Preterm Labor

preemie baby

Preterm labor is labor that occurs before 37 weeks. Having your baby early can present a hardship for you and lifelong health problems for your baby. The most important aspect of preventing preterm birth is recognizing it and calling your OB provider promptly. Nearly 500,000 babies are born prematurely in the U.S. each year, about 12 percent of all pregnancies.

What Are Some of the Signs of Preterm Labor?

These signs necessitate a call to your OB Health Care provider.

  • Contractions or a tightening of your abdomen more often than every 10 minutes. Sometimes this feels like the cramps that come when you are having your period. Regular contractions that don't go away sometimes suggest preterm labor also.
  • Increase in vaginal discharge, or a watery type vaginal discharge with a salty or fishy smell. This can indicate a vaginal infection or your baby's amniotic fluid.
  • Increased pelvic pressure and a feeling that your baby is pushing down
  • A low, dull backache that continues, and doesn't go away
  • Abdominal cramps with or without diarrhea
  • Bloody mucous with no other associated cause

What Should I Do if I Think I'm Having Preterm Labor?

Call your OB health care provider or your hospital and discuss your concerns with them. In the meantime, stop what you are doing, and rest on your left side. Drink 2-3 glasses of water and then drink at least a glass an hour to be sure you are hydrated. If your signs continue and don't go away for over an hour, you will need to go to your OB provider's office, or go to the hospital. Try to talk with them before going to the hospital.

What Are Some of the Causes?

Sometimes the cause of preterm labor can't be identified, but there are many contributing factors. Identifying the causes and these complex hormonal interactions can help you prevent your baby from being born before 37 weeks.

Chronic Psychosocial Stress

Psychosocial stress in the mother or physical stress (such as insufficient blood flow from the placenta) in the fetus appears to result in production of a stress-related hormone called corticotropin-releasing hormone (CRH). CRH may stimulate production of a cascade of other hormones that trigger uterine contractions and premature birth. Individuals in a high stress job, or stressful relationship might have her baby early. Lack of good family support can contribute to preterm birth. An abusive relationship can also increase stress and bring on premature labor. Do what you need to do to protect yourself and your baby.

Infections and the Body's Natural Immune Response

When challenged, the body's immune response to infection can lead to premature labor. Bacterial and viral infections which involve the vaginal and urinary tracts and the fetal membranes and even infections of the gums can contribute to a preterm birth.

Placenta Abruption and Placenta Previa

Both the conditions placenta abruption and placenta previa can cause a preterm birth and might begin with contractions or just bleeding. Bloody show can indicate the cervix is opening sooner than expected. Bleeding can release various proteins involved in blood clotting, and these can stimulate uterine contractions. Even a small amount of bloody mucous can be a sign you might be in preterm labor.

An Overstretched Uterus

An overstretched uterus such as with twins, or a large amount of amniotic fluid, can contribute to premature labor.

Structural Defects of the Uterus or Cervix

When there is a structural defect with the uterus or the cervix, it might initiate labor as the pregnancy grows. Uterine, cervical or placental abnormalities can lead to a release of chemicals that can stimulate uterine contractions. A shortening cervix or a cervix that opens without contractions (called an Incompetent Cervix) can occur early in pregnancy and might result in premature labor. Women who work at jobs where they are on their feet a lot seem to be at increased risk. This would include waitresses and hairdressers.

Exposure to Chemicals

Exposure to environmental chemicals such as smoking, secondhand smoke, alcohol and other recreational drugs can contribute to premature labor and birth. Exposure to DES has been linked with preterm birth.

Nutritional Deficiencies

Deficiencies in nutrition such as underweight or overweight mom, poor weight gain, suboptimal living conditions, and closely spaced pregnancies all have an impact upon the growing fetus and can result in preterm labor. Women who have had a previous preterm birth are at an increased risk of having her next baby early. Ideally, there should be an adequate period of time between pregnancies to replenish nutrition and iron stores.

What Can I Do to Prevent Early Labor?

