) and ask for an ambulance. At the hospital, staff will check whether the neck of your womb (cervix) is shortening and opening, which indicates labor has started.

They may test for infection#

The hospital may also test for a substance called ‘fetal fibronectin’ in the fluid in your vagina. The presence of this substance can help your doctor decide if there is a risk of your baby being born sooner rather than later.

If it is not clear whether you are in labor, the hospital will admit you to the antenatal ward to keep an eye on you.

The hospital will also want to monitor your baby’s heartbeat, which is done via a monitor strapped to your tummy (this is called a called a CTG machine.), the hospital can give you medication to slow down your labor. This may delay the birth for long enough to transfer you to a hospital with a neonatal intensive care unit., your doctors will probably allow labor to continue at its own pace.

Your baby is likely to do very well even though he or she will be small. The hospital will offer you steroid injections to help your baby’s lungs develop and to reduce breathing difficulties after birth. This help is needed because a baby is not fully ready to breathe air until about 36 weeks of pregnancy.

Being in premature labor doesn’t mean you must have a cesarean section. But you may need one if you are bleeding or your baby is distressed.

You may go into premature labor unexpectedly#

Or you may have pregnancy complications that mean you know an early birth is likely or definite.

However it happens, you will probably feel shocked to find you are giving birth weeks or months earlier than full term.

And you may feel worried about your baby#

Further, because you’ll receive a lot of medical attention, you may also feel you’ve lost control. You can ask your midwives, nurses and doctors to explain everything to you.

They will want to help you feel as calm as possible#

If you know your baby will be born prematurely, it can help to put some plans in place.

If your baby will be in the NICU after birth, you’ll want to be there as much as possible. So you will need support with grocery shopping, housekeeping, minding your other children, and other everyday chores like watering the plants.

Try to have a support plan in place before you go to hospital. You may want to read about premature births and premature babies. It may also help to talk to other parents of premature babies, midwives and doctors.

Be prepared to change your birth plan – for example, if you planned to give birth at home or at a birthing center, understand that your baby may instead need a hospital’s care and technology.

If you have older children, let them know the baby may come early. Become familiar with the NICU and the machines around the babies.

Your doctor or midwife will be able to arrange a visit for you. Use strategies (such as listening to music) to try to stay relaxed. Take one day at a time, and keep thinking about your baby in a loving and positive way.

(NICU) of a hospital, or the special care nursery Risk factors for premature birth having had a premature labor before having a poor diet or poor health smoking or using recreational drugs having a lot of stress or violence in your life carrying twins or more babies general infections bleeding from the placenta problems with the neck of the womb (your cervix) if the woman’s blood pressure is too high (pre-eclampsia), there is bleeding from the placenta Not labor, just Braxton Hicks contractions False labor versus true labor Signs of premature labor a dull ache in your lower back pressure in your pelvis, as if your baby is pushing down swelling of your hands, feet or face contractions more than four times an hour nausea, vomiting or diarrhea trouble with your eyesight (such as blurred or double vision) stomach cramps like period pain What happens during premature labor If you are less than 34 weeks pregnant If you are more than 34 weeks pregnant Feelings about premature labor Things to do before a premature birth

Where to get help#

Key Points#

• It’s important to recognize premature labor, in case you and your baby need medical care
• Treating the infection seems to reduce the risk of premature labor
• Other risks for labor starting too early include: problems with the womb, such as fibroids
• Remember, if any or all of these risks apply to you, you may still have a full term pregnancy
• And, if you have none of the risks, you may still have a premature labor