Session 4: Week 22 - Premature Labor

Labor that begins before 37 weeks is considered premature. Babies born early can have problems with their lungs and other organs since they had not had enough time to fully develop. Premature births occur in about 1 out of 10 pregnancies. The healthiest babies are born close to full term. Learning about preterm labor may help keep your baby from being born too early.

Risk factors for premature labor include:

• Smoking, vaping, alcohol, street drugs and unprescribed medication during pregnancy.
• Having premature birth run in your family
• Mothers younger than 18 or older than 40.
• Not eating healthy food or consuming the right vitamins.
• Having an infection during pregnancy
• Having already delivered a child prematurely.
• Being very overweight or not weighing enough
• Twin (or other multiples) gestation.
• Having problems or a surgical procedure on your uterus or cervix
• Having health conditions, like high blood pressure or diabetes
• Getting pregnant again too soon after having a baby
• Having a lot of stress in your life

Many women without risk factors still deliver early. That is why all pregnant women need to be aware of warning signs for preterm labor. Many of the symptoms are similar to the normal discomforts of pregnancy. Being in tune with your body and noticing a problem early can help initiate medical treatment that may prevent your baby from being born prematurely.

• Menstrual cramping/irregular or regular uterine contractions that may not be painful with or without diarrhea
• Low, dull back ache
• Increased vaginal discharge, spotting or fluid leaking from the vagina.
• Increased pressure in the pelvis
• Contractions that make your belly tighten up like a fist every 10 minutes or more often

If you experience any of the above, stop what you are doing. Drink several glasses of water, empty your bladder and rest with your feet elevated.

If the above symptoms do not go away and you are experiencing six (6) or more uterine contractions in an hour, call your provider.

Yes. Ask your provider if these treatments are right for you:

Progesterone

Progesterone is a hormone that helps your uterus grow and keeps it from having contractions. There are two kinds of progesterone treatment:

1. Vaginal progesterone may help reduce your risk for premature birth if you have a short cervix (shorter than normal) and are pregnant with just one baby. The cervix is the opening to the uterus where your baby grows.
2. Progesterone shots may help reduce your risk for premature birth if you've had a premature birth in the past and you're pregnant with just one baby now.

If you're pregnant with twins, triplets or more, progesterone treatment is not for you. It's only for women who are pregnant with just one baby. To learn more go to marchofdimes.org/progesterone

Cerclage

A cerclage is a stitch that your provider puts in your cervix. The stitch may help keep your cervix closed so your baby isn't born early. Your provider removes the stitch at about 37 weeks. A cerclage is used only for certain women. For example, your provider may recommend a cerclage if you have a short cervix (shorter than normal).

Antenatal corticosteroids (also called ACS)

These medicines help speed up your baby's lung development. They also help reduce your baby's chances of having certain health problems after birth like breathing and stomach problems and bleeding in the brain.

Antibiotics

These medicines kill certain infections that you and your baby have.

Tocolytics

These medicines help slow or stop contractions. They may help delay labor, even for a few days. This delay may give you time to get treatment with antenatal corticosteroids or to get to a hospital that can take care of you and your baby if you give birth early.

Bed Rest

Providers don't know for sure if bed rest can help you stay pregnant longer. But it may. Bed rest means that you take it easy and stay calm and still. Your provider may want you to rest just a few times each day or you may need to stay in bed all day.

It's best to wait at least 18 months between giving birth and getting pregnant again. This means your baby will be at least 1 1/2 years old before you get pregnant.

Too little time between pregnancies increases your risk of premature birth. The shorter the time between pregnancies, the higher your risk. Your body needs time to fully recover from one pregnancy before it's ready for the next one.

Here's what you can do:

• Use birth control to make sure there's at least 18 months between giving birth and getting pregnant again. Talk to your provider about birth control options.
• If you're older than 35 or if you've had a miscarriage or stillbirth, talk to your provider about how long to wait between pregnancies.