What is Preterm Labor?
Why the Concern?
Signs of Preterm Labor
Diagnosing Preterm Labor
Women at Risk
Stopping Labor
Preterm Delivery
Your Preterm Bahy

What Is Preterm Labor? 

In most pregnancies, labor starts between 38 and 42 weeks after the last menstrual period. Labor is considered preterm labor when it starts before the beginning of the 37th week. 

Labor starts with regular contractions of the uterus. The cervix thins out (effaces) and opens up (dilates) so the baby can enter the birth canal. It is not known exactly what causes labor to start. Hormones produced by both the woman and fetus play a role.  Changes in the uterus, which may be caused by these hormones, may cause labor to start. 

Preterm labor may be a normal process that starts early for some reason. Or, it may be started by some other problem, like infection of the uterus or amniotic fluid. In most cases of preterm labor, the exact cause is not known. 

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Why the Concern?

Preterm birth accounts for about 75% of newborn deaths that are not related to birth defects. Growth and development in the last part of pregnancy is critical to the baby's health. The earlier the baby is born, the greater the risk of problems. 

Preterm babies (also called premature babies or "preemies") tend to grow more slowly. They may have problems with their eyes, ears, breathing, and nervous system. School, learning, and behavior problems are more common in children who were preterm babies. 

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Signs of Preterm Labor

If preterm labor is found early enough, delivery can sometimes be prevented or postponed. This will give your baby extra time to grow and mature. Even a few more days may mean a healthier baby. 

Sometimes the signs that preterm labor may be starting are fairly easy to detect. The warning signs of preterm labor are listed below. If you have any of these signs, don't wait. Call your health care provider. 

• Watery vaginal discharge (enough to make your underwear wet) 
• Any vaginal bleeding before 37 weeks
• If you experience any of the following for  4-6 hours or longer:  Pelvic or lower abdominal pressure; constant, low, dull backache; mild abdominal cramps like a menstrual period, with or without diarrhea; regular contractions or uterine tightening, often painless 
• Constant backache or pressure without any other signs is not likely to be preterm labor
• Ruptured membranes (your "water breaks") 

If you are having contractions: 

• Drink 16 oz. of a non-caffeinated beverage, lie down, turn onto your side, and count the contractions for an hour. 
• If your contractions are occurring more than once every 10 minutes (six or more per hour), call your health care provider or nurse right away. 
• If you have had very short labors before, call sooner – don't wait. 

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Diagnosing Preterm Labor 

It can be hard to tell the difference between true and false labor. Preterm labor can only be diagnosed by finding changes in the cervix. It is common for women to have contractions before labor starts, sometimes called Braxton Hicks contractions  or false labor. These may be painful and regular, but usually go away within an hour or with rest. If you have contractions more often than six times an hour that continue for more than an hour, call your health care provider right away. 

Fetal monitoring is used to record the heartbeat of the fetus and contractions of your uterus. You may be watched for a time and then examined again to see whether your cervix changes. 

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Women at Risk 

Some women are at greater risk for preterm labor than others.  Women who have little or no prenatal care and those who have had preterm labor before are at increased risk. Preterm labor can happen to anyone, however, without warning. 

A number of other factors have also been linked to preterm labor.  There are also factors linked to the fetus that make preterm labor more likely. For instance, too much fluid in the amniotic sac that surrounds the baby is a risk factor. Problems with the placenta or certain birth defects also increase the risk. You may be at risk for preterm labor if any of the following factors apply to you: 

Despite what is known about these risk factors, much remains to be learned about preterm labor. Half of the women who go into preterm labor have no known risk factors. 

If you are at risk for preterm labor, you may be advised to take certain steps to lower the risk of preterm birth. These steps may involve changing your life style, having more frequent visits with your health care provider, and learning how to monitor your contractions. 

If you are at risk for preterm labor, be sure to get early prenatal care, eat well, and get enough rest. You may need to see your health care provider more often for exams and tests. You should give up unhealthy habits, such as drinking alcohol and smoking cigarettes. Stay away from drugs other than those prescribed by your health care provider. 

