Premature Labor

What does premature labor mean?

In medical terms, a premature birth is when a baby arrives before 37 completed weeks of pregnancy. A baby who arrives at 36 weeks is unlikely to have any problems, although he may be a bit small and may possibly have some breathing difficulties. However, babies who are born earlier than this still have a lot of growing to do and their internal organs need to mature. They may be quite weak and find sucking and breathing difficult. Babies born as early as 22 to 25 weeks now stand a good chance of survival, but more than half will have disabilities ranging from mild to severe.

Why Does Premature Labor Occur?

There are no easy answers. Stress might play a part for some women, personal health history or infection for others, or smoking or drug use for others. There are a number of other risk factors. Remember that you could have all of these and still carry your baby the full nine months, or you could have none and still give birth prematurely. The risks factors are:

infections of the vagina and urinary tract
expecting twins or more
smoking
using recreational drugs, such as cannabis, ecstasy or cocaine
living in poverty
being the victim of domestic violence
some abnormalities of the uterus
previous surgery to the cervix
previous terminations of pregnancy (abortion)
previous miscarriages, especially between 16 and 24 weeks
previous premature birth
changing partner between your first two babies

Who Is at Risk for Premature Labor?

Premature labor and delivery can happen to any pregnant woman. But they happen more often to some women than to others. Researchers continue to study preterm labor and birth. They have identified some risk factors, but still cannot generally predict which women will give birth too early. Having a risk factor does not mean a woman will have preterm labor or preterm birth. It just means that she is at greater risk than other women.

Three groups of women are at greatest risk of premature labor and birth:

Women who have had a previous preterm birth
Women who are pregnant with twins, triplets or more
Women with certain uterine or cervical abnormalities

If you have any of these three risk factors, it's especially important for you to know the signs and symptoms of premature labor and what to do if they occur.

What are the symptoms?

It can be hard to tell when labor starts, especially when it starts early. So watch for these symptoms:

Contractions of your uterus, about 4 in 20 minutes or 8 every hour, that don't go away. These contractions may make your belly feel firm.
Leaking or gushing of fluid from your vagina. You may notice that it is pink or reddish.
Pain that feels like menstrual cramps, with or without diarrhea.
A feeling of pressure in your pelvis or lower belly.
A dull ache in your lower back, pelvic area, lowers belly, or thighs that do not go away.
Not feeling well, including having a fever you can't explain and being overly tired. Your belly may hurt when you press on it.

If your contractions stop, they may have been Braxton Hicks contractions. These are a sometimes uncomfortable, but not painful, tightening of the uterus. They are like practice contractions. But sometimes it can be hard to tell the difference.

If preterm labor contractions do not stop, the cervix begins to open (dilate) or thin (efface). Before or after contractions begin, the amniotic sac that holds the baby may break. This is called a rupture of membranes. It causes a leakage or a gush of amniotic fluid. Rupture of membranes before contractions start is called premature rupture of membranes, or PROM. Before 37 weeks of pregnancy, it is called preterm premature rupture of membranes, or PROM.

Prevention of Premature Labor

While not all cases of premature labor can be prevented there are a lot of women who will have contractions that can be prevented by simple measures.

One of the first things that your practitioner will tell you to do if you are having contractions is staying very well hydrated. We definitely see the premature labor rates go up in the summer months. What happens with dehydration is that the blood volume decreases, therefore increasing the concentration of oxytocin (hormone that causes uterine contractions) to rise. Hydrating yourself will increase the blood volume.

Others things that you can do would be to pay attention to signs and symptoms of infections (bladder, yeast, etc.) because they can also cause infections. Keeping all of your appointments with your practitioner and calling whenever you have questions or symptoms. A lot of women are afraid of "crying wolf," but it is much better to be incorrect than to be in preterm labor and not being treated.

How is it treated?

If you are in premature labor, your doctor must weigh the risks of early delivery against the risks of waiting to deliver. Depending on your situation, your doctor may:

Try to delay the birth with medicine. This may or may not work.
Use antibiotics to treat or prevent infection. If your amniotic sac has broken early, you have a high risk of infection and must be watched closely.
Give you steroid medicine to help prepare your baby’s lungs for birth. This treatment has some risks, but it can improve your baby’s chances of surviving a premature birth between 24 and 34 weeks of pregnancy.
Treat any other medical problems causing trouble in pregnancy.
Allow the labor to go on because delivery is safer for the mother and baby than letting the pregnancy go on.