11 Things You Need To Know About Preterm Labour
Don't be caught unaware when the process of childbirth starts weeks earlier than expected.
All pregnancies have a due date. It is reassuring for the mother-to-be to know when she will give birth and finally get to meet her new son or daughter. But things do not always go as planned. Sometimes, pregnancies have a surprise or two (or more) for the expectant mum, like when labour begins early and the baby seems to want to come out way before the ideal 40-week period. This is called premature or preterm labour.
“Preterm labour is having labour pains or uterine contractions that lead to the opening up of the cervix between 20 weeks and less than 37 completed weeks of pregnancy,” said Dr. Katleen del Prado, an obstetrician-gynecologist based in Lucena City, Quezon, Philippines, whose subspecialties are maternal-foetal medicine (perinatology) and high risk pregnancies. Early labour could result in delivery and having a premature baby.
11 noteworthy facts about preterm labour
1. Preterm labour is not life-threatening to the mother
The premature birth that usually results from it, however, is the leading cause of death for neonates or newborns all around the world, shared Dr. del Prado. According to the World Health Organization (WHO), an estimated 15 million babies are born too early every year, and about one million die annually due to complications of preterm birth. WHO also reported that globally, prematurity is the leading cause of death in children under the age of five.
2. Being pregnant with twins, triplets or more increases the risk of preterm labour
This is because carrying more than one baby can overstretch the uterus.
Other risk factors are:
- having medical conditions like high blood pressure, preeclampsia, diabetes, anemia, and blood clotting disorders
- having a premature baby in the past
- being pregnant after in vitro fertilization (IVF)
- having a baby with birth defects
- having problems with your uterus, cervix or placenta
- getting pregnant too soon (less than six months) after giving birth
- lack of or no prenatal care
- being overweight or underweight before pregnancy
- smoking, drinking alcohol or taking illegal drugs while pregnant
- chronic stress
According to the American Pregnancy Association, premature labour occurs in about 12% of all pregnancies. But mothers-to-be are at the greatest risk for it if they have these three simultaneously:
- multiple babies (carrying triplets or more)
- a previous premature birth
- certain uterine or cervical abnormalities
3. Pregnant women with no known risk factors can experience preterm labour. Conversely, having one or several risk factors does not automatically mean you will go into early labour
4. Infections can cause preterm labour
According to Dr. del Prado, “The most common causes are urinary tract infection (UTI) and cervico-vaginal infections, but infections elsewhere, like in the lungs for pneumonia or in the mouth for periodontal disease, can trigger preterm labour as well.”
Other causes of preterm labour are:
- Uterine stretch or conditions that stretch the uterus, like when there is too much fluid or the baby is too big. Uncontrolled diabetes mellitus for instance, can increase the amniotic fluid.
- Cervical incompetence or the opening up of the cervix even if without uterine contractions. “This is actually not under the classification of preterm labour but is a very significant cause of preterm delivery,” explained Dr. del Prado.
- Spontaneous preterm birth, which causes about two-thirds of all premature births, is when labour happens on its own and/or the pregnant woman’s water breaks early.
“There are many causes of preterm labour,” said Dr. del Prado. “We must understand how labour works. Labour happens because of uterine contractions and opening up of the cervix. The basic mechanism is that of inflammation, muscle stretch, and opening of the cervix either spontaneously or secondary to the contractions.”
5. The warning signs of preterm labour are very similar to labour that occurs at term
- regular or frequent contractions (five or more in an hour) that feel like menstrual cramps or could be painless
- a dull, low backache that is constant or may come and go
- watery fluid leaking from your vagina (a gush or a trickle) to show that your bag of water or amniotic sac has broken
- pelvic or lower abdominal pressure
- vaginal spotting or bleeding
- increase or change in vaginal discharge (it may be watery, bloody or include mucus)
- nausea, diarrhoea or intestinal upset
The woman will feel labour pains, said Dr. del Prado, like any other labouring woman. “The contractions usually happen hourly, then the interval in between shortens, until it becomes every two to three minutes. The pain is like the pain we feel during menses in the lower belly and radiates to the lower back. There is watery or a bloody-mucoid type of vaginal discharge. There are contractions of the uterus and opening up of the cervix upon digital internal examination by the doctor.”
Contact your doctor immediately if you experience these signs and symptoms.
6. Doctors can stop or slow down early labour
Medications can be given, for example, to stop contractions and to delay delivery or keep the baby in the womb as long as possible. “Choice of medications is highly individualised because these are not without side effects, and hence, cannot be overly prolonged. Response to these medications depends also on the patient, who may or may not be admitted depending on the case,” said Dr. del Prado.
7. Sometimes, preterm labour stops on its own
This happens in three out of 10 pregnant women, said the American College of Obstetrics and Gynecology (ACOG). The Centers for Disease Control and Prevention (CDC) likewise reported that up to 50% of women who experience preterm labour go on to have their babies at 37 weeks or later.
8. Preterm labour can be scheduled
Yes, this type of labour is not always surprising or unexpected. According
to the National Health Service (NHS), certain cases call for planned and induced premature labour because it is safer for the baby to be born at an earlier time. An example is when the expectant mother has a high blood pressure disorder like preeclampsia.
9. A pelvic exam is done by the doctor to confirm preterm labour
Your doctor will check your cervix for changes and monitor your contractions. Examples of these changes are effacement (the cervix thins out) and dilation (the cervix opens so that the fetus can enter the birth canal). Your doctor may need to examine you repeatedly as your labour progresses in the next few hours. He/she could do other tests too, like a transvaginal ultrasound, to check the length of the cervix, and to determine if specialized care or hospitalisation is needed.
10. Management of preterm labour is highly individualised
Women have different histories, risk factors, and pregnancy experiences. Not all who go into early labour, for example, will need a cervical cerclage or a cervical stitch. This is a treatment for cervical weakness (when the cervix starts to shorten and open too early during pregnancy) and could help prevent a late miscarriage or premature birth.
You might receive one or more treatments and medications from your doctor to stop or delay early labour, hasten your baby’s development, or to help you feel better. It is important to have professional medical care throughout your pregnancy. “Those with previous preterm birth/s must be managed by obstetricians and deliver their babies in the hospital.” stressed Dr. del Prado.
11. You can reduce the risk of preterm labour by dealing with treatable risk factors
Start by getting very early prenatal care with a perinatologist or a high risk pregnancy expert, even if you have yet to conceive, Dr. del Prado recommended. This way, you can plan your pregnancy well, control chronic conditions effectively, and make the necessary lifestyle changes to improve your health. For those already pregnant, consult with an obstetrician regularly, and at the earliest stage of pregnancy as possible.
Here are other steps you can take to reduce the risk of preterm labour and have a healthier pregnancy:
- Eat a well-balanced diet and take vitamins/supplements if needed.
- Strive to reach your ideal weight before getting pregnant, especially if you need to lose or gain several pounds.
- Avoid all products and substances that could harm you and your baby like tobacco, illegal drugs, and alcohol.
- Work with your doctor to manage medical conditions such as high blood pressure and diabetes.
- Seek treatment for all infections. Ideally, this should be done before pregnancy.
- Get enough rest and sleep.
- Minimise stressful situations, strenuous activities, and long periods of standing.
- Discuss pregnancy spacing and birth control options with your doctor.
Obstetrician-gynecologist Katleen del Prado, MD, FPOGS, FPSMFM is a perinatologist and high risk pregnancy specialist who practices in Lucena City, Quezon, Philippines. You can find her on Facebook: Katleen Del Prado, MD-ObGyn