Pregnancy - premature labour

What is premature labour?

Sometimes, babies arrive early. It’s important to recognise premature labour, in case you and your baby need medical care.

First, let’s look at what is ‘early’. Pregnancy usually lasts for 38 to 42 weeks. A premature birth is when a baby arrives before 37 weeks.

For premature babies, we talk about their ‘gestational age’. This means how long they have been growing in the womb. It is calculated from the first day of your last period. The words used to describe prematurity based on gestational age are:

• extremely premature – 23 weeks to less than 28 weeks
• very premature – 28–32 weeks
• moderately premature – 32–36 weeks
• late pre-term – 36–37 weeks.

When babies are born prematurely they are less developed than full term babies. Their gestational age is an indicator of what stage of development they have reached. This, in turn, relates to what sort of medical support they will need.

The health professionals and equipment needed to look after premature babies are usually located in the neonatal intensive care unit (NICU) of a hospital, or the special care nursery (for babies who are a little stronger than those needing intensive care).

Equipment in the NICU helps to support and monitor babies’ breathing, heart rate, feeding and temperature, and the workings of their stomach and bowels.

Risk factors for premature birth

It is hard to predict whether you will go into early labour, particularly if you are healthy. Most premature labours happen by themselves and are unexplained.

The presence of certain germs in the urine (even without signs of an infection) seems to make premature labour more likely. Treating the infection seems to reduce the risk of premature labour.

Other risks for labour starting too early include:

• having had a premature labour before
• having a poor diet or poor health
• smoking or using recreational drugs
• having a lot of stress or violence in your life
• carrying twins or more babies
• general infections
• bleeding from the placenta
• problems with the neck of the womb (your cervix)
• problems with the womb, such as fibroids.

Some women will have labour deliberately started early by their doctor because it is safer for the baby to be born than to remain in the womb. Some of the reasons are:

• if the woman’s blood pressure is too high (pre-eclampsia),
• there is bleeding from the placenta
• the baby is not growing.

Remember, if any or all of these risks apply to you, you may still have a full term pregnancy. And, if you have none of the risks, you may still have a premature labour.

Not labour, just Braxton Hicks contractions

After 20 weeks of pregnancy, you may have a tight feeling in your womb. These contractions are called Braxton Hicks contractions (also known as false contractions) – they are your body preparing for giving birth, not the start of labour. If your pregnancy is your first, the feeling may be quite strong and even painful.

Late in pregnancy, it can be hard to tell Braxton Hicks contractions from the real start of labour. Look for these differences:

• Real labour pains become regular. They start to be more intense and more frequent. Braxton Hicks contractions usually happen only once or twice an hour, a few times a day. And they usually last less than a minute.
• Real labour pains become longer and more painful. Braxton Hicks contractions may stop if you change what you’re doing – for example, they may go away if you’ve been walking and then you sit down, or if you’ve been resting and then you move about.

If you are not sure, call the health professional who will be delivering your baby.

False labour versus true labour

You may experience false labour before your real labour. It tends to happen in late pregnancy, and more often affects women who have had a baby before.

False labour contractions can be painful, so they may seem to be the real thing. However, they are usually short (less than 45 seconds) and irregular, and they cause discomfort in different places – such as your groin, your lower abdomen or your back.

True labour contractions are usually regular and become longer and stronger. They cause pain that starts at the top of your womb and moves down to your pubic bone. You can feel the pain in your lower back and pelvis too.

False labour is not dangerous for your baby.

Signs of premature labour

Premature labour needs immediate medical help.

If your waters break, or you start contractions before 37 weeks of pregnancy, call your midwife, doctor or hospital immediately (at any time of day or night).

You may also need help if you have any of the following symptoms. Immediately talk to your midwife, doctor or hospital to work out whether your symptoms mean you’re in labour:

• a dull ache in your lower back
• pressure in your pelvis, as if your baby is pushing down
• swelling of your hands, feet or face
• contractions more than four times an hour
• nausea, vomiting or diarrhoea
• trouble with your eyesight (such as blurred or double vision)
• stomach cramps like period pain
• blood or fluid coming from your vagina.

Other signs of labour can be that your baby stops moving, or moves less. Or maybe you just don’t feel right.

If you experience any of these labour symptoms before 37 weeks, see a midwife or doctor as quickly as possible.

What happens during premature labour

After you speak with your midwife or doctor, you will probably have to go to the hospital. Don't drive yourself. If no-one can drive you, call 000 and ask for an ambulance.

At the hospital, staff will check whether the neck of your womb (cervix) is shortening and opening, which indicates labour has started. They may test for infection.

The hospital may also test for a substance called ‘fetal fibronectin’ in the fluid in your vagina. The presence of this substance can help your doctor decide if there is a risk of your baby being born sooner rather than later.

If it is not clear whether you are in labour, the hospital will admit you to the antenatal ward to keep an eye on you.

The hospital will also want to monitor your baby’s heartbeat, which is done via a monitor strapped to your tummy (this is called a called a CTG machine.)

If you are less than 34 weeks pregnant, the hospital can give you medication to slow down your labour. This may delay the birth for long enough to transfer you to a hospital with a neonatal intensive care unit.

If you are more than 34 weeks pregnant, your doctors will probably allow labour to continue at its own pace. Your baby is likely to do very well even though he or she will be small.

The hospital will offer you steroid injections to help your baby's lungs develop and to reduce breathing difficulties after birth. This help is needed because a baby is not fully ready to breathe air until about 36 weeks of pregnancy.

Being in premature labour doesn’t mean you must have a caesarean section. But you may need one if you are bleeding or your baby is distressed.

Feelings about premature labour

You may go into premature labour unexpectedly. Or you may have pregnancy complications that mean you know an early birth is likely or definite.

However it happens, you will probably feel shocked to find you are giving birth weeks or months earlier than full term. And you may feel worried about your baby. Further, because you’ll receive a lot of medical attention, you may also feel you’ve lost control.

You can ask your midwives, nurses and doctors to explain everything to you. They will want to help you feel as calm as possible.

Things to do before a premature birth

If you know your baby will be born prematurely, it can help to put some plans in place.

• If your baby will be in the NICU after birth, you’ll want to be there as much as possible. So you will need support with grocery shopping, housekeeping, minding your other children, and other everyday chores like watering the plants. Try to have a support plan in place before you go to hospital.
• You may want to read about premature births and premature babies. It may also help to talk to other parents of premature babies, midwives and doctors.
• Be prepared to change your birth plan – for example, if you planned to give birth at home or at a birthing centre, understand that your baby may instead need a hospital’s care and technology.
• If you have older children, let them know the baby may come early.
• Become familiar with the NICU and the machines around the babies. Your doctor or midwife will be able to arrange a visit for you.
• Use strategies (such as listening to music) to try to stay relaxed. Take one day at a time, and keep thinking about your baby in a loving and positive way.

Where to get help

• In an emergency, call 000 for an ambulance
• Your GP (doctor)
• Midwife
• Obstetrician
• Your hospital or birth centre