What should I know about preterm labor?

A preterm birth is any birth that happens before 37 weeks. 70-80% of these happen spontaneously. Either the woman started contracting, they couldn't be stopped or slowed and she went on to deliver, or her water broke too early. For the other 20-30%, these women had to be induced or delivered because they were having complications. They had placenta previa, or placental abruption, or they were pregnant with twins, or had growth restriction, or preeclampsia. There was something complicating the pregnancy and the doctor decided that the risk of staying pregnant was higher than the risk of delivery.

One of the greatest risks associated with spontaneously delivering early is a history of delivering prematurely. We always say on Labor & Delivery that the best way to predict your future is to look at your past when it comes to timing of delivery. There's also a genetic component. If you have a 1st degree relative that's had an issue with preterm delivery or you were born prematurely, then you're at slightly higher risk to have issues with preterm labor. Uterine malformations and history of abortion also increase a woman's risk. A lot of people have questions about the paternal side of things, like if the dad was born prematurely or if his family has issues with preterm birth, is his baby more likely to be born prematurely? That doesn't play a role. It has to do with the woman, her body and her family genetics.

Age also appears to play a role. If a girl has a baby when she's really young or when she's older, then it does increase her chances with preterm birth. When a girl is young or when she's an adolescent, she's at higher risk, normally because of immaturity or because of socioeconomic status and lack of prenatal care. When a woman is older, she may be at higher risk because as you get older, you're more likely to be a little more obese than you were when you were younger or to have underlying medical conditions that can complicate the pregnancy and increase your chance for preterm birth. So it's good to talk with your doctor if you're thinking about conceiving, because they can look at your medical history, look at your current circumstances, and give you advice about things that need to be managed before you get pregnant in order to make sure that you're optimally healthy going into the next pregnancy and that your risk is as low as possible.

Some chronic issues that may need to be addressed might include obesity, high pressure, diabetes or thyroid problems. Those are just a few. If you're taking different medications, they can talk with you about what you should continue taking or discontinue while trying to conceive. Also start taking a prenatal vitamin, because that will make you optimally healthy when you get pregnant. If you're already pregnant or have a history of preterm delivery, talk with your doctor. They can assess your risk and talk about things that might need to be done to reduce your risk for preterm birth. Progesterone administration during pregnancy has been shown to significantly reduce a woman's chance of delivering prematurely. That's an intervention that might be considered. Another is measuring the woman's cervix at different points during the pregnancy and monitoring for shortening. If it starts to shorten, sometimes intervention is warranted to help reduce the chance of the woman delivering prematurely. So talk with your doctor and they can determine if intervention is warranted.

What are signs and symptoms of preterm labor and when should you get checked out? If your experiencing sensations associated with contractions, you need to pay attention. These sensations include lower abdominal cramping, lower backache, abdominal tightening, pressure and sometimes pain in your thighs, like you've done a million squats but haven't exercised in a while. If you're experiencing any of these sensations and you've been on your feet all day, then rest and drink water, because activity and dehydration can potentiate contractions. If they fizzle out over the course of about 1/2 hour, then you're good. But if they persist and/or get worse, then you need to get checked out. There's no way to know if what you're experiencing is concerning unless you've been seen by a doctor. And it's never a wasted trip. The best case scenario is that you'll be sent home with peace of mind that everything is looking okay.

It can be normal to have a few contractions a day. A lot of people have questions about Braxton Hicks contractions. I call these growing pains. You might have a few a day as the uterus grows and stretches. The more babies you've had, the more likely you are to have a few more each day as the pregnancy progresses. If they start to become regular (4-5 an hour), then that's when you need to pay attention, rest, drink water, and see what happens. If they persist and/or get worse, then you need to get checked out.

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