How do you know if youre at risk for preterm labor?

What is Premature Labor?

A term pregnancy takes about 40 weeks to complete. Babies born before 37 weeks may have problems breathing, eating and keeping warm. Premature labor occurs between the 20th and 37th week of pregnancy, when uterine contractions cause the cervix, the mouth of the uterus or womb, to open earlier than normal. This can result in premature birth.

Certain factors may increase a woman's chances of having premature labor, such as carrying twins. However, the specific cause or causes of premature labor are not known. Sometimes a woman may have premature labor for no apparent reason.

Warning Signs of Premature Labor

It may be possible to prevent a premature birth by knowing the warning signs of premature labor and by seeking care early if these signs occur. Warning signs and symptoms for premature labor include:

• Uterine contractions that happen six or more times in an hour, with or without any other warning signs.
• Menstrual-like cramps felt in the lower abdomen that may come and go or be constant.
• Low dull backache felt below the waistline that may come and go or be constant.
• Pelvic pressure that feels like your baby is pushing down. This pressure comes and goes.
• Abdominal cramping with or without diarrhea.
• Increase or change in vaginal discharge such as change into a mucousy, watery or bloody discharge.

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Uterine Contractions: How to Tell What's Normal

It is normal to have some uterine contractions throughout the day. They often occur when you change positions, such as from sitting to lying down. It is not normal to have frequent uterine contractions, such as six or more in one hour. Frequent uterine contractions or tightenings may cause your cervix to begin to open.

Since the onset of premature labor is very subtle and often hard to recognize, it is important to know how to feel your abdomen for uterine contractions. You can feel for contractions in this way:

• While lying down, place your fingertips on the top of your uterus
• A contraction is a periodic tightening or hardening of your uterus. If your uterus is contracting, you will actually feel your abdomen get tight or hard, and then feel it relax or soften when the contraction is over.

What To Do If You Think You May Have Symptoms of Premature Labor

If you think you are having uterine contractions or any other signs and symptoms of premature labor:

1. Lie down tilted towards your side. Place a pillow at your back for support.
• Sometimes lying down for an hour may slow down or stop the signs and symptoms.
• Do not lie flat on your back, because lying flat may cause the contractions to occur more often.
• Do not turn completely on your side, because you may not be able to feel the contractions.
• Hydrate yourself by drinking several large glasses of water. Sometimes being dehydrated can cause contractions.
2. Check for contractions for one hour.
• To tell how often contractions are occurring, check the minutes that elapse from the beginning of one contraction to the beginning of the next.
3. Call your provider or the UCSF Birth Center at (415) 353-1787 or go to the hospital if you experience any of the following:
• You have six or more uterine contractions in one hour
• You have any of the other signs and symptoms for one hour
• You have any spotting or leaking of fluid from your vagina

With acknowledgement to Dr. Robert K. Creasy for his assistance and to the March of Dimes Birth Defects Foundation for their support.

Early labour means going into labour before 37 weeks. After this point, your pregnancy is classed as full term.

If you think you may be going into early labour, call the hospital or your midwife straight away for advice. They will usually tell you to go straight to hospital, and they may send an ambulance for you.

It’s very difficult, but try not to panic. In 7 out of 10 cases, the symptoms go away and women give birth at term. More than 9 out of 10 women do not give birth within 14 days of having these symptoms.                     

What are the signs of premature labour?

If you have any of the following symptoms, call the hospital or midwife straight away, because you could be in labour:

• regular contractions or tightenings
• period-type pains or pressure in your vaginal area
• a "show" – when the plug of mucus that has sealed the cervix during pregnancy comes away and out of the vagina
• a gush or trickle of fluid from your vagina – this could be your waters breaking
• backache. 

Tell your midwife or hospital staff immediately if:

• you are bleeding
• your baby is moving less than usual
• your waters have broken and they are smelly or coloured. 

Braxton Hicks

You may have some signs labour has started, but not others. For example, your waters may have broken but with no contractions, or you may have contractions but your waters haven’t broken. 

Many women experience Braxton Hicks, sometimes known as practice contractions. These can become quite strong during the third trimester, and it's easy to mistake them for the real thing. They are usually not painful, so it is important to get checked in hospital if you are having painful contractions.

Find out what contractions really feel like.

What happens at the hospital?

The doctor or midwife at the hospital will examine you and offer you tests to find out if:

• your waters have broken 
• you’re in labour
• you have an infection.

These tests may include:

• a vaginal examination to check if your cervix is opening
• blood tests to check for infection
• urine tests to check for infection (or protein for pre-eclampsia)
• a check of your pulse, blood pressure and temperature
• feeling your bump to check the baby’s position 
• swabs for infections such as bacterial vaginosis and group B strep
• monitoring and recording any contractions
• a check of your baby’s heartbeat
• a vaginal swab (such as a fetal fibronectin test) to see if your body is preparing to give birth. 

Your baby’s movements

Your healthcare team should also ask you about your baby’s movements in the last 24 hours. If they don’t, tell them about your baby’s movements. You should continue to feel your baby move in a normal pattern right up to the time you go into labour and during labour. Tell your healthcare professional immediately if you think your baby’s movements have slowed down, stopped or changed.

If your waters have broken early (preterm premature rupture of the membranes – PPROM) 

Normally your waters break shortly before or during labour. If your waters break before labour at less than 37 weeks of pregnancy, this is known as preterm prelabour rupture of membranes or PPROM. If this happens, it can (but does not always) trigger early labour.

Find out more about PPROM.

How will I know if my waters have broken?

This may feel like a mild popping sensation and/or a trickle or gush of fluid that you can’t stop, unlike when you wee. You may not have any sensation of the actual ‘breaking’, and then the only sign that your waters have broken is the trickle of fluid. 

Find out more about what to expect when your waters break.

What happens if I am in preterm labour?

The midwife or doctor will talk to you about whether it’s best to birth your baby now (either by vaginal delivery or caesarean section) or try to slow down labour using medication. They will consider:

• how many weeks pregnant you are
• you and your baby’s health     
• what neonatal facilities are available and whether you need to be moved to another hospital
• what you want to do. 

You may need to be moved to a hospital that has facilities for premature deliveries. Find out more about in utero transfer.

Removing a stitch (cerclage) if you have one

If you are going to give birth and have had a transvaginal cervical stitch, you will need to have it removed before your baby is born. This is because there is a risk of it tearing if it is still in place while you are having contractions. 

If you had a transabdominal stitch, the healthcare team will prepare for a caesarean section. This is because this type of stitch will prevent the cervix from opening so you will not be able to have a vaginal birth. 

Medications

Sadly, babies that are born prematurely are more likely to have some health problems. To help reduce the risks you may be offered medication either to delay the birth, or to improve the baby’s health before they are born. Find out more about preparing your baby for a premature birth and giving birth to a premature baby.

What happens if I’m not in labour?

If labour hasn't started, your healthcare professional will investigate what may be causing your symptoms and if you and your baby would benefit from further treatment.     

They may sometimes recommend that you stay in hospital so they can monitor you and your baby.

What makes you high risk for preterm labor?

What are 3 warning signs of premature labor?

What are the chances of going into preterm labor?

What are 4 risk factors for having a preterm birth?