Pregnancy is supposed to be 40 weeks long. You start counting from the first day of your last menstrual period. That gives the date your baby should be born. That’s your “due date.” Preterm labor is when your labor begins too soon. Three weeks or more before your due date is too soon. When you deliver your baby between week 32 and week 37, it’s called preterm birth. Very preterm birth is when the baby is born before week 32.
Symptoms
(after 20 weeks)
Contractions that:
Occur every 15 minutes or closer
Last from 20 seconds to 2 minutes each
Come closer together as time goes on
Sudden gush of vaginal fluid (your water breaks)
Change in vaginal discharge. This could be blood, water, or mucus.
Pressure in your pelvis, back, or in the insides of your thighs. It feels like the baby is pushing down.
A dull backache below your waist. This can come and go or you can feel it all the time.
Cramps like you get with a menstrual period
Causes
There are many risk factors for preterm labor. These include:
Preterm delivery in the past
Three or more miscarriages in a row
Incompetent cervix. This means the cervix doesn’t stay closed as it should until labor begins. It opens weeks or months before the pregnancy should end. It does this without pain.
Placenta previa
Pregnancy with more than one baby
Uterus is not normal shape
Fibroid uterus
Mother is a daughter of a woman who took DES. That’s a medicine used from 1940-1970. It was used mostly to prevent miscarriage. It was also given to pregnant women who had morning sickness.
Infections of the urinary tract, vagina, or cervix
Infections from STIs
Mother had surgery on the cervix
German measles (rubella)
Hormone imbalance
Mother’s chronic illness (diabetes, heart disease, high blood pressure)
Too much or too little amniotic fluid
Dehydration from flu or not drinking enough water
Not enough weight gain, poor diet, lack of prenatal care
Smoking
Alcohol use
Drug use
Too much exercise or heavy physical work
Mother is younger than 18 or older than 35
Prevention
If you have any risk factors in your medical history, tell your health care provider. Do this before you get pregnant.
Lead a healthy lifestyle before and while you are pregnant.
Eat healthy foods. Drink 8 to 10 glasses of fluid every day.
Get moderate exercise.
Don’t drink alcohol. Don’t smoke. Don’t use drugs.
Don’t misuse medicines.
Get plenty of rest.
Take the prenatal vitamins your health care provider prescribes.
For women with an incompetent cervix, surgery can be done. Stitches are given to close the cervix until term. Then the stitches are removed. This needs to be done before the cervix starts to open.
Treatment
Your health care provider can take tests to find out if you are at risk for preterm labor. Follow their advice. Treatment depends on the causes and the stage of the pregnancy. Some treatment options are:
Rest. Laying on your left side is best. This could be complete bed rest.
No sex or orgasm during last 2 or 3 months of pregnancy
Drinking extra liquids. Sometimes fluid has to be given through an IV.
Medications to slow labor.
Hospital care. Medicine may be given to delay labor. Medicine may be given to help the baby’s lungs mature sooner.
Delivery of the baby.
Self-Care
Know the signs of preterm labor. That’s labor that begins 3 weeks or more before your due date.
If you have signs of preterm labor, call your health care provider. Follow his or her advice. You may be told to do these things:
Pass urine.
Drink 8 to 12 ounces of a clear liquid.
Pour 2 more glasses of a clear liquid. Take these with you for the next step.
Lie down tilted toward your left side. This aids blood circulation. Lie down for 1 hour. Don’t lie on your back.
Time how long your contractions are and how often they occur in 1 hour. You can feel them by gently pressing down on your belly with your hands. When you have a contraction, you will feel your uterus or belly tighten and become hard. Then it relaxes and gets soft. Drink the 2 glasses of clear fluids during this hour.
Call your health care provider back. Give the provider the timing of your contractions.
Know the signs of true labor and the signs of false labor.
Sign
True Labor
False Labor
Contractions
Come in regular time patterns. Get closer together as time goes on such as every 15, then 10, then 5 minutes. Last longer as time goes on.
Do not come in regular time patterns. Do not get closer together as time goes on (called Braxton-Hicks contractions).
Get stronger as time goes on. Stay the same or get stronger when you walk or move around.
Usually weak or may be strong and then get weak. Do not get stronger (or may stop) when you walk or move around.
Pain
Is usually felt in the lower back and moves around to the belly.
Is usually felt in the lower part of your belly.
Triage Questions
Question 1
Do you have sudden vaginal bleeding or do you pass large clots of blood?