Initiate relaxation techniques for stressful times. Lay down for awhile after working all day, or working in a high stress environment. Listen to peaceful music, and eliminate the major stress issues in your life. Talk with your partner and those are around you so that they can help you decrease stress.

Get prenatal care as early in your pregnancy as you can. Stop smoking and eat healthy frequent snacks and avoid exposure to environmental and work related risks, especially early in pregnancy. Sometimes your OB Health Provider might give you medications to try to delay or stop premature labor. Birth can be delayed to help the baby mature its lungs and for other measures that will help prevent your baby from coming early. Early management helps to prevent preterm birth. If you use drugs or herbal remedies or supplements that are not prescribed by your health care provider, stop using them. It's best to stop before you get pregnant.

What Will Happen if I go into Labor Early?

First of all your OB Provider will evaluate your individual situation and determine if you are in preterm labor. Then, efforts will be made to stop your labor for as long as possible. Once active labor has started, it will be difficult to stop, and that is why it is important to call if you think you might be in labor early.

Restricted Activity

Most OB health care providers recommend that women restrict their activities and decrease stress to prevent preterm birth. Sometimes women need long periods off their feet to stop labor.

Restricted activity means no regular exercise, and this can be very discouraging for a women who is used to being active. Extended bed rest and inactivity can contribute to blood clots, and limit sexual activity, as male semen contains prostaglandins, and sometimes this can initiate active labor.

With their activities restricted, some women feel bored, depressed or anxious; others feel isolated. A woman or her partner might feel frustrated, angry or resentful. Support and good communication, and efforts to reduce any added stress is critical at this time. A woman may feel guilty because she may feel she has done something to cause the preterm labor.

Some women are unable to work, and then the family may suffer financially. Within the family, roles and responsibilities may change. Childcare, meal preparation and other household tasks may need to be handled by others, and this can add more stress to the family unit.

Some women may qualify for medical leave. Under the Family Medical Leave Act, a woman's job is protected for 12 weeks of unpaid medical leave. Check with the human resources department where you work to find out.

Staying Occupied

Women need to nurture themselves and their growing baby while on restricted activity. While it is tempting to bring work home, this might created an added level of stress. The baby needs to be moms highest priority, and she needs to do things that will help her to relax and feel peaceful rather than stressed. Having people visit often and help with her other children can be a tremendous assistance for her. Sidelines National Support Network provides assistance to women who are experiencing preterm labor.

Drug Treatments

Women who develop premature labor are often treated with one of the available drugs to stop contractions. They are given intravenously, orally or rectally depending upon the best route for your needs, and many times these drugs hydration and restricted activity will help stabilize a woman having preterm labor.

Tocolytics may slow down or stop premature labor contractions, buying some extra time to treat the pregnant women with steroid drugs. Steroids (such as betamethasone and dexamethasone) speed the growth of the baby's lungs and organs. These drugs reduce infant deaths by about 30 percent. They also reduce the two most serious complications of premature birth, respiratory distress syndrome (by about 50 percent) and bleeding in the brain (by about 70 percent) which occur in babies born before 30-32 weeks. Treatment for infections might also be indicated.

Hospitalization

Depending upon the circumstances, the health care provider may recommend that the woman enter a hospital. If she is hospitalized for weeks or months, the concerns and issues are similar to long periods of restricted activity at home.

What Will Happen if My Baby Is Born Before 37 Weeks?

A lot will depend upon what steps have been taken to prevent your baby's early birth. Babies born before 30 weeks weigh about three pounds, and usually need special care in a Neonatal Intensive Care Unit (NICU). The staff will explain everything that is happening to your baby, should your baby need to be in the NICU. Once your babies lungs are mature, the baby can do quite well, and just needs to gain weight and develop its strength and reflexes. Babies at this point can be very alert and responsive to their parents. We are learning more and more about causes of premature labor and many feel preterm birth can be prevented. If you feel you are at risk for a Preterm Birth, please discuss your concerns with your health care provider.

Additional Pregnancy Resources

Preterm Labor