Women at risk for preterm labor usually do not have to give up their jobs unless preterm labor has actually been diagnosed. You may be advised to avoid prolonged standing, heavy lifting or other hard or tiring tasks during pregnancy. If you take childbirth preparation classes, you should tell the teacher you are at risk for preterm labor. He or she may advise you to skip certain exercises. Women at risk may also be advised to cut down on travel. Ask your health care provider about any other changes you may need to make in your daily routine. 

If you have a history of preterm labor or birth, or have signs of preterm labor, you may wonder about having sex during pregnancy. Many women worry that the uterine contractions that often follow sex and orgasm will lead to preterm labor. Although in most cases the contractions stop, these are natural and realistic concerns that should be discussed with both your partner and your health care provider. You may be advised to restrict sexual activity or to monitor yourself for contractions after sex. Your health care provider may also ask that your partner use a condom during sex to lower the risk of infection.   

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 Stopping Labor  

Your health care provider may try to stop preterm labor a number of ways. 

Monitoring for Contractions 
After about 20 weeks of pregnancy, you may be asked to monitor yourself for signs of uterine activity or tightening. To monitor yourself, lie down and gently feel the entire surface of your lower abdomen with your fingertips. This is called palpation. You are feeling for a firm tightening over the surface of your uterus. Usually these feelings of tightening are not painful. 

If you feel contractions, turn onto your side and keep monitoring for an hour. Keep track of when each contraction starts and ends and the total number in one hour. If you have had very short labors before, you should call your health care provider sooner--don't wait. Having some uterine activity before 37 weeks of pregnancy is normal. But, if your contractions are occurring more than once every 10 minutes (six or more per hour), you need to call your health care provider right away. You may be in preterm labor. 

Remember, a diagnosis of preterm labor can be made only after a pelvic exam to see whether your cervix has begun to change. You should contact your health care provider each time you have more than six contractions per hour, unless he or she has advised otherwise. 

Treatment 
Sometimes labor can be stopped. Other times, the baby must be delivered. Your health care provider may try to stop labor if: 

• It is detected early enough 
• You or your baby are not in danger from infection, bleeding, or other complications 

Sometimes bed rest and hydration--extra fluids given by mouth or through a tube inserted into a vein--are enough to stop contractions. You may also be given medications that stop contractions.  These will be started in the hospital and any need to continue medication at home will be reviewed with you. 

You may be able to go home if you are not really in preterm labor or if labor is stopped. Otherwise, you may need to stay in the hospital for a while. This depends upon what the health care provider's exam reveals and other factors. 
 
Limit Your Activity  
If you have had preterm labor, limits on activity may be prescribed. If you have a job that requires heavy lifting or standing a lot, it may require some changes. You may have to stop working. You may be advised to go on partial bed rest, which means you can get up, go to the bathroom, and have limited activity. Or, you may be advised to stay off your feet and not do certain activities, such as climbing stairs. Or, you may be confined to total bed rest. 

For most women, having to limit your activity week after week is very hard. You may often feel moody, helpless, and depressed.  Sometimes you may feel that the frustration and boredom just aren't worth it, and you may be tempted to resume your activities. It can be especially hard for you to take care of your other children and spend time with your partner and friends. 

If you must limit your activity, structure your life to help lessen your frustration. Arrange for help with housework, shopping, and older children. Don't be afraid to rely on others for support. 

Because you will be less active, you may need to make changes in your diet so you take in fewer calories. High-fiber foods, such as fresh fruits and vegetables and whole grain products, and plenty of fluids will help you avoid constipation. 

If bed rest is prescribed, plan your days to include a change into day clothes and tasks that you can do in bed, perhaps with a phone nearby. You may want to talk to your health care provider about exercises you can do in bed to improve your circulation.   

