Preterm Labor & Birth Preterm labor is labor that starts before the end of 37 weeks of pregnancy. It can lead to preterm birth. About 1 of every 10 babies born in the United States is born preterm. Your baby can have problems if it is born too early. Serious illness or death can occur because the baby is not yet ready for life on his or her own. This article will explain: · The warning signs of preterm labor · How to detect it at an early stage · What could put you at risk · What to expect if you need treatment or if you give birth to a preterm baby 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. What Is Preterm Labor? In most pregnancies, labor starts between 38 and 42 weeks after the last menstrual period. Preterm labor starts before the end 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 for certain 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, such as infection of the uterus or amniotic fluid. In most cases of preterm labor, the exact cause is not known. Why the Concern? Preterm birth accounts for about 75 percent of newborn deaths that are not related to birth defects. Growth and development in the last part of pregnancy is vital 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. Signs of Preterm Labor If preterm labor is found early enough, delivery can be prevented or postponed in some cases. 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 box lists the early signs of preterm labor. If you have any of these signs, don't wait. Call your doctor or nurse or go to the hospital. Diagnosing Preterm Labor It can be hard to tell true and false labor apart. Preterm labor can be diagnosed only by finding changes in the cervix. This means your doctor or nurse-midwife will have to examine you. It is common for women to have contractions before labor starts. This is 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 last for more than an hour, call your doctor or nurse-midwife right away. Fetal monitoring tests are used to record the heartbeat of the fetus and contractions of your uterus. Ultrasound may be used to estimate the size and age of the fetus and to see where it is in the uterus. You may be watched for a time and then examined again to see whether your cervix changes. Signs of Preterm Labor Call your doctor or nurse right away if you notice any of these signs: · Vaginal discharge o Change in type (watery, mucus or bloody) o Increase in amount · Pelvic or lower abdominal pressure · Constant, low, dull backache · Mild abdominal cramps, with or without diarrhea · Regular or frequent contractions or uterine tightening, often painless · Ruptured membranes (your water breaks) 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, though, without warning. A number of other factors also have been linked to preterm labor (see box). 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. 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 lifestyle · Having more frequent visits with your doctor or nurse · Learning how to time your contractions Risk Factors for Preterm Labor Check any area that applies to you: · You have warning signs of preterm labor. · You have had preterm labor during this pregnancy. · You had preterm labor or preterm birth in a previous pregnancy. · You are carrying more than one baby (twins, triplets). · You have had one or more second-trimester induced abortions (the planned ending of a pregnancy). · You have an abnormal cervix (due to surgery, for instance). · You have an abnormal uterus. · You have had abdominal surgery during this pregnancy. · You have had a serious infection while pregnant. · You have had bleeding in the second or third trimester of your pregnancy. · You are underweight or you weigh less than 100 pounds. · You were exposed to DES (diethylstilbestrol, a medication given to many pregnant women in the 1950s and 1960s) as a fetus. · You smoke cigarettes or use cocaine. · You have had little or no prenatal care. If you checked any of these boxes, you may be at risk for preterm labor. 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 doctor or nurse-midwife more often for exams and tests. You should not drink alcohol or smoke cigarettes. In many cases, women at risk for preterm labor do not have to take a leave from their jobs unless preterm labor has been diagnosed. You may be advised to avoid 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 also may be advised to cut down on travel. Ask your doctor or nurse-midwife about these and other changes you may need to make in your daily routine. If you have a history of preterm labor 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 real concerns that should be discussed with both your partner and your doctor or nurse-midwife. You may be advised to restrict sexual activity or to monitor yourself for contractions after sex. Your doctor or nurse-midwife also may ask that your partner use a condom during sex to lower the risk of infection. Stopping Labor Your doctor may try to stop preterm labor a number of ways. If your cervix begins to open earlier than it should, your doctor may suggest cerclage. This procedure places a stitch in the opening of the cervix to keep it closed. It is unclear how well it works to stop preterm labor. 