Understanding Preterm Labor and Birth: Symptoms, Risks, and Prevention

A typical pregnancy spans approximately 40 weeks, which is defined as a “full-term” birth. However, this period can become complicated when a pregnancy experiences an early or preterm labor and birth. Deliveries that occur before 37 weeks of pregnancy are considered “preterm” or premature and can carry significant health risks and implications for both the baby and the mother, landing many babies in the neonatal intensive care unit or worse, infant deaths. There are many pregnancy complications that can lead to an early birth, but there are also some things you can do to prevent it.

Understanding the terms: 

Full-Term Birth:

A full-term birth is one that occurs between 39 weeks and 40 weeks. This time frame is considered optimal for the well-being of both the mother and the baby, as it allows the baby to develop fully in the womb. Infants born during this period are categorized as full-term infants, enjoying the benefits of a complete gestational period.

Early Term Birth:

Infants born during the 37th and 38th weeks of pregnancy, which were previously considered term, are now referred to as “early term” infants. It’s important to note that these early term infants face more health risks compared to those born at 39 or 40 weeks. The shift in terminology reflects the growing understanding of the potential health issues associated with births in this time frame.

Preterm or Premature Birth:

A preterm or premature birth is one that occurs before 37 weeks of pregnancy. These infants are commonly referred to as “preemies,” emphasizing the fact that they are born prematurely and may require specialized care and attention due to their early arrival.

Late Preterm Birth:

Late preterm births encompass the 34th through 36th weeks of pregnancy. Although these infants are termed “late-preterm,” they still face many of the same health challenges as preterm infants. Alarmingly, more than 70% of these births fall within this time frame, emphasizing the significance of understanding and addressing such births.

Signs and Symptoms of Preterm Labor 

As mentioned, labor is considered preterm if it occurs between 20 weeks through 36 weeks of pregnancy. Here are the most common symptoms: 

• Contractions: Birth pains or tightening of the stomach muscles every 10 minutes or more often 
• Pelvic pressure: Increase or sudden signs of the feeling of pressure in the pelvis
• Change in vaginal discharge: This could appear as fluid leaking or bleeding from the vagina
• Backache: Low, dull pain the back 
• Cramps: This could appear as menstrual cramps or abdominal cramps (with or without diarrhea)

While it is normal for pregnant women to have some contractions throughout the day, it is not normal to have them frequently, such as six or more in one hour. Frequent uterine contractions may cause the cervix to begin to open and thus start the delivery of the baby. 

If a woman believes she might be going into labor early, it is recommended that she call her doctor or go to the hospital to be evaluated. 

The Risks of Preterm Birth 

Preterm labor and birth can come with several different risk factors. Some of the risks are modifiable, meaning they can be changed to help reduce the risk, while others cannot. 

When considering high risk labor or birth, health care providers typically consider the below factors:

• Women who have previously delivered preterm, or who have experienced preterm labor before, are considered to be high risk for this condition and birth once again
• Women who are pregnant with twins, triplets, or more (also know as “multiple gestations”) or those who have used assisted reproductive technology, this includes all fertility treatments in which eggs or embryos are handled, is associated with a higher risk.  
• Women with certain anomalies of the reproductive organs are at greater risk. This could include women who have a short cervix or those whose cervix shortens in the second trimester, instead of the third trimester. 

There are also health problems that can put a woman at higher risk when a baby is born too early. Some of those conditions include but are not limited to: 

• UTIs: Urinary tract infections
• STIs: Sexually transmitted infections
• Vaginal Infections: This could include bacterial vaginosis and trichomoniasis 
• High blood pressure
• Vaginal bleeding
• Certain fetus developmental anomalies 
• Pregnancy via in vitro fertilization 
• Weight: being underweight or obese before pregnancy 
• Time in between pregnancies: Less than 6 months between a birth and the beginning of the next pregnancy
• Placenta previa: A condition in which the placenta grows in the lowest part of the uterus and covers part of all of the opening of the cervix 
• Risk of rupture of the uterus: This is more likely to happen if you have had a prior c-section, or cesarean delivery, or have had a uterine fibroid removed 
• Diabetes: This includes high blood sugar and gestational diabetes, which only occurs during pregnany) 
• Issues with blood clotting

