Occasionally, labor may begin prematurely. Although you may not be at risk for premature labor, it is important to know the signs and symptoms that may indicate an early onset of labor. Many pregnancy symptoms, such as backache, are common discomforts throughout pregnancy and may or may not indicate premature labor. The following information will help you understand what is normal and when you need to call your health care provider.

What is premature labor?

Premature labor is labor that occurs before the 37th week of pregnancy due to uterine contractions that cause the cervix (mouth of the uterus) to open earlier than normal. This can result in the birth of a premature baby.

What is a contraction?

When any muscle in your body contracts, it becomes tight and hard to the touch. As the muscles of your uterus contract, you will feel your abdomen harden. As the contraction goes away, your uterus and abdomen soften.

It is normal for your uterus to contract during your pregnancy. The muscle layers of the uterus tighten sporadically from the early weeks and throughout pregnancy. You may feel them as early as four months, but many women do not notice them until seven or eight months. Usually, these contractions are not painful. You may notice more contractions when you first lie down, after orgasm, if you have a full bladder, or after you walk up and down stairs. Also known as Braxton-Hicks, these normal contractions are usually irregular and do not change or open the cervix. If these contractions become regular (e.g., every 10 to 12 minutes for at least one hour), they may be preterm labor contractions, which can cause the cervix to change or actually open.

How do I check for contractions?

Lie down and place your hand on your uterus to feel the tightening and softening. Usually during contractions, your entire abdomen will feel hard, not just one area. Sometimes you may confuse the baby’s movement with contractions, especially as the baby grows. It is common for your abdomen to be firm over the baby’s head and buttocks, but in the absence of uterine contractions, your abdomen should be soft in all other areas.

Timing contractions

If your uterus is tightening and softening at regular intervals, you may want to time these contractions. Start timing from the beginning of one tightening to the start of the next tightening for about one hour. Some tightening feels harder or stronger than others. It is not normal to have frequent contractions (more than five in an hour) before your baby is due. Call your health care provider immediately if you think you may be in premature labor.

Warning signs of premature labor

Below are signs and symptoms of premature labor. Call your health care provider if you suspect you are in premature labor. Waiting too long to call for help could result in your baby being born too early.

Premature Labor Signs and Symptoms

A contraction every 10 minutes or more often within one hour (five or more uterine contractions in an hour)

• Watery fluid leaking from your vagina (could indicate that your water bag is broken)
• Menstrual-like cramps
• Low, dull backache
• Pelvic pressure that feels like the baby is pushing down
• Abdominal cramps that may occur with or without diarrhea
• Unusual or sudden increase of vaginal discharge
• Blood from your vagina

• Empty your bladder
• Lie down on your left side and drink fluids

Risk factors associated with premature labor

Some risk factors have been associated with a higher chance of premature labor. However, just because you have some risk factors does not mean that you will experience premature labor. Review the following risks factors and let your health care provider know if any apply to you.

Possible risk factor for premature labor:

• Premature labor or delivery during a previous pregnancy
• Misshapen uterus
• DES (Diethylstilbestrol) daughter (If your mother was prescribed this medication during her pregnancy to prevent miscarriage, you are considered a DES daughter. DES has been linked to shortening of the cervix.)
• Abdominal surgery during pregnancy and/or cervical cerclage (a stitch in your cervix)
• More than two second trimester miscarriages or elective abortions
• Previous Cone Biopsy or LEEP (procedures used to diagnose and/or treat the cervix of women with abnormal Pap tests)
• Carrying more than one baby
• Dehydration
• History of cervical change and/or excessive uterine contractions at less than 33 weeks in a previous pregnancy
• Serious infections with fever (greater than 101 degrees Fahrenheit) during this pregnancy
• Recurring bladder and/or kidney infections
• Excessive amount of amniotic fluid
• Unexplained vaginal bleeding after 20 weeks of pregnancy
• Using recreational drugs, such as cocaine or amphetamines
• Domestic violence
• Smoking more than 10 cigarettes per day
• Extreme emotional or physical stress