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. In most cases, 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 doctor or nurse-midwife sooner - don't wait. Having some uterine activity before 37 weeks of pregnancy is normal. But, if your contractions occur more than once every 10 minutes (six or more per hour), you need to call your doctor or nurse-midwife right away. You may be in preterm labor. Keep in mind, 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 doctor or nurse-midwife 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 doctor 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 also may be given medications that stop contractions. You may be able to go home if you are not really in preterm labor or if labor is stopped. Or, you may need to stay in the hospital for a while. This depends upon what the doctor's exam reveals and other factors. You may need to take certain medicines after you have had signs of preterm labor. If you have been prescribed medication, ask about its side effects. If any symptoms persist or are strong, call your doctor. Your medicine may need to be changed. Limit Your Activity If you have had preterm labor, your doctor may suggest limits on activity. If you have a job that requires heavy lifting or standing a lot, it may require some changes. You may have to stop working. The kind of limit advised can vary. It may be partial bed rest. This means you can get up, go to the bathroom, and have limited activity. It may mean staying off your feet and not doing certain activities, such as climbing stairs. Or, it may be total bed rest. For most women, having to limit your activity week after week is very hard. You may feel moody, helpless and depressed. Sometimes you may feel that the frustration and boredom just aren't worth it. You may be tempted to resume your activities. It can be 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 and plenty of fluids will help prevent constipation. If bed rest is prescribed, plan your days to include a change into day clothes and tasks that you can do in bed. You may want to talk to your doctor about exercises you can do in bed to improve your circulation. Preterm Delivery Sometimes preterm labor may be too far along 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 · Signs that the fetus may be having problems Preterm labor, delivery, and care of the baby require care in a hospital with special facilities. You or your baby may be moved to a different hospital that can provide this expert care. Preterm babies may be delivered by cesarean birth, in which the baby is born through a cut made in the mother's abdomen and uterus. Your Preterm Baby Many preterm babies are tiny and fragile. The baby may need special medical care to breathe, eat and keep warm. It depends on how early he or she is born. 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 a Neonatal Intensive Care Unit (NICU) for weeks and sometimes months. Preterm babies often are kept in an incubator to keep them warm. They are cared for by specially trained nurses and doctors. 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 babies survive. Physical Features Preterm babies often weigh less than 5 1/2 pounds at birth (low birth weight). Babies born too early often have organs that are not developed enough to function as they should. For instance, the lungs of a preterm baby often are 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 medication 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 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. This causes his or her skin to appear yellow for a short while. A preterm baby also may 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. Preterm babies who are fed breast milk gain weight at a slower rate than those fed formula, but the benefits of breast milk outweigh the benefits of increased weight. Emotional Needs Hospitals often are 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 feelings are normal. Talk to the nurses and doctors 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 a longer time and help with the baby's care. Care at Home If you have a preterm delivery, you will be shown how to care for your new baby. Preterm babies often need special - and different - care. Preterm babies usually require more doctor 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 (such as wheezing or 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. A standard infant car seat may not be safe to use. It depends on the size of your baby. There are special car seats designed for smaller babies. Discuss this with your baby's doctor. 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 to help you. 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. Get regular prenatal care. Lead a healthy lifestyle. Be alert to warning signs, and follow your doctor's or nurse-midwife's advice. Glossary Amniotic Fluid: Water in the sac surrounding the fetus in the woman's uterus. Cervix: The lower, narrow end of the uterus. Fetal Monitoring: A procedure in which instruments are used to record the heartbeat of the fetus and contractions of the mother's uterus during labor. Fetus: A baby growing in the woman's uterus. Jaundice: A buildup of bilirubin that causes a yellowish appearance. Placenta: Tissue that provides nourishment to and takes away waste from the fetus. Ultrasound: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus. Uterus: A muscular organ that is located in the female abdomen and contains and nourishes the developing embryo and fetus during pregnancy