Things To Know About Preterm Labor & Premature Birth
- Preterm labor is when you go into labor before 37 weeks of pregnancy.
- Preterm labor does not always result in preterm birth.
- Signs and symptoms include contractions, abnormal discharge, backache and stomach ache, cramps, etc.
- In case you have these symptoms, talk to your doctor, who will then diagnose and treat you.
- Treatment involves delaying delivery or accelerating the baby's growth to minimize complications.
- Preterm infants require special care and attention.
If you're a pregnant mom reading this, we bet you can't wait to meet your little one! All the planning and preparation must be overwhelming, but worth the wait, am I right? But this wait needs to be sufficiently long, as it is intended to be. Your baby takes its own sweet time to develop in your belly, thanks to your love and care.
But sometimes, this time is up way too soon, leaving the baby with little to no time to finish its development. This happens in the case of preterm labor and preterm birth. Here's everything about preterm labor and preterm birth.
What do preterm labor and preterm birth mean?
Normally, a pregnancy lasts for about 40 weeks. This is around 9 months. In the case of preterm labor, you go into labor before 37 weeks of pregnancy. Preterm labor and preterm birth are not the same.
If you go into preterm labor, it does not necessarily mean that your baby will be born prematurely. However, it needs to be addressed medically at the earliest.
Preterm birth means that you give birth to your baby before 37 weeks of pregnancy are completed. Preterm birth is associated with health complications during childhood as well as adulthood. Preterm birth is further classified as:
- Extremely preterm (less than 28 weeks)
- Very preterm (28 to 32 weeks)
- Moderate to late preterm (32 to 37 weeks).
Key facts about preterm labor and birth
To give you an idea about the bigger picture and how common preterm birth and labor are, here are some key facts from around the world.
- Nearly 15 million babies are born preterm (before 37 completed weeks of gestation) every year.
- Across 184 countries, the rate of preterm birth is up to 18% of babies born.
- Preterm birth complications are the leading cause of death among children under 5 years of age.
- Preterm birth complications were responsible for approximately 1 million deaths in 2015.
- About 75% of these deaths could be prevented with medical interventions.
These facts might have instilled some fear in you. Let us dive deeper into the concept of preterm birth to understand it better, and to take steps to prevent the same.
1. Causes of preterm labor
It is not well understood why preterm labor occurs. Here are some of the probable causes:
- Vaginal bleeding
- Hormone changes
- Genetic influence
- Multiple pregnancies
- Chronic conditions such as diabetes and high blood pressure
2. Premature labor signs and symptoms
Preterm labor causes changes in your cervix such as thinning and dilation. Signs and symptoms of premature labor include the following:
- Tightening of the uterus (contractions), especially more than 4 in 1 hour
- Mild abdominal cramps(these may or may not be accompanied by diarrhea
- A change in the type of vaginal discharge—watery, bloody, or with mucus
- Backache with constant and dull pain
- Spotting or bleeding from the vagina
- An increase in the amount of discharge
- Pressure in the lower abdomen or pelvis
- Ruptured membranes with a gush of fluid flowing from your vagina
If you experience any of these symptoms, you have no time to waste. You need to seek medical attention immediately.
3. Signs Of Preterm Pre-labor Rupture Of Membranes Or P-PROM
Preterm pre-labor rupture of membranes, or simply P-PROM, is when your water has broken. P-PROM increases the risk of infections. Signs and symptoms include:
- Increased body temperature
- Feeling hot or shivering
- Greenish or smelly fluid coming out of your vagina
- Change in baby's movement patterns
- Backache or stomach ache
This does not mean you will go into labor, however, you may be advised to stay in the hospital.
