Preterm labor: Take prevention seriously

A full-term pregnancy lasts about 40 weeks. Sometimes, however, contractions begin to open the cervix before week 37. This is known as preterm labor. While the specific cause of preterm labor often isn't clear, you can take steps to prevent it and promote a healthy pregnancy.

Why is preterm labor a concern?

If preterm labor can't be stopped, your baby will be born too soon. And the earlier preterm birth happens, the greater the risks for the baby — including low birth weight, breathing difficulties, underdeveloped organs and potentially life-threatening infections. Children who are born prematurely also have a higher risk of learning disabilities, developmental disabilities and behavioral problems.

Who's at risk of preterm labor?

Preterm labor can affect any pregnancy. Common risk factors include:

• Previous preterm labor or preterm birth
• Pregnancy with twins, triplets or other multiples
• Certain problems with the uterus, cervix or placenta
• Smoking cigarettes, drinking alcohol or using illicit drugs
• Some infections, particularly of the amniotic fluid and lower genital tract
• Some chronic conditions, such as high blood pressure and diabetes
• Being underweight or overweight before pregnancy, or gaining too little or too much weight during pregnancy
• Stressful life events, such as the death of a loved one
• Domestic violence or any form of abuse during pregnancy
• Multiple miscarriages
• Anemia
• An interval of less than six months since the last pregnancy

Still, many women who have preterm labor have no known risk factors.

Can preterm labor be prevented?

There are no guarantees — but there's much you can do to nurture a healthy, full-term pregnancy:

• Seek regular prenatal care. Prenatal visits can help your health care provider monitor your health and your baby's health. Mention any signs or symptoms that concern you, even if they seem silly or unimportant.
• Eat a healthy diet. During pregnancy, you'll need more folic acid, calcium, iron, protein and other essential nutrients. A daily prenatal vitamin — ideally starting a few months before conception — can help fill any gaps.
• Manage chronic conditions. Diseases such as diabetes and high blood pressure increase the risk of preterm labor. Work with your health care provider to keep any chronic conditions under control.
• Follow your health care provider's guidelines for activity. If you're at risk of preterm labor or develop signs or symptoms of preterm labor, your health care provider might suggest working fewer hours or spending less time on your feet. Sometimes it makes sense to scale back other physical activities, too.
• Avoid risky substances. If you smoke, quit. Smoking may trigger preterm labor. Alcohol is off-limits, too. In addition, medications of any type — even those available over-the-counter — deserve caution. Get your health care provider's OK before taking any medications or supplements.
• Ask your health care provider about sex. If you have a history of preterm labor or experience signs or symptoms of preterm labor, you may need to restrict sexual activity or monitor yourself for contractions after sex.
• Manage stress. Set reasonable limits — and stick to them. Set aside some quiet time every day. Ask for help when you need it.
• Take care of your teeth. Brush and floss daily, and visit your dentist for regular cleanings and dental care. Some studies suggest that gum disease may be associated with preterm labor and premature birth.

If you have a history of preterm birth, your health care provider might suggest weekly shots of a form of the hormone progesterone to decrease your risk of another preterm birth. In addition, new research shows that treatment with a vaginal progesterone gel during the second and third trimesters might decrease the risk of preterm birth in women who have short cervixes.

What are the signs and symptoms of preterm labor?

For some women, the clues of preterm labor are unmistakable. For others, the signs and symptoms are more subtle. Be on the lookout for:

• Contractions — a tightening sensation in the abdomen similar to menstrual cramping — that occur eight or more times each hour
• Low, dull backache
• A sensation of pelvic pressure
• Diarrhea
• Vaginal spotting or bleeding
• Watery vaginal discharge
• An increase in vaginal discharge

If you're concerned about what you're feeling — especially if you have vaginal bleeding accompanied by abdominal cramps or pain — contact your health care provider. Don't worry about mistaking false labor for the real thing. Everyone will be pleased if it's a false alarm.

Can preterm labor be stopped?

While you're evaluating your contractions, drink a couple of glasses of water or juice. If you're experiencing false labor, the fluids might stop your contractions. In other cases, lying down — usually on your left side to improve circulation to your uterus — can halt false labor. Sometimes bed rest is recommended, although bed rest isn't a proven remedy for preventing preterm birth.

If you're admitted to the hospital, your health care provider might:

• Use a uterine monitor to measure your contractions
• Use a fetal heart rate monitor to evaluate your baby's well-being
• Use an ultrasound to evaluate the length of your cervix
• Test a swab of your vaginal secretions for the presence of fetal fibronectin — a substance that acts like a glue between the fetal sac and the lining of the uterus
• Give you medication to stop the contractions

What if the contractions continue?

Many women treated for preterm labor deliver at or near term. Sometimes, however, preterm labor can't be stopped — or an infection or other complications make an early delivery safer for mother or baby.

If you're between weeks 23 and 34, your health care provider might recommend an injection of potent steroids to speed your baby's lung maturity. After week 34, your baby's lungs might be mature enough for delivery without steroids.

What can I expect during labor?

Aside from starting too early, preterm labor typically resembles normal labor. If relaxation and breathing techniques aren't enough to control the pain, ask for relief. Your health care provider might recommend an epidural block, a spinal block or other options.

Pediatric experts might be on hand for the delivery to evaluate your baby and meet any special needs.

What about recovery and future pregnancies?

Preterm labor won't affect your physical recovery from childbirth. However, the common stresses after delivery could be magnified by your baby's condition. Preemies often need intensive medical care after birth, sometimes requiring lengthy hospital stays. This time will be busy and stressful. Surround yourself with supportive loved ones and friends. Accept their help in caring for your baby or older children.

After one preterm birth, you're at risk of a subsequent preterm birth. Work with your health care provider to manage any risk factors and respond to early warning signs.

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