|Definition: Premature Labor
A normal full-term pregnancy should last 40 weeks. A premature or preterm labor is when labor starts after week 20 but before the end of week 37. More than 500,000 babies are born prematurely every year in America which accounts for about 1 in every 8 births. Some are born so small they can fit in the palm of an adult's hand. Fortunately most babies who are born after 32 weeks have a good chance of growing up healthy without any problems. Generally the more advanced the pregnancy is the better. This is because the baby's vital organs, specifically the lungs and brain are more developed and the last few weeks in the womb are critical for this. Babies born before week 28 are less likely to survive delivery and childbirth and if they do, about 50 percent will have a disability such as cerebral palsy and one in five will have intellectual difficulties. Babies born before week 24 are not likely to survive. Babies that are born preterm in hospitals with neonatal intensive care units (NICU) usually have the best chance of survival. If you deliver in a hospital without an NICU unit the baby is usually transferred to the nearest facility.
What Are The Signs And Symptoms?
Signs can include all of or just some of the following:
1. Regular contractions that occur every 10 minutes or more frequently. They do not disappear even when you change positions (if they do, it is likely to be Braxton Hicks contractions, false labor).
2. Menstrual-type cramps with or without bouts of diarrhea.
3. Pelvic and lower back pain; a feeling like the baby is pushing down.
4. Bloody vaginal discharge. See also: Early signs of labor.
What Should I Do If It Happens?
If you think you may be showing the signs of a premature labor call one of your pregnancy healthcare team immediately. Then:
1. Empty your bladder.
2. Lie down on your left side, this may slow symptoms down. Never lie on your back; this can cause contractions to speed up.
3. Drink a couple of glasses of water as dehydration can cause contractions.
4. Monitor contractions for an hour. If they do not reduce or in fact become closer together, make your way to the hospital. Call your healthcare provider to let them know.
At the hospital they can examine your cervix, if it starts to open up then labor is likely to be starting. If it turns out to be a false alarm, so much the better! Never feel embarrassed, it really is one of those instances where it is better to be safe than sorry.
How Is It Treated?
If labor has started, it may very well stop on its own without treatment. This happens in about 50 percent of all cases. The doctor's primary goal will be to keep the baby in the womb as long as possible to improve its chances of surviving. If you are admitted to hospital the doctor will administer intravenous fluids. The more hydrated the woman is the lower the chances that contractions will continue. So if you are at home when contractions start, keep drinking plenty of water.
If it is believed that an infection has caused the contractions, antibiotics which are safe for the baby will be administered. If you are in pain an epidural pain relief may be given. Your baby's heartbeat will be monitored throughout the procedure.
There are some medications which the mother is sometimes given that can temporarily halt contractions. These are tocolytic agents such as terbutaline, indomethacin, nifedipine and magnesium sulfate (although the latter is used less commonly nowadays in the U.S.).
If the baby is younger than 34 weeks steroids (antenatal corticosteroids) may be administered to help its lungs develop more quickly and to try and delay the birth a little longer. Ultimately, if labor continues, there is very little else a doctor can do.
If the baby is over 34 weeks the gynecologist will probably let the labor continue at its own pace. Although the baby will be small, s/he is still likely to do better without intervention. If at any point fetal distress is noted or the mother begins to bleed heavily, an emergency C-section delivery is likely to be performed.
What Are The Causes And Risk Factors?
Sometimes there is no obvious cause. In fact 50 percent of cases occur where no known risk factors were identified. This means we still have a lot to learn. Yet, even if a cause can be identified, it is not always possible to prevent an early labor.
Known Risk Factors
• Expecting more than one baby.
• Previous premature births.
• Infections such as bacterial vaginosis, one of the types of vaginitis, urinary tract infections, amniotic fluid infections and STDs.
• Experiencing chronic illness during the pregnancy including hypertension, diabetes and kidney disease.
• Unexplained bleeding in pregnancy after week 20.
• Placenta previa or placental abruption occurred.
• Pregnancy after 35 or before 17 can increase the risk of premature births.
• Obesity in women or low BMI before conception.
• Babies diagnosed with intrauterine growth restriction.
