Preterm Labor

Babies born prior to 37 weeks of pregnancy may experience various problems due to incomplete growth and development. They may experience problems of varying severity depending on their development. Because a preterm birth can affect your child for years to come, it is important that you are aware of the signs and symptoms of preterm labor so you can identify preterm labor as early as possible and help prolong your pregnancy.

If you are having preterm labor, your doctors/midwives and nurses may suggest a number of things for you to consider:

  • Rest
  • Fluid intake
  • Bedrest
  • Activity
  • Work related activities
  • Sexual activity

And place a strong emphasis on:

  • Being aware of the signs and symptoms of preterm
  • labor
  • Being aware of the various techniques to monitor your uterine contractions or tightening

Preterm Labor

Labor is the process by which the uterus contracts and causes the cervix to open and prepare for delivery. Preterm labor occurs when this process takes place prior to your 37th week of pregnancy. These changes can be difficult to detect. Your role in the early identification of labor is to monitor your uterine contractions and report the signs and symptoms of preterm labor to your doctors/midwives.

The cause of preterm labor is not completely understood. However, it is known that certain situations are associated with preterm labor and may increase your risk of experiencing a preterm delivery. The most common factors associated with preterm labor include; a current pregnancy of twins or triplets, and/or having experienced a prior preterm delivery.

At this time preterm labor cannot be prevented. We can only do the next best thing -- identify it early and treat it effectively to help prolong the pregnancy. Early recognition of the signs and symptoms of preterm labor can help better manage your pregnancy.

Because you are the only person who can be aware of your body`s normal activity, you should be the one to identify anything that is not normal including the early signs and symptoms of preterm labor.

What is normal?

  • Occasional uterine contractions
  • Backache as your baby grows and causes your posture to change.
  • Pressure as your growing baby presses on your pubic bone and your legs
  • Pulling and stretching of muscles as the uterus grows that may cause pain

What is NOT normal?

  • Regular uterine contractions
  • Rhythmic, lower abdominal cramps
  • Persistent low, dull backache that feels different that what you normally experience
  • Persistent diarrhea or intestinal cramps
  • Unusual rhythmic or persistent pelvic pressure
  • A large amount of mucous or water leaking from the vagina
  • A change in color of vaginal discharge to pink or brown

Remember it is important to know what is normal for you. Then you will know how to identify what is NOT normal.

Signs and Symptoms of Preterm Labor

The following are signs and symptoms that are associated with preterm labor. However, these signs can also be a part of a normal healthy pregnancy. What you need to keep in mind is what may represent a change from your normal patterns and experiences:

  • Uterine contractions: The uterus (womb) is composed of muscle fibers. A uterine contraction is the tightening of the muscles within the uterus. Using your fingertips to feel your uterus, you should be able to slightly indent your uterus when it is relaxed. During a contraction you can feel your uterus tighten and become hard. Contractions occur normally throughout pregnancy. They are usually painless and they can occur at any time. Certain activities such as changing your position or having a full bladder may cause you to have a contraction.
  • Menstrual-like cramps: These are felt low in the abdomen, just above the pubic bone. The cramping may be rhythmic, feeling like waves or fluttering. You may also feel a constant cramp.
  • Lower, dull backache: This backache is located mainly in the lower back and may radiate to the sides or front. It may be rhythmic or constant. And often is not relieved by changing position.
  • Pelvic pressure: You may feel pressure or fullness in the pelvic area, in your back or thighs. It may feel as though the baby is going to "fall out."
  • Intestinal cramps: These may occur in the presence or absence of diarrhea. You may have the feeling of "gas pains."
  • Increase or change in vaginal discharge: The amount may be more that that which is normal for you. The consistency may change to mucous or watery. The color may become pink or brown-tinged.
  • A general feeling that something is not right: even without a specific cause. If you experience any of the above, or if you feel something is different, contact your provider.