4. Who is at risk for preterm labor?
Preterm labor can happen to anyone, and without any warning. However, some factors increase the risk of going into labor prematurely:
- Having a low pregnancy weight
- Being younger than 17 years or older than 35 years
- Having a preterm birth in the past pregnancy, particularly in the most recent one
- Too short or too long intervals between subsequent pregnancies(less than 12 months or more than 59 months)
- Being pregnant with two or more babies(twins, triplets, etc)
- Having a short cervix early in the pregnancy
- Pregnancy complications like gestational diabetes, preeclampsia, etc
- Smoking cigarettes or using drugs like cocaine
- Too much amniotic fluid
- Birth defects in the baby
- Issues with the placenta, like early separation of the placenta from the uterus
5. How does premature birth impact the child?
Premature birth can lead to several complications during childhood and adulthood. This is because the baby is delivered before the complete development of its organs. Here are some ways your baby might be impacted:
- Low birth weight(2,500 grams or 5.5 pounds)
- Breathing difficulties
- Vision problems
- Cardiovascular problems, including heart defects and blood and heart rate problems
- Low RBC count(anemia)
- Low blood sugar
- Trouble feeding and improper digestion
- Kidney problems
- Blood infections
- Problems with the nervous system, including seizures
6. How does premature birth impact the mother?
Premature labor can also impact the mother and she can develop psychological disorders like:
- Postpartum depression
- Post-traumatic stress disorder (PTSD)
- Problems bonding with their baby
7. How is preterm labor diagnosed?
If you experience any of the signs and symptoms mentioned above, you need to go see your OB-GYN immediately. They will be the ones who make an official diagnosis of whether you are in preterm labor or not.
Your doctor will ask you about your signs and symptoms and review your medical history to analyze whether you are at risk of preterm labor. They will mainly be looking to see if contractions have started and if there are any changes in the cervix.
After the contractions start, the doctor may notice some changes in your cervix, like if it is beginning to soften, which would lead them to diagnose preterm labor. These changes will be examined and monitored by your health care professional and it can take a few hours.
Some of the ways preterm labor may be diagnosed include:
- Pelvic exam: Your doctor might perform a pelvic exam to evaluate the firmness and tenderness of your uterus and also to know the baby's size and position.
- Uterine monitoring: This is done to measure the spacing between your contractions.
- Ultrasound: An ultrasound can help measure the length of the cervix. It can also provide information about:
- Baby's position
- Problems with the placenta
- The volume of amniotic fluid
- Baby's weight estimate
- Lab tests: These might be performed to look for signs of infection. A swab of discharge might be taken from your vagina along with a urine sample. These samples will be tested for bacteria and microbes and for a glue-like substance called fetal fibronectin.
8. Management of preterm labor
When you go into labor prematurely, here are some things your doctor might do:
- Prescribe medications to slow down your contractions
- Prescribe medications to help your baby's organs mature faster
This depends on several factors, including, how far along are you in your pregnancy, availability of facilities, your/spousal consent, etc. Sometimes, the best option might be to deliver your baby.
Preterm infants need special care and are kept in the hospital for days or weeks depending on their condition. They are kept in a special unit called Neonatal ICU(NICU). Preterm infants can not perform some functions on their own, hence may need assistance in:
- Gaining weight
- Maintaining body temperature
9. Can preterm birth be prevented?
Preterm labor can happen to anyone. However, some women are at a higher risk of going into labor prematurely. Certain things can be done to prevent preterm labor.
1. What Can You Do?
Once you have found out that you are at risk of preterm labor, here are some things you should do to avoid it the best you can:
- Attain a healthy pregnancy weight
- Eat more nutritious food, especially if you have gestational diabetes or preeclampsia
- Avoid cigarette smoking or even secondhand smoke
- Stop drinking alcohol
- Do not consume illicit drugs
- Reduce your stress levels
- Go through routine prenatal checkups
2. Treatment to prevent early labor
Your healthcare professionals might consider treatment in the following cases:
- Delivery in less than 34 weeks pregnant before
- History of miscarriage from 16 weeks pregnant
- If your water has broken before 37 weeks in the past or current pregnancy
- Cervical injury, for example in a surgery
- Having a short cervix
There is very little healthcare professionals can do to prevent preterm delivery once it has started.
However, here are some medications they might consider to delay it as much as possible and to improve the outcomes for you and your baby:
- Corticosteroids: These steroids can help your baby's lungs mature faster. If your doctor suspects preterm labor, he might prescribe these medications sometime around 23-34 weeks of your pregnancy and may also recommend repeating a course later on in the pregnancy.
- Magnesium sulfate: This medication can minimize the damage that might be caused to your baby's brain, and might be considered if you are at risk of delivering between weeks 24 and 32 of pregnancy.
- Tocolytics: These are substances that can delay or slow down your contractions to allow for enough time for the other drugs to take effect.