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 Preterm Delivery 

Sometimes preterm labor may be too advanced to be stopped. Or, there may be reasons that the baby is better off being born, even if it is early. These can include infection, high blood pressure, bleeding, or signs that the fetus may be having problems. Preterm babies may be delivered by cesarean birth, in which the baby is born through an incision made in the mother's abdomen and uterus. Some preterm babies are delivered vaginally. 

Preterm labor, delivery, and care of the baby require care in a hospital with special facilities. University of Michigan's Women's Hospital and the Holden Neonatal Intensive Care Unit can provide this specialized care. 

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 Your Preterm Baby 

Many preterm babies are tiny and fragile. Depending on how early the baby is born, he or she may need special medical care in order to breathe, eat, and keep warm. Preterm babies can have physical and mental disabilities that can be long-term. Babies born before 32 weeks of pregnancy are most at risk. 

Preterm babies may not be ready to live on their own. They may be cared for in Holden Neonatal Intensive Care Unit (NICU) for weeks and sometimes months. Preterm babies are often kept in an incubator to keep them warm. They are cared for by specially trained nurses and other health care providers. Today, with special NICU care, even very early, tiny babies have a much better chance of survival than in the past. In spite of the best medical care, though, not all preterm babies survive. 

Women at high risk for preterm labor can take a tour of the Holden NICU. 

Physical Features  
Preterm babies are usually of low birth weight (weighing less than 5 and 1/2 pounds at birth). Babies born too early often have organs that are not developed enough to function properly. For instance, the lungs of a preterm baby are often not fully developed, and the newborn may have trouble getting enough air.  This condition is called respiratory distress syndrome (RDS).  Sometimes a woman in preterm labor is given drugs to reduce the risks to the baby. Other drugs could be given to the baby after birth to improve breathing. Your baby may be placed on a respirator to help with breathing. Apnea, or interrupted breathing, often occurs in preterm and low-birth-weight babies in the first days or weeks of life. 

Your preterm baby may not look like what you expected. Most preterm babies are quite red and skinny because they have less fat under their skin and their blood vessels are close to the surface. After a few days, your preterm baby may develop jaundice, causing his or her skin to appear yellow. This condition is temporary. 

A preterm baby may also have problems with swallowing. This means he or she may need to be fed through a tube. You may need to express or pump your breasts to provide breast milk to your baby. 

Emotional Needs  
Hospitals are often busy, crowded places. At first, you may feel that everyone else is taking care of your baby and there is no place for you. You may wish for privacy. You may feel frightened and awkward. These are normal reactions to this new situation.  Talk to the health care providers caring for your baby. They will help you with any questions you may have and advise you on how often you should visit the baby. 

Your baby needs to hear your voice and to feel your touch.  Contact with the baby is important for the parents, too. As soon as you can, talk to your baby. Stroke him or her in the incubator. After a while, you may be able to hold and cuddle your baby for longer periods of time and help with the baby's care.   

Care at Home 
If you have a preterm delivery, it is especially important for you to follow instructions about care for your new baby. Preterm babies usually require more health care provider visits in the first few months at home. This may include special eye and ear exams. You may have to give your baby special medicines, vitamins, or feeding supplements. 

Some preterm babies can leave the hospital but need to take extra oxygen at home. You may need to watch for signs of breathing problems (wheezing, congestion). Sometimes monitors can be used to check the baby's breathing. You should be prepared to perform infant cardiopulmonary resuscitation (CPR) in case of an emergency. Depending on the size of your baby, a standard infant car seat may actually be dangerous to use. Discuss this with your health care provider. 

Your preterm baby may be more irritable, more active, and more dependent on you than other children would be. Be patient and get support when you need it. There are many support services available to help you through this demanding time. The hospital staff can discuss this with you. 
 

Finally...

Although the exact causes of preterm labor are not known, there are things you can do to improve your baby's chances of being born healthy. Regular prenatal care is an important first step in preventing preterm labor. Lead a healthy life style, be alert to warning signs, and follow your health care provider's advice.

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