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Definition
Most pregnancies last about 40 weeks. By definition, a premature birth takes place more than three weeks before the due date.
A premature birth gives a baby less time to develop and mature in the womb. The result is an increased risk of various medical and developmental problems, including trouble breathing and bleeding in the brain. If you go into labor too early, your doctor may try to delay your baby's birth. Even if premature birth is inevitable, a few extra days in the womb can promote significant development.
Although the rate of premature birth seems to be on the rise, there's good news. A healthy lifestyle can go a long way toward preventing preterm labor and premature birth.
Symptoms
Prompt recognition of preterm labor may help you prevent premature birth. Even months before your due date, be on the lookout for:
- Contractions that occur more than eight times each hour — you'll feel a tightening sensation in your abdomen, often reminiscent of menstrual cramps
- Low, dull backache
- Pelvic pressure or pain
- Diarrhea
- Vaginal spotting or bleeding
- Watery vaginal discharge — this may be amniotic fluid, which surrounds your baby in the uterus
When to see a doctor
If you develop any signs or symptoms of preterm labor — such as a watery vaginal discharge or regular contractions that occur more than eight times an hour — contact your health care provider or hospital right away. It's a good idea to keep phone numbers for these handy so that you can find them quickly.
If you're at risk of preterm labor or premature birth, your health care provider may recommend more-frequent visits.
Risk factors
Often, the specific cause of preterm labor or premature birth isn't clear. Many factors may increase the risk of early labor and premature birth, however, including:
- Having a previous preterm labor or premature birth
- Pregnancy with twins, triplets or other multiples
- An interval of less than six months between pregnancies
- Conceiving through in vitro fertilization
- Problems with the uterus, cervix or placenta
- Smoking cigarettes, drinking alcohol or using illicit drugs
- Poor nutrition
- 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
- Stressful life events, such as the death of a loved one or domestic violence
- Multiple miscarriages or abortions
- Physical injury or trauma
For unknown reasons, black women are more likely to experience preterm labor and premature birth than are women of other races. But preterm labor and premature birth can happen to anyone. In fact, many women who have a premature birth have no known risk factors.
Complications
Preterm labor and premature birth may have various complications.
For mothers
Aside from starting too early, preterm labor typically resembles normal labor. Unfortunately, treatments used to delay delivery have only limited success and may carry risks. Medications that halt uterine contractions may cause fluid to collect in your lungs, which can make it difficult to breathe. Other side effects depend on the medication used to stop labor. Some medications can lead to fatigue and muscle weakness. Others may cause a rapid heartbeat, blood sugar abnormalities, headaches, dizziness or nausea.
On a more positive note, your doctor can give you medications that will increase the rate your baby matures in the uterus. These can have a beneficial impact in as little as 48 hours.
Your health care provider will weigh the potential risks from medications used to stop labor against the risks for your baby if he or she is born too soon.
For babies
The risks of premature birth vary depending on how soon a baby is born. Although survival is possible for babies born as early as 23 to 26 weeks, the risks are greatest for the youngest babies.
Complications of premature birth may include:
- Difficulty breathing
- Episodes of stopped breathing (apnea)
- Bleeding in the brain (intracranial hemorrhage)
- Fluid accumulation in the brain (hydrocephalus)
- Cerebral palsy and other neurological problems
- Vision problems
- Intestinal problems
- Developmental delays
- Learning disabilities
- Hearing problems
Less serious complications may include:
- Yellowing of the skin and whites of the eyes (jaundice)
- Decreased number of red blood cells (anemia)
- Low blood pressure
For some premature babies, difficulties may not appear until later in childhood or even adulthood. Not performing well in school is often a prime concern. Some studies suggest that premature babies may face an increased risk of type 2 diabetes and cardiovascular disease in adulthood.
But not all preemies have medical or developmental problems. By 28 to 30 weeks, the risk of serious complications is much lower. And for babies born between 32 and 36 weeks, most medical problems related to premature birth are short term.
Preparing for your appointment
If you develop any of the signs or symptoms of preterm labor, call the doctor who is caring for you during pregnancy (obstetrical care provider) right away. Depending on the circumstances, your doctor may recommend immediate medical care.
Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
- Ask about pre-appointment restrictions. In most cases you'll be seen immediately. If that's not the case, ask whether you should restrict your activity while you wait to come in.
- Share your medical history. Depending on your prior care, your doctor likely will already know important medical details about this pregnancy and much of your reproductive history. But if you haven't yet told your doctor about previous uterine surgeries, including surgical treatment for abnormal Pap tests or dilation and curettage (D and C) following a miscarriage or abortion, it's important for your health and your baby's health to share this information now.
- Find a family member or friend who can join you for your appointment. The fear you may be feeling about the possibility of preterm labor can make it difficult to focus on what the doctor says. Take someone along who can help soak up all the information.
- Write down questions to ask your doctor. That way, you won't forget anything important that you wanted to ask and you can make the most of your time with your doctor.
Below are some basic questions to ask your doctor about preterm labor and premature birth. If any additional questions occur to you during your visit, don't hesitate to ask.
- Am I in labor?
- Is my baby at risk of being born prematurely?
- Is there anything I can do to help prolong my pregnancy?
- Are there any treatments that can prolong my pregnancy or help the baby?
- Do I need to be on bed rest? For how long? Will I need to be in the hospital?
- What signs or symptoms, if they occur, should cause me to call you?
- What signs or symptoms, if they occur, should cause me to go to the hospital?
- What will happen to my baby if he or she is born this soon? What can I expect?
What to expect from your doctor
Your doctor may have a number of questions for you:
- When did you first notice symptoms?
- Are you having contractions? How many an hour?
