Premature labour and birth
If you go into labour before 37 weeks, you are in what is known as preterm or premature labour. If you think you might be going into labour too early, you should contact your midwife straight away, but try not to panic. There's lots that can be done to help and you will be admitted to a hospital with specialist facilities for premature babies
What is a premature birth?
Any baby born before 37 weeks (when you are considered full term) is described as ‘premature’. You and your baby will probably receive special care during labour and after the birth, and may stay in hospital longer than usual, but how long will depend on whether there are any related health problems and exactly how early you went into labour.
There are varying degrees of prematurity:
- Extremely preterm – less than 28 weeks.
- Very preterm – 28 weeks to 32 weeks.
- Moderate to late preterm – 32 weeks to 37 weeks.
How many babies are born premature?
Around 8% of labours are premature (before 37 weeks) in the UK. However, most of those are not extremely preterm. Only 2% of births in England happen before 32 weeks.
What are the causes of premature labour?
There are no definitive answers about what causes preterm labour but there are some medical factors that may make it more likely:
- Being pregnant with more than one baby.
- Previously having had a premature birth.
- Having an abnormally shaped cervix or womb.
- Carrying an infection, such as a bladder, urinary tract or kidney infection or any infection that causes a temperature higher than 38°C.
- Having a sexually transmitted infection, such as gonorrhoea.
- Having had a previous cone biopsy of cervix.
- Having had a late miscarriage previously.
- If there was a gap of less than six to nine months between you giving birth and getting pregnant again.
- Your waters breaking early.
- Trauma to your abdomen.
- The placenta partially or completely separating from the womb (placental abruption).
There are also some “lifestyle” factors that increase your risk of going into labour too early:
- Using street drugs, especially cocaine.
- Smoking and drinking.
- Having a job that involves strenuous work or standing for long periods of time.
- Being a victim of domestic violence.
- Being under the age of 17 or over the age of 35.
- Being severely underweight or overweight at the start of pregnancy.
Sometimes there's something at play that doesn't necessarily “cause” early labour, but which may mean medical staff want to induce you early. About a quarter of premature babies are born early because the mother is induced for various reasons. These can include:
- Your baby having a medical condition that means it's safer for them to be born early.
- You having pre-eclampsia, obstetric cholestasis, or gestational diabetes – though this may not always cause premature labour.
But sometimes there's simply no explanation for why labour begins prematurely.
I have absolutely no idea why both my sons' births happened early. I don't smoke, didn't drink, ate well, took pregnancy vitamins and had no more stress than anyone else.
Am I in premature labour?
The signs of early labour are the same no matter when it occurs. But these are the main things to look out for:
- Period-like cramps
- A show (the mucus plug coming away from the neck of the cervix)
- Watery fluid, either clear or pinkish in colour, leaking from the vagina – this can be just a trickle or a real gush
- Vaginal discharge that is different or more than usual or smells strange
- Stomach cramps, with or without diarrhoea and sickness
- Pressure in your pelvis
What should I do if I think I'm in labour too early?
If you're not sure whether or not you're in labour, then call your doctor or midwife. It could be a false alarm, or it could be premature labour – either way, you and your baby need to be checked out.
What happens if my waters have broken early?
Medically known as “premature rupture of the membranes”, your waters can break before or after contractions have started. If you aren't having contractions, the doctors may give you antibiotics to help prevent any infections and will then try to keep the pregnancy going as long as possible.
You may be put on bed rest and have to stay in hospital. They may also give you steroids to help strengthen the baby’s lungs and prevent breathing problems after birth.
It's likely they will do blood tests to check for any signs of infection or bleeding, a urine sample to check for UTIs and pre-eclampsia, and will also monitor the baby's heart rate to check for chorioamnionitis, an infection of the foetal membranes.
What happens if my waters haven't yet broken?
You'll be examined to try to ascertain whether you are having contractions. You may have an ultrasound to check the length and shape of the cervix, which can give clues as to whether or not labour is imminent. An ultrasound can also make a guess about the baby's weight and check if the placenta is functioning normally, which will help medics make decisions about whether the baby is better off in there or out in the big wide world.
Electronic foetal monitoring can check the baby's heart rate, and they sometimes do a “fibronectin test”. This looks for a substance found in amniotic fluid and vaginal secretions which is only present pre-20 weeks and when the body is preparing for birth.
My daughter was delivered at 27 weeks after I developed pre-eclampsia, she was a tiny scrap at 1lb 8oz, but doctors decided that it was too risky to do anything else.
Whether or not you are in labour, you may well be kept in for further monitoring.
If they think you are in labour, the medical team will have to make decisions about whether they should get the baby out quickly (sometimes via caesarean) or try to keep the pregnancy going as long as possible to let the baby continue to grow and develop.
Even if you do go into labour early, in around half of cases where women appear to be going into premature labour, the symptoms stop and the pregnancy continues. But if this is it and your baby is about to be born, you can talk to other women who've been through the same experience on our childbirth Talk boards, at any time of the day or night.
Remember most women will give birth a couple of weeks either side of their due date, so you don’t need to have your hospital bag packed for months in advance just in case. And even if you don't have it packed ready in time, your birth partner or family can grab the bare essentials. The shops will still be open afterwards!
What Mumsnetters say about premature birth
“I had a cone biopsy for cervical cancer which has weakened my cervix – my son was born three months prematurely, so the stitch will hopefully prevent the same thing happening in this pregnancy.”
“I had a premature birth at about 23/24 weeks after lifting a very heavy object (about 15-20kg). Labour started immediately and couldn't be stopped.”
“I have the dubious distinction of a very short cervix (19mm or so outside pregnancy) and was very lucky to have this picked up at the 23-week scan and monitored thereafter. I had my daughter at 27+5 weeks.”
“A friend had a urine infection at 28 weeks and that caused premature labour.”
“My son arrived at 35.5 weeks following spontaneous rupture of membranes. He was fine apart from jaundice and being slow to establish breastfeeding.”
“In my case it was spontaneous labour, no real warning, no time for steroids (I was 9+cm by the time it was discovered I was in labour).”