What Is Preterm Labor?
Preterm labor and preterm birth refer to labor and birth that occur before the 37th week of pregnancy.
According to the March of Dimes, approximately 12% of American pregnancies result in preterm birth. The difference between 37 weeks and 40 weeks of pregnancy is the difference in body fat and final development of your baby. Preterm babies are often at significant risk for health conditions and problems. The risks are greater the earlier the pregnancy ends.
Why Does Preterm Labor Occur?
Preterm labor may be caused by many factors, which are not always clear. It may have to do with stress, genetics, health, infection, substance abuse, or other factors. Preterm labor can occur in any pregnancy, but some women are more prone to it than others, although it is not understood why.
What Are the Symptoms of Preterm Labor?
Preterm labor and birth can be prevented in some instances, particularly if you are able to recognize the signs and symptoms and get prompt medical care. It is important to get medical care quickly as this improves the odds that you and your baby will be healthier.
Symptoms of preterm labor include:
- Change in vaginal discharge
- Pelvic pressure
- Low, dull backache
- Abdominal cramps
- Abdominal cramps with diarrhea
If you have any of these symptoms, drink two to three glasses of water, rest on your left side, or go to your doctor or hospital. If symptoms do not subside after an hour, go to the hospital. If symptoms go away and return, seek medical attention or go to the hospital.
Who Is At Risk For Preterm Labor?
Women who have had a previous preterm birth, are pregnant with multiples or have uterine or cervical abnormalities have been identified as the groups of women who are at higher risk for preterm labor. Only half of women with preterm labor fall into one of these groups.
In addition to those higher risk groups, factors such as environment, concurrent medical conditions, age, and even socio-economic conditions have been linked to higher risk for preterm labor.
Environmental Risks For Preterm Labor:
- Lack of adequate prenatal care
- Smoking and tobacco use
- Alcohol use
- Substance use
- Exposure to the medication diethylstilbestrol (DES)
- Domestic violence
- Physical, sexual, or emotional abuse
- Poor social network
- Working long hours while standing
Medical Risks For Preterm Labor:
- Urinary Tract Infections
- Vaginal infection
- Sexually Transmitted Diseases
- Clotting disorders
- Vaginal bleeding
- Birth defects
- IVF pregnancy
- Short time between pregnancies
- Multiple miscarriages
Other Risk Groups For Preterm Labor:
Women with low income, African-American women and women who are younger than 17 or older than 35 have been identified as the three groups of women who are at more risk for preterm labor.
How Is Preterm Labor Stopped?
Treatment may include medication, which may stop or slow labor if administered early. Many times, preterm labor is suppressed by a combination of medication and rest. Sometimes, labor is delayed long enough to transport the laboring mother to a hospital with a NICU.
Medications To Treat Preterm Labor:
Tocolytics: Tocolytics can be delivered in many forms (IV, shot, orally, and rectally) and may be able to stop contractions. There are several medications that fall under the tocolytics class, which include calcium channel blockers, terbutaline, ritodrine, magnesium sulfate, ketorolac, sulindac, and indomethacin. Tocolytics may delay delivery up to an additional week to allow physicians to treat the baby with steroids to speed lung development.
Steroids: Primarily corticosteroids may be used to speed up lung and brain development when preterm birth seems likely. Steroids can reduce infant deaths, respiratory distress syndrome, and bleeding in the brain. They can also buy the mother some time to treat any infection with antibiotics or transfer her to another hospital with a NICU if necessary. These steroids include betamethasone and dexamethasone.
Progesterone may be used with women who have previously had preterm birth.
Bedrest/Activity Restrictions to Manage Preterm Labor: While the jury is out about the effectiveness of bedrest to manage preterm labor (there has been no evidence to suggest bedrest decreases the rate of premature births), many doctors advise that a woman restrict her activities to manage preterm labor. The recommendations for bedrest/activity restriction vary from resting several times a day, to staying in bed, to avoiding activities that trigger contractions.
Hospitalization to Manage Preterm Labor: Depending upon the circumstances surrounding the preterm labor, a health care provider may admit the woman to the hospital for weeks or months. In the hospital, she can be better monitored and treated for certain conditions.
What Can I Do to Reduce the Risks of Premature Labor?
Here are some things you can do at home to reduce your risk of developing preterm labor and prevent preterm births:
- Get appropriate prenatal care
- Eat healthy foods
- Manage chronic health conditions
- Avoid substances listed above
- Discuss sexual activity with your doctor
- Take care of your teeth
- Manage stress
How to Survive on Bedrest:
Okay, so bedrest isn't exactly the easiest thing to handle. Sure, it sounds great in theory. In practice, however, bedrest can be exceptionally challenging.
Here are some tips to help manage bedrest:
Schedule yourself. It seems weird to schedule your day in, but sticking to a schedule can make you feel as though you're accomplishing something and taking care of yourself.
Do your favorite non-strenuous tasks. These may include:
- Organizing photo albums
- Starting a family tree
- Creating a calendar of important events
- Writing letters or emails
- Watching DVD's and television.
- Writing thank you notes for the shower
- Updating address books
- Completing any insurance paperwork
- Writing a post for Band Back Together
Stock up your house with necessary baby stuff. You can do almost everything you need to do online - including ordering diapers!
Ask visitors to perform specific tasks - make dinner, pick up your dry cleaning, anything.
Find a support system - like The Band - and keep in touch with them.
Resist the urge to punch anyone who says, "better rest now while the baby's not here!" in the throat. Or Mushroom Print 'em.
Don't expect that you're going to feel perfect. You might feel sad or mad or anywhere along that continuum. Just remember that you're allowed to feel what you feel. Period.
Make lists of things to keep organized (even if they're lists of dumb things) and feel accomplished.
Try to remember that, although it may feel like time has stopped, bedrest and pregnancy are both finite.
Additional Preterm Labor Resources:
Sidelines - non-profit organization providing international support for women and their families experiencing complicated pregnancies and premature births.
March of Dimes - A national organization that works globally to help mothers take charge of their health and provide resources when something goes wrong. The organization has a wealth of information for health care providers and parents on all areas of prenatal and neonatal health, including prematurity.
The American College of Obstetricians and Gynecologists (ACOG) provides information and resources for health care professionals and patients, including an informational brochure on preterm labor.