If your doctors/midwives and nurses believe that you are experiencing any of the early warning signs and symptoms of preterm labor, or are at-risk of experiencing preterm labor, you may be asked to do the following:

  • Increase your rest: Resting on your side is a helpful way to keep your uterus relaxed. Also elevating your bed so that your hips are slightly higher than your head will keep the pressure of the baby off your cervix.
  • Maintain adequate fluid intake: During your pregnancy, it is important to drink 6 to 8 glasses of fluid per day or as other wise directed by your provider.
  • Bedrest: They may ask you to take rest periods during the day, or stay in bed all day except for getting up to go to the bathroom and sitting up for meals.
  • Decrease strenuous activity: Your doctors/midwives and nurses may ask that you do not do any heavy physical activity such as jogging, running, tennis or frequent trips up and down stairs. Your provider may also limit heavy lifting, cleaning, and long trips.
  • Consider a temporary change in work activities: Work activities may need to be changed or stopped. Your doctors/midwives and nurses will tell you about decreasing your activity and what they feel would be best for you.
  • Sexual activity Your doctors/midwives and nurses may ask that you stop or limit your sexual activities.
  • Be alert for the signs and symptoms of preterm labor.
  • Be aware of your uterine activity using one or more available methods (ask your doctor/midwife which method is most appropriate for your situation):
    • Use of Self-palpation - You can check for contractions after the 20th week of pregnancy by emptying your bladder and drinking a glass of water. Lie down on your left side. Use pillows to help support yourself so you can find a comfortable position. Do not lie flat on your back. Place your fingers on your stomach on either side of your belly button. Wait for your uterus to contract or tighten. During a contraction, your uterus will feel hard like your forehead. Use a watch to see how long the contraction lasts. After the contraction, your uterus will relax and you can press into it with your fingertips. If you have 4 or more contractions in an hour, call your provider right away. Contractions occur normally throughout pregnancy. They are usually painless and they can occur at any time. If you are having difficulty feeling contractions, you may not be having contractions or you may not be aware they are occurring.
    • Use of a small recording device similar to the one used in the hospital labor and delivery unit - An electronic monitor may be used in certain situations to help you detect the contractions that may be associated with preterm labor. You will wear a belt around your stomach for an hour, most likely twice a day. The belt has a sensing device, which is attached to a small recorder. If you have a contraction while you are wearing the belt, the sensing device records the information about your contraction. Once each day you will be asked to send any information that has been recorded across your telephone line to a monitoring center so the information can be provided to your doctor/midwife.

Always remember to follow your doctor/midwife and nurses instructions about your prenatal care and activities.

What to do if you think you are experiencing preterm labor

  • Call your provider's office
  • Go to the bathroom and empty your bladder
  • Check to make sure you have not missed a dose of any medication you might be taking
  • Maintain adequate fluid intake
  • Rest, lying down on your left side
  • Monitor you uterine activity

EMERGENCY SITUATIONS

Sometimes a problem can occur that needs attention right away. If you experience any of the following signs and symptoms, CALL YOUR DOCTOR/MIDWIFE IMMEDIATELY.

  • Bleeding: If you experience vaginal bleeding, a large gush or steady stream of bright red blood, IT IS AN EMERGENCY. Get help immediately, lie on your side and put your feet higher than your head. Save pads or cloths used to catch the blood.
  • Rupture of the bag of water (amniotic sac): Sometimes the bag of water around the baby will rupture prematurely. If you notice a gush of fluid or a steady trickle of fluid you should call our office. Be sure to note any color or odor that might be present in the fluid. Save pads or cloths and bring with you to the office or hospital.
  • Severe stomach pain If you have constant severe pain that does not go away when you change position, with or without contractions notify our office.

Any of the above situations may indicate an emergency, contact your office immediately.

What will happen if you are asked to go to the hospital

You may be told by one of your doctor/midwife or nurses to go to the hospital if they feel you may be experiencing preterm labor. At the hospital a nurse will take your temperature, pulse, and blood pressure. A fetal monitor may be placed on your abdomen to see if you are having contractions and to check your baby`s heart rate. If you are in labor, and your provider feels your pregnancy should be prolonged, treatment may include bedrest, I.V. fluids, medications, and continued monitoring of your contractions and your baby's heart rate. If it is felt you are not in labor, or having any other problems, you may be allowed to go home.

Reprinted by Pregnancy.org, LLC from Her HealthCare.