• Clotting disorders such as thrombophilia.
• Pregnancy with one fetus after In Vitro Fertilization (IVF).
• Babies who have developed birth defects.
Preventable Risk Factors
• Not receiving adequate prenatal care.
• Drinking alcohol or using illegal drugs.
• Low income disadvantaged women experience more preterm births. Non-Hispanic blacks are most prone.
• Working long hours on your feet all day.
When Might A Baby Be Induced Early?
Occasionally for medical reasons a doctor may decide to induce an early labor or to perform an early C-section delivery. About one in five preterm labors occur in this way. Reasons for doing so include:
1. The fetus is not growing as it should in the uterus.
2. If the woman has some medical condition which means it is safer for the baby to born earlier, such as preeclampsia.
3. The mother has had some trauma to the stomach, from domestic violence or a car accident for example.
What Happens To The Baby After It’s Born?
Born After 34 Weeks
The prognosis is excellent. The baby may appear small, but in most cases s/he will need no treatment and can go straight to the postnatal ward with mom.
Born Before 34 Weeks
The baby may need specialized care for breathing or feeding or it may need treatment for possible infections. This means s/he is taken instantly to a special care baby unit (SCBU) or a neonatal intensive care unit (NICU). This can be very frightening for the mother and so she will need lots of emotional support.
Born Before 28 Weeks
A baby born this early will need care from a hospital specialized in very premature babies. In this instance, parents will be encouraged to participate actively by stroking and talking to the baby as much as possible.
What Medical Complications Do Premature Babies Develop?
Respiratory distress syndrome (RDS)
More common (23,000 cases a year reported in America) in babies born before week 34. It is generally treated with surfactant which helps the baby breath more easily. Since it was introduced in 1990, surfactant has reduced the amount of deaths from RDS by 50 percent. Babies may also need the support of a ventilator until their lungs mature enough to breathe on their own.
This is where the baby stops breathing for 20 seconds or more. Premature babies are constantly monitored for this. If it occurs the baby is patted to start breathing again.
Intraventricular Hemorrhage (IVH) or b
Bleeding of the brain. Those born before week 32 are most at risk. Most cases are mild and heal themselves. If severe bleeding develops surgery will be required.
Patent Ductus Arteriosus (PDA)
Usually diagnosed with an echocardiography this condition can cause congestive heart failure. Treatment usually involves drugs, or if they do not work, surgery.
Necrotizing Enterocolitis (NEC)
A potentially serious intestinal problem which can develop 2 or 3 weeks after childbirth. Antibiotics or sometimes surgery is necessary.
Where the baby develops a yellow tint to its skin because their livers are too immature to function normally. Treatment is straight forward.
Can occur because the baby has not developed enough red blood cells (what is blood?). Treatment usually involves iron supplements or occasionally a blood transfusion.
Chronic Lung Disease
More common in those born before week 36. Affected babies will be treated with oxygen and medications before being gradually weaned. It may take two years for the lungs to develop normally. Even then, infants with lung diseases tend to become asthmatic.
All premature babies are prone to infections because their immune system has not had time to develop. Serious infections include pneumonia, meningitis and sepsis (infection of the blood). Treatment usually involves antibiotics or antiviral medications.
In 2008 the rate of preterm deliveries in America declined for the first time in 30 years. Nearly 80 percent of the decline was among babies who were born just a few weeks too soon. The reason for the decline? According to March of Dimes which tracks this:
1. 28 States reported reduced numbers of childbearing age women who smoke.
2. 17 States reported more women of childbearing age with medical insurance. These statistics indicate the importance of not smoking for women, particularly those planning on having children. Furthermore, the increase in medical coverage suggests that more women are availing of better prenatal care.
It is also advised to:
3. Take folic acid before and during pregnancy.
4. Eat a balanced diet and stay hydrated.
5. As part of a program in preparing for pregnancy, consider getting tested for UTI's and STD's.
Women who had spontaneous preterm births in the past are considered particularly high risk in any subsequent pregnancies. They may benefit from weekly progesterone supplements which can help prevent premature births. Although no problems have been observed with this treatment, there is still not enough long-term research yet to rule out any side effects.