Early Labor and Preterm Birth

Early labor, also known as preterm labor, is labor that begins before the 37th week of pregnancy. Because infants born before 37 weeks of gestation have a higher risk of complications and health problems, doctors often try to delay or stop early labor so that the pregnancy can continue and the fetus will have more time to grow and develop.

When labor can’t be stopped and the fetus is born before 37 weeks of pregnancy, it is a preterm birth. Babies born between 32 and 37 weeks are considered preterm, and babies born before 32 weeks are early preterm.

Potential health problems in preterm babies

The earlier infants are born, the more problems they will likely have and the more severe the problems may be. Some preterm babies do very well and don’t require a lot of medical intervention. However, others are very sick and need lots of help. The complications of preterm birth may be short-term and go away after they develop and get stronger, and others may be long-term or permanent. It’s common for preterm babies to be slightly behind their peers in meeting developmental milestones, such as crawling, walking and talking, but most of them will catch up within the first couple of years.

Some of the problems preterm babies may have are:

Preventing preterm birth

Once early labor has begun, it’s difficult (though not impossible) to prevent preterm birth, but it is sometimes possible to delay labor. If you are at risk of delivering your baby before 34 weeks, your doctor may give you a corticosteroid injection to help your baby’s lungs mature or a medication (either tocolytics or progesterone) to prolong your pregnancy. There are some instances where your doctor would not stop your labor, such as ruptured membranes or placental abruption.

Tocolytics can slow or stop uterine contractions, which can prevent labor. In many cases, delaying labor can give corticosteroids time to help with development of the lungs and prevent bleeding in the brain. Delaying labor can also give you time to get to a hospital that offers a neonatal intensive care unit (NICU) where they can provide specialized care for your baby should he or she need it.

Benefits of care at a NICU

If your baby is born preterm, he or she will have a better chance of survival and getting proper care if the hospital where he or she is born has a neonatal intensive care unit (NICU). The doctors, nurses and staff have specialized training in working with preterm infants, and the units often have the most advanced equipment available.

Most NICUs also have staff and equipment to provide surfactant replacement therapy for preterm infants. Surfactant is a substance made by the lungs that helps the air sacs in the lungs stay inflated. The lungs usually start making it around the 23^rd week of pregnancy. When babies are born too early, their lungs lack surfactant, so they cannot inflate on their own. This is the main cause of respiratory distress syndrome (RDS) in newborns. Most hospitals without NICUs cannot offer this type of care (or other critical, life-saving care), which is why it’s important to deliver preterm babies at hospitals with NICUs if at all possible.

Signs of early labor

There are a few sings that you’re in labor and not just having Braxton Hicks contractions (a type of contraction that can happen throughout pregnancy), and we’ll cover those here. But if you’re ever in doubt, call your health care provider. It’s best to be safe and rule out labor early, especially if you haven’t yet reached your 37th week of pregnancy.

Some signs of labor are:

• painful contractions (you may feel like your uterus is getting hard and painful)
• timeable contractions where you are having more than six every hour
• pain that does not go away by changing positions
• change in pelvic pressure with a change in discharge or back pain

Braxton Hicks contractions

Braxton Hicks contractions are a type of contraction that can happen throughout the pregnancy. Some women feel them for most of their pregnancies, and some women don’t notice them at all. These contractions are not the same as the contractions that occur during labor. And until the end of your pregnancy, they should be irregular, infrequent, and relatively painless.

As your pregnancy progresses, you may experience Braxton Hicks contractions more frequently, and they may even become regular. Some women say that they can feel a lot like labor. So how will you know the difference? Labor contractions will increase in length, will likely happen at regular intervals. Braxton Hicks contractions will not.

Treatment for early labor

If you have not yet reached the 34th week of pregnancy when labor begins, your healthcare provider may treat you using medications, including:

• nifedipine, a drug that helps slow your contractions
• steroid injections and other medications to help your baby’s lungs get stronger and help prepare him or her for life outside of the womb
• antibiotics to help clear up any infection that could be causing your preterm labor

Some doctors may also prescribe bedrest, especially if you cannot take nifedipine, in hopes of keeping your pregnancy going as long as possible to give your baby more time to develop fully. You may also be admitted to the hospital so they can monitor you and be ready to care for your baby immediately if he or she needs special medical care after birth.

If you have contractions at any time during your pregnancy or you have other symptoms that worry you, you should call your healthcare provider. Don’t worry about being paranoid or a bother. It’s important to ask questions and seek help any time you feel like things just aren’t right. If your preterm labor is diagnosed early in the process, it may be easier to slow or even stop it for a while.