Preterm labor: Take prevention seriously

(MayoClinic.com) A full-term pregnancy lasts about 40 weeks. Preterm labor refers to contractions that begin to open the cervix before week 37.

Often, the specific cause of preterm labor isn't clear — but that's not the end of the story. Taking good care of yourself can go a long way toward preventing preterm labor and delivering a healthy baby.

If preterm labor can't be stopped, your baby will be born too soon. And the earlier preterm birth happens, the greater the risks for the baby — including low birth weight, breathing difficulties, underdeveloped organs and potentially life-threatening infections. Children who are born prematurely also have a higher risk of learning disabilities, developmental disabilities and behavior problems.

Preterm labor can affect any pregnancy. The most common risk factors include:

• Previous preterm labor or preterm birth
• Pregnancy with twins, triplets or other multiples
• Certain problems with the uterus, cervix or placenta
• Smoking cigarettes, drinking alcohol or using illicit drugs
• Some infections, particularly of the amniotic fluid and lower genital tract
• Some chronic conditions, such as high blood pressure and diabetes
• Being underweight or overweight before pregnancy, or gaining too little or too much weight during pregnancy
• Stressful life events, such as the death of a loved one or domestic violence
• Multiple miscarriages

Still, many women who have preterm labor have no known risk factors.

There are no guarantees — but there's much you can do to nurture a healthy, full-term pregnancy:

• Seek regular prenatal care. Prenatal visits can help your health care provider monitor your health and your baby's health. Mention any signs or symptoms that concern you, even if they seem silly or unimportant.
• Eat healthy foods. During pregnancy, you'll need more folic acid, calcium, iron, protein and other essential nutrients. A daily prenatal vitamin — ideally starting a few months before conception — can help fill any gaps.
• Manage chronic conditions. Diseases such as diabetes and high blood pressure increase the risk of preterm labor. Work with your health care provider to keep any chronic conditions under control.
• Follow your health care provider's guidelines for activity. If you develop signs or symptoms of preterm labor, your health care provider may suggest working fewer hours or spending less time on your feet. Sometimes it makes sense to scale back other physical activities, too.
• Avoid risky substances. If you smoke, quit. Smoking may trigger preterm labor. Alcohol and recreational drugs are off-limits, too. Even prescription and over-the-counter medications deserve caution. Get your health care provider's OK before taking any medications or supplements.
• Ask your health care provider about sex. It's not a concern for women who have healthy pregnancies, but sex may be off-limits if you have certain complications — such as vaginal bleeding or problems with your cervix or placenta.
• Manage stress. Set reasonable limits — and stick to them. Set aside some quiet time every day. Ask for help when you need it.
• Take care of your teeth. Brush and floss daily, and visit your dentist for regular cleanings and dental care. Some studies suggest that gum disease may be associated with preterm labor and premature birth.

If you have a history of preterm birth or significant risk factors for preterm birth, your health care provider may suggest weekly shots of the hormone progesterone to help prevent preterm labor.

For some women, the clues of preterm labor are unmistakable. For others, the signs and symptoms are more subtle. Be on the lookout for:

• Contractions that occur more than eight times each hour (You'll feel a tightening sensation in your abdomen, often reminiscent of menstrual cramps.)
• Low, dull backache
• A sensation of pelvic pressure
• Diarrhea
• Vaginal spotting or bleeding
• Watery vaginal discharge

If you're concerned about what you're feeling — especially if you have vaginal bleeding accompanied by abdominal cramps or pain — contact your health care provider. Don't worry about mistaking false labor for the real thing. Everyone will be pleased if it's a false alarm!

While you're evaluating your contractions, drink 16 ounces (473 milliliters) of water or juice. If you're experiencing false labor, the fluids may suppress your contractions. In other cases, lying down — usually on your left side to improve circulation to your uterus — can halt contractions. Sometimes bed rest is recommended, although bed rest isn't a proven remedy for preventing pregnancy complications or preterm birth.

If you're admitted to the hospital, your health care provider may use a uterine monitor to measure your contractions. If your cervix is closed, your health care provider may use an ultrasound to evaluate your cervix. You may be given medication to stop the contractions.

Many women treated for preterm labor deliver at or near term. Often, however, advanced preterm labor can't be stopped — or an infection or other complications make an early delivery safer for mother or baby.

If you're between weeks 23 and 34, your health care provider may recommend two treatments:

• Medication to temporarily stop labor, either given orally or by injection
• An injection of potent steroids to speed your baby's lung maturity

After week 34, steroids may not be needed because your baby's lungs may be mature enough for delivery.

Aside from starting too early, preterm labor typically resembles normal labor. If relaxation and breathing techniques aren't enough to control the pain, ask for relief. Your health care provider may recommend narcotic analgesics, an epidural block or other options.

Pediatric experts may be on hand for the delivery to evaluate your baby and meet any special needs.

Preterm labor won't affect your physical recovery from childbirth. However, the common stresses after delivery may be magnified by your baby's condition. Preemies often need intensive medical care after birth, sometimes requiring lengthy hospital stays. This time will be busy and stressful. Surround yourself with supportive loved ones and friends. Accept their help in caring for your baby or older children.

After one preterm birth, you're at risk of a subsequent preterm birth. To boost the odds, work with your health care provider to manage any risk factors and respond to early warning signs.

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