I'm 35 weeks pregnant and contracting, but not dilating. What should I do?

You mentioned that you're 35 weeks along. You're on the downslope, so congratulations for that. But you're concerned because you have a full-time job, you're on your feet 40 hours a week, and you're contracting regularly, and it's hurting you, and affecting your ability to even walk. But it also sounds like you've brought it up with your doctor, your cervix has been checked, and you're not dilated, so that is the most reassuring part about that entire story. You've made it to 35 weeks with contractions you've been having, and you're cervix hasn't changed. So you can actually have contractions that don't cause you to be in labor. A lot of women say, "I was in labor for 5 days.", when really, they were only in labor for the hours leading up the delivery of their baby when their cervix was changing.

But the definition of this is a little bit different when you are preterm, or less than 37 weeks. Before 37 weeks, we don't want you to deliver. Your baby will have major hurdles to overcome, especially if they're born at a very early gestational age, so ideally, we'd like you to stay pregnant until 39 weeks when your baby will do best. But there is a grey area. Between 34 and 37 weeks, we will not stop a woman who goes into labor spontaneously, and it's because babies who are born after 34 weeks will have the same long-term effects as a full-term baby. But this certainly doesn't mean that we want them to deliver. It is not desirable at this point. These babies often spend time in the newborn ICU, and they have breathing problems, their liver is immature, so they have jaundice issues, and they come out with a weak suck reflex, and so they don't eat well. And they have problems gaining weight, so oftentimes, all the other issues have resolved, but they're still in the NICU learning how to eat and grow before they can go home.

So these are all major hurdles to overcome in the short-term, but long-term things will usually be okay. Again though, these hurdles are not usually a problem if the baby is born after 39 weeks, and so that's why it's best to make it to this point. And if you get to 39 weeks, and you've already had a baby before, and your cervix is ripe and ready for labor (which means it's softened on its own, it's moved forward in your pelvis and started to thin out a little bit), your doctor might offer you the option of being induced "for fun", but that's a conversation you need to have with them, because they know the specifics of your situation and can decide if you're a good candidate for that or not.

Now back to the fact that you're 35 weeks and having contractions. There are a couple of things that can cause contractions that we know of. The first is dehydration. There is a center in your brain that releases a hormone that tells your body to retain fluid when you're dehydrated. And this hormone actually mimics oxytocin, which is what your brain releases to tell your uterus when to contract. So women who are dehydrated contract. So one of the best things you can do is stay well-hydrated. Drink at least 8 to 10 tall glasses of water each day. And at work, when you're about and start to hurt, drink water, and rest for a few minutes, and see if that helps it go away. And if it does, then great! You can continue on with your day. But if it doesn't make a difference, and the contractions start to become more regular and more intense, then that's when it's time to go get checked out.

Another common cause of preterm labor is a urinary tract infection, or UTI. This is something we always rule out when a woman comes into the hospital contracting that's less than 37 weeks. So if this comes back positive, we can treat the woman and send her home to have a happy, healthy full-term pregnancy. But if treatment is delayed, then it can become a problem if the woman is preterm, and those contractions can then lead to cervical change if it goes on long enough. Symptoms of a urinary tract infection include feeling like you have to pee all the time, but when you sit down to go, nothing comes out, and burning. But the first two sound a lot like pregnancy, so a lot of pregnant women don't know if they have one. They just show up to the hospital contracting, and then that's how they find out that they had a UTI.

Now another thing that causes contractions, like I mentioned earlier, is the release of oxytocin from the brain. And we don't exactly know what triggers this, and so there are a lot of cases of preterm labor that we don't know the cause. We look into it, but we can't rule out anything specific. We just have to treat the women. So again, at 35 weeks, you're in that gray area, we don't want you to have your baby, so watch yourself and get checked out if you feel like things are becoming more intense and more frequent. Hopefully you make it to at least 39 weeks when your baby will do best.

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