- Have you had any vaginal discharge or bleeding?
- Have you had any previous pregnancies, miscarriages, or cervical or uterine surgeries that I'm not aware of?
- Do you or did you smoke? How much?
- How far do you live from the hospital?
- How long would it take to get to the hospital in an emergency, including time to arrange child care, transportation, and so on?
- Do you have friends or family nearby who could care for you if you need bed rest?
- Have you been exposed to an infectious disease? Do you have a fever?
Tests and diagnosis
If preterm labor seems likely, your health care provider will check to see if your cervix has begun to dilate and whether the fetal membranes have ruptured. The duration and spacing of your contractions may be closely monitored. In some cases, your health care provider may use ultrasound to monitor the length of your cervix. A swab from the cervical canal may be tested for the presence of fetal fibronectin, a glue-like tissue that's discharged during labor.
If you're in preterm labor, you and your health care provider will discuss the risks and benefits of trying to stop your labor.
Treatments and drugs
Treatment may focus on women in preterm labor or on newborns after delivery.
For mothers
If you're experiencing preterm labor, treatment depends on your stage of pregnancy and how far labor has progressed. Given your situation, your health care provider may recommend:
- Rest. Sometimes resting and drinking plenty of fluids is enough to stop premature contractions.
- Cervical cerclage. If you're not having contractions but your cervix is opening, a surgical procedure known as cervical cerclage may help prevent premature birth. During this procedure, the cervix is stitched closed with strong sutures. The sutures may be removed in the last month of pregnancy.
- Medication to delay labor. In some cases, your health care provider may recommend medication. Some medications stop contractions by relaxing smooth muscles, including those of the uterus. Others block the production of substances that stimulate uterine contractions. These drugs may be given intravenously or by injection. Unfortunately, these medications typically stop labor only briefly — perhaps long enough to accomplish other goals, such as transferring you to a facility better equipped to care for a premature baby.
- A steroid injection to mature your baby's lungs. If your pregnancy is between weeks 23 and 34, your health care provider may recommend an injection of potent steroids to speed your baby's lung maturity. After week 34, steroids may not be needed because fetal lung development is more advanced.
For newborns
Hospital neonatal intensive care units (NICUs) are designed to provide round-the-clock care for premature babies and full-term babies who develop problems after birth.
Specialized care for your baby may include:
- Being placed in an incubator. In the NICU, your baby will probably be kept in an incubator — an enclosed plastic bassinet that's kept warm to help your baby maintain normal body temperature. Because preemies have immature skin and very little body fat, they often need such care to stay warm.
- Monitoring of your baby's vital signs. Sensors may be taped to your baby's body to monitor blood pressure, heart rate, breathing and temperature. Caregivers may also use ventilators to help your baby breathe. This high-tech equipment may seem overwhelming at first, but it's all designed to help your baby.
- A feeding tube. At first your baby may receive fluids and nutrients through an intravenous tube. Breast milk may be given later through a tube passed through your baby's nose and into his or her stomach. When your baby is strong enough to suck, breast-feeding or bottle-feeding is often possible. The antibodies in breast milk are especially important for preemies.
Your baby's caregivers will help you learn how to touch and eventually hold and feed your baby. Talk or sing softly to your baby, or simply provide quiet company.
Taking your baby home
Your baby is ready to go home when he or she:
- Can breathe without support
- Can maintain a stable body temperature
- Can breast- or bottle-feed
- Is gaining weight steadily
Your baby's health care team will help you learn how to care for your baby at home. Keep in mind that preemies are more susceptible than are other newborns to serious infections, and their illnesses tend to progress more quickly. Schedule frequent checkups for your baby. Routine checkups are a great time to ask questions about caring for your baby.
Coping and support
Caring for a premature baby can be physically and emotionally exhausting. You may be anxious about your baby's health and the long-term effects of premature birth. You may feel angry, guilty or overwhelmed. Some of these suggestions may help during this difficult time:
- Learn everything you can about your baby's condition. In addition to talking to your baby's doctor and other caregivers, read books on premature birth and look for information online.
- Take care of yourself. Get as much rest as you can and eat healthy foods. You'll feel stronger and better able to care for your baby.
- Establish your milk supply. Use a breast pump until your baby is able to breast-feed. Ask the hospital staff for help, if needed.
- Accept help from others. Allow friends and family to help you. They can care for your other children, prepare food, clean the house or run errands. This helps you save your energy for your baby.
- Keep a journal. Record the details of your baby's progress as well as your own thoughts and feelings. You may want to include pictures of your baby so that you can see how much he or she changes from week to week.
- Seek good listeners for support. Talk to your partner or spouse, friends, family or your baby's caregivers. If you're interested, your baby's caregivers may be able to suggest a support group in your area. Many parents find it particularly helpful to talk to other parents who are caring for a preemie.
Remember, caring for a premature baby is a great challenge. Take it one day at a time.
Prevention
A healthy lifestyle can go a long way toward preventing preterm labor and premature birth.
- 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 unimportant.
- Eat healthy foods. 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. Uncontrolled 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 develop signs or symptoms of preterm labor, your health care provider may 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 and recreational drugs are off-limits, too. Even over-the-counter supplements and medications deserve caution. Get your health care provider's OK before taking any medications or supplements.
- Ask your health care provider about sex. It's not a concern for women who have healthy pregnancies. But sex may be off-limits if you have certain complications, such as vaginal bleeding or problems with your cervix or placenta.
- Limit 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 premature birth or significant risk factors for premature birth, your health care provider may suggest weekly shots of a form of progesterone. Although much remains to be learned about progesterone therapy, initial studies suggest that progesterone may help prevent preterm labor and premature birth in some women.
Last Updated: 2009-11-25
