Preterm labor is defined as labor that starts between 20 and 37 weeks of pregnancy. Approximately 12 percent of babies are born preterm in the United States. This can be an overwhelmingly scary time, especially if you are earlier in your pregnancy.
While preterm contractions may be uncomfortable or cause your obstetrics provider to recommend closer monitoring, true preterm labor is distinguished from simple contractions. Preterm labor occurs when contractions cause cervical change—that is, dilation or shortening.
If you are in the hospital because of preterm labor, your doctor and nurses will need to do a thorough evaluation. They will first want to make sure your baby is tolerating the labor; this is done by monitoring the baby’s heart rate on a fetal monitor. The next step is to try to figure out why you are in preterm labor. Your obstetrics team will want to make sure you are not dehydrated, your bag of water isn’t broken, and there aren’t any infections or bleeding that might be causing contractions. This evaluation often involves a speculum exam, multiple cervical exams to monitor for dilation, lab work, and possibly an ultrasound. You may also be transferred to a different hospital if the one you are at does not have a neonatal intensive care unit (NICU) available to take care of such a young newborn.
Generally, if you are between 24 and 34 weeks along, you will be given injectable steroids to help mature your baby’s lungs and the blood vessels in the brain and intestines in case delivery is imminent. These steroids decrease respiratory and bleeding complications, which are sometimes seen in premature babies. This steroid medication is usually given as two doses 24 hours apart. During that time, you will likely be put on another medication to stop the contractions long enough to let the steroids take effect.
Once you are in confirmed preterm labor, you may need to stay in the hospital for a few days or until you deliver, depending on the circumstances of your pregnancy. During that time you will probably see many different providers. This may include a neonatologist (they take care of preterm babies in the NICU) or a high-risk obstetrician called a maternal-fetal medicine doctor. Ask questions! This can be a difficult time, and it is important to feel you understand exactly what is going on.
If you are having trouble coping with the possibility of delivering a premature baby, please be sure to let your doctors and nurses know. They can offer their experience, support, and get you the help and information you need.
- American Congress of Obstetricians/Gynecologists
- Practice Bulletin #127: Management of Preterm Labor.
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