What You Should Know: Preterm Labor

This article is intended to cover signs and symptoms of pre-term labor, as well as treatments. Hopefully this should give you an understanding of what to expect if you suspect or enter pre-term labor.

Pre-term labor can have many causes, and many symptoms. You should be aware of these symptoms so that you can head off pre-term labor if you find yourself experiencing it, for the health and safety of your baby.

Pre-term labor is defined as labor before 37 weeks gestation. If you deliver your baby before you are 37 weeks pregnant, it will be considered premature. About 12% of babies in the US are born prematurely.

What can cause pre-term labor?

Pre-term labor can be caused by many things. The truth is, sometimes we don't know what causes a woman to go into pre-term labor...but there are some risk factors. Some we can fix, and some we can't. Here are some of those risk factors:

Infection - certain types of infections such as bacterial vaginosis, chlamydia, and trichomoniasis can cause you to go into labor

Uterine malformations - some types of uterine malformations can cause your uterus to not be able to grow to the point of carrying a term baby.

Placenta previa - placenta previa is a condition where part of the placenta implants atop the cervix. If you go into labor with placenta previa, you will start bleeding. This can become a life-threatening situation. Many women are diagnosed with placenta previa at an early ultrasound, but it can resolve itself by delivery, and typically does.

Placental abruption - placental abruption occurs when part of the placenta comes off the uterine wall and begins to bleed. There are many causes for this, including trauma to the baby, but this doesn't always mean that you are somehow to blame if this happens.

Incompetent Cervix - an incompetent cervix begins to dilate before the baby is ready to be born. If caught in time, your doctor can insert a stitch in the cervix called a cerclage to help keep your cervix closed.

Carrying multiples - multiples increase the size of your uterus more quickly than carrying a singleton. This can cause you to go into pre-term labor.

Polyhydramnios - a condition in which the baby has too much amniotic fluid surrounding his body, it can enlarge your uterus and make you go into pre-term labor.

Certain Maternal Disorders - some disorders have been linked to pre-term labor. These include: diabetes, sickle cell anemia, severe asthma, lupus, inflammatory bowel disease, and chronic active hepatitis.

Past surgeries - Any surgery you've had in your abdominal region, or past trauma to the abdominal region, can increase your risk of pre-term delivery.

Peridontitis - a gum infection that can get into the bones and tissues that support your teeth. That is why it is so important to see a dentist while you are pregnant.

What are the symptoms of pre-term labor?

An increase in vaginal discharge or a change in your vaginal secretions. For example, if they become watery or tinged with blood.

Loss of mucus plug. It will look like "snot" and may be streaked with red or brown blood.

Menstrual-like cramping or more than 4 contractions in an hour, even if they don't hurt.

Increased pressure in the pelvic area. Your pelvis will start to feel "full" as the baby's head bears down on the cervix.

Lower back pain, particularly a recent onset of lower back pain.

A feeling that things are not right.

Tests for pre-term labor

Besides fetal monitoring, there are two tests that can tell your doctor if you are at risk for pre-term labor.

One of those is via ultrasound. The doctor does an ultrasound of your cervix to see if it is shorter than normal, considering your gestational age. If it is, you may have to get a cerclage to keep your cervix from opening.

The other is called Fetal Fibronectin Screening.

Fetal fibronectin is a protein secreted by the fetal membranes. A doctor can do a swab of your vaginal/cervical secretions and see if this protein is present. If the test is positive, you are at higher risk of delivering prematurely. This test is only accurate to 34 weeks.

If you think you may be in pre-term labor

There are things you can do at home before you have to go to the hospital, unless you feel you are leaking amniotic fluid or the pain is too severe.

Try drinking a big glass of water and laying on your left side. During this time you can time your contractions to see how far apart they are. If the contractions strengthen or other symptoms crop up, contact your doctor or midwife. They may want to see you.

What can be done at the hospital to stop pre-term labor?

You may be given a drug called Terbutaline or Magnesium Sulphate. There are also other drugs they can give you to stop labor. Each of them works in a different way but the goal is the same. The goal is to minimize the strength and number of contractions.

These medications can be delivered by pill, IV, or even subcutaneously by injection. If you are at high risk of pre-term labor, your doctor may put you on a terbutaline pump, which works like an insulin pump by delivering medication at timed intervals.

Drugs to stop labor are called tocolytics.

They stopped my labor. What now?

If they stopped your labor but are concerned it may start up again, they may send you home and teach you how to chart your contractions, with instructions to call or come in again if they increase or become stronger.

You may also be placed on something called Home Uterine Activity Monitoring, or HUAM. HUAM is an external monitoring device worn twice a day for an hour. The HUAM records contractions and sends the data over the phone to a nurse who analyzes the information. If you are having excessive contractions, your doctor will be notified.

I hope that you have a happy, healthy pregnancy without fear of pre-term labor. Be sure to check out my other articles on pregnancy and birth, as well as homebirth.