While there are a number of health related conditions that can put a woman at risk of preterm labor and birth, there are also other factors that could include: 

• Ethnicity: Certain ethnic groups are disproportionately affected
• Age of the mother: Women younger than age 18 and women older than age 35 are at risk of having preterm delivery. 
• Lifestyle  and environmental factors including:
  • Smoking 
  • Drinking alcohol
  • Using illegal drugs 
  • Stress 
  • Exposure to certain environmental pollutants 
  • Long working hours with long periods of standing 
  • Lack of social support 
  • Domestic violence which could include physical, sexual or emotional abuse 

It’s important to discuss age and family history with your doctor so you can come up with a tailored treatment plan while you are pregnant. Before getting pregnant, it’s also important to make necessary lifestyle changes, like quitting drinking, smoking, cutting out any recreational drugs, and reducing stress.

How Early Labor or Birth Can Affect The Baby

If a mother delivers a premature baby, there are a number of negative health affects that can occur either right away or later in life. These conditions include, but are not limited to:

1. Respiratory Distress Syndrome (RDS): RDS is a condition in which the baby is born to underdeveloped lungs. This can lead to respiratory issues and may require ventilation or oxygenation.
2. Jaundice: This is a yellowing of the skin and the eyes and typically occurs when the baby’s liver is not fully developed. As a result, that baby’s body has a hard time breaking down bilirubin and may require phototherapy.
3. Infections: Premature babies are more susceptible to infections because their immune systems are not fully developed. This may require antibiotics.
4. Temperature Regulation: When a baby is born early, they often have a hard time regulating their own body temperature. This can lead to hypothermia and requires close monitoring. Incubators or warms may be used to aid in this.
5. Feeding Challenges: Difficulty with feeding stemming from underdeveloped suck and swallow reflexes. This may required a feeding tube or fortified breast milk.
6. Gastrointestinal Issues: Conditions like necrotizing enterocolitis (NEC), are more common in preterm infants and may require surgery.
7. Brain Development: Brain development can be affected by early birth, and in extreme cases can cause conditions like bleeding in the brain or periventricular leukomalacia, which is damage to the white matter of the brain.
8. Developmental Delays: Developmental delays, including cognitive, motor, and social development, can be affected. These may require occupational therapy to address any delays.
9. Vision and Hearing Impairments: Vision and hearing impairments, such as retinopathy of prematurity (ROP) and sensorineural hearing loss can occur in these newborns.
10. Cerebral Palsy and Other Disabilities: Cerebral palsy and other disabilities is higher in extremely preterm babies can occur. These are lifelong conditions.
11. Long-Term Health Issues: Chronic lung disease, heart problems, and metabolic disorders are all more common in premature babies.

Prevention and Treatments for Preterm Labor and Delivery

While there is no treatment to prevent this condition, there are some things that can be done to help delay childbirth. 

Some studies have found that progesterone supplementation as hormone treatment is often looked to as a way to help reduce the chances of preterm birth by one-third when started at 16 weeks of gestation and continued to 37 weeks of gestation. However, subsequent research did not show the same results, so the use of progesterone to prevent early labor and birth is now under review by the U.S. Food and Drug Administration. 

A surgical procedure called cervical cerclage, in which a doctor stitches the cervix closed ahead of the woman’s due date, is sometimes used to try to prevent preterm labor in women who have a weak cervix. The stitch is then removed closer to the woman’s due date to allow for delivery of the baby. 

It is recommended that women discuss all of their treatment options with their healthcare providers to review the benefits and the risks of each option. It is advised that these discussions occur during regular prenatal care visits, ahead of any emergency, to allow for a full discussion on these issues. Staying on top of these issues and continuing to monitor the development of your baby with the health of a doctor can go a long way in minimizing risks associated with preterm labor.