10. WHO guidelines to improve outcomes
WHO constantly strives to minimize the risk of preterm births and is taking active measures in doing so. It updates and develops new guidelines and recommendations to improve the survival chances and health outcomes for premature infants.
Some of the things WHO recommends for improving the outcomes of preterm labor and premature birth include:
- Steroid injections before birth
- Antibiotics when the water breaks before the onset of labor to prevent infections
- Magnesium sulfate to prevent future neurological impairment of the child
Interventions recommended for the newborn baby include:
- Thermal care
- Feeding support
- Kangaroo mother care
- Safe oxygen use, and other treatments to help babies breathe more easily.
11. FAQs of a mother about preterm birth and labor
We're sure you're quite overwhelmed with information at the moment. Here are some frequently asked questions by mothers about preterm birth and labor.
1. Can preterm labor stop on its own?
In some cases, yes it can. For nearly 30% of women, preterm labor can stop on its own. If it does not, your doctor might put you on medications to accelerate your baby's growth and deliver the baby.
2. Does preterm labor always mean preterm birth?
No, it doesn't always. Preterm birth happens when the baby is born after undergoing preterm labor. This is why monitoring is performed by hospitals to take the best measures to delay contractions and delivery.
3. What do the medications do? Can they harm your baby?
The medications are given for any of the following reasons:
- Help the organs mature more quickly
- Reduce the risk of complications
- Slow down contractions temporarily
The use of these medications depends on the assessment by the doctor of your and your baby's conditions. They are generally safe to use.
4. What if it's too late to stop preterm labor?
In this case, the only option is to deliver the baby. A premature baby requires special care. Your healthcare provider might recommend transferring you to a facility equipped to manage preterm infants.
5. What if I wish to get pregnant again?
There is a high risk of past preterm birth. The risk is about 2 to 3 times higher than for women with no history of preterm labor. Talk to your doctor before planning a future pregnancy and space the two pregnancies around 18 months apart.
Now we know, that preterm labor and preterm birth are two different things. Going into preterm labor does not always mean your child will be born prematurely. Once you observe the signs and symptoms of preterm labor such as contractions, backache, unusual discharge, cramps, etc., you should inform your doctor immediately.
Your doctor will diagnose preterm labor by using a pelvic examination or ultrasound and perform other tests to get an idea about the situation. Following this, you might be put on medication to slow down the contractions or accelerate the growth of the baby before the delivery. These steps can help to minimize the complications of preterm birth.
WHO is taking steps to increase awareness and improve health outcomes of preterm birth. On your end, you can follow a nutritious and well-balanced diet, maintain a healthy pregnancy weight, avoid alcohol/drugs/smoking, and switch to an overall healthy lifestyle. If you are at a high risk of preterm birth, you might require some additional treatments as well. You need not worry too much. Discuss your risk well in advance with your doctor and take the necessary steps. Even though your little one arrives a little too early in the world, with the right treatment and facilities, your baby can have a healthy life, and a happy future pregnancy as well!
Keep reading our blogs for complete information on related health conditions.
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- Preterm Labor Available at https://www.stanfordchildrens.org/en/topic/default?id=preterm-labor-90-P02497
- Premature Birth: Complications, Management & Causes Available at https://my.clevelandclinic.org/health/diseases/21479-premature-birth
- The Long-Lasting Effects of Preterm Birth | NICHD Available at https://www.nichd.nih.gov/newsroom/resources/spotlight/012612-effects-preterm-birth
- Premature labor and birth - NHS Available at https://www.nhs.uk/pregnancy/labour-and-birth/signs-of-labour/premature-labour-and-birth/
- Preterm Labor and Birth | ACOG Available at https://www.acog.org/womens-health/faqs/preterm-labor-and-birth
- Preterm birth Available at https://www.who.int/news-room/fact-sheets/detail/preterm-birth
- Preterm labor - Symptoms and causes - Mayo Clinic Available at https://www.mayoclinic.org/diseases-conditions/preterm-labor/symptoms-causes/syc-20376842
- Preterm labor - Diagnosis and treatment - Mayo Clinic Available at https://www.mayoclinic.org/diseases-conditions/preterm-labor/diagnosis-treatment/drc-20376848