Preterm Labour: Signs and Causes

It’s natural to eagerly await your baby’s arrival around week 40 of pregnancy, but sometimes nature has other plans. Occasionally, premature labour can occur, and this may be a challenging time for parents. In this article, we'll explore the causes, symptoms and treatments of premature labour, so that both you and baby can remain safe and healthy. So, let's take a deep breath and dive into the world of premature labour.

Key Facts and Overview on Preterm Labour

• Premature labour occurs before week 37 of pregnancy.

• A baby that’s born before 37 weeks is known ‘premature’ or as a ‘preterm’ baby.

• About 1 in 13 babies are born prematurely in the UK – around 60,000 each year.

• Premature babies can range from extremely premature (before 28 weeks) to very premature (between 28 and 32 weeks) and moderate to late prematurity (between 32 and 37 weeks).

• Care is provided for premature babies and mothers in a neonatal care unit or NICU.

What Causes Premature Birth?

Around three-quarters of pregnant people who give birth prematurely have gone into labour spontaneously. You may be wondering what can cause you to go into labour early? In many cases, precisely what causes premature labour and birth in humans is unknown. In the remaining quarter of all premature births, due to a complication affecting the pregnant person or the baby, doctors have recommended either inducing labour or performing a caesarean section before the pregnancy reaches full-term.

Although the precise reasons for giving birth prematurely are not always known, there are some factors that may make an induced or spontaneous preterm labour (or an early caesarean section) more likely.

The most common factors that increase the risk of premature birth include:

• Twins, triplets or more. Twins are usually born between 34 and 36 weeks. If you’re pregnant with multiples and labour hasn’t started spontaneously after 37 weeks, you’ll likely be offered an induced labour as after this time the risk of complications increases. If you’re pregnant with twins (or other multiples), throughout your pregnancy you’ll be monitored more closely than you would with a single pregnancy. If your midwife or doctor have any concerns about the health of you or your foetuses, they may advise an early induction of labour or caesarean section.

• Infections. Urinary tract infections, vaginal infections or respiratory illnesses such as influenza are known to be associated with premature birth. Gum disease has also been linked to an increased risk of prematurity.

• Early breaking of waters. The membranes surrounding the baby in the uterus are a major barrier to infection. In rare cases they can break or rupture early, putting the baby at risk of infection. This is known medically as premature, pre-labour rupture of membranes (PPROM). It affects around 2 percent of pregnancies, but if it does happen and any signs of infection are detected in you or your baby, an early delivery will be needed. In the meantime, you may be offered medicine to help prepare your baby’s lungs for breathing outside the uterus.

• Uterine or cervical abnormalities. Pregnant people with an abnormally shaped uterus or short cervix have a higher risk of giving birth prematurely. These can be detected with a vaginal scan. If you have a short cervix, you may be offered an injection of progesterone or a surgical procedure known as a cervical stitch to lower the risk of preterm labour.

• A chronic health condition in the mother. If you have a condition such as diabetes, high blood pressure or kidney disease, this may increase the likelihood of a preterm birth. Some other factors linked to a higher rate of preterm birth include:

• A previous preterm delivery

• Fertility treatment

• A previous late miscarriage (after 14 weeks of pregnancy)

• Vaginal bleeding after 14 weeks

• Smoking.

Signs of Preterm Labour

It’s natural to wonder ‘What does premature labour feel like?’ Determining as soon as possible whether labour has started, is very important, (add commas) so that measures can be taken to ensure the safest possible birth or even delay the delivery if this is the best course of action. Whether you’re at 25, 30, 32, 35, etc., weeks pregnant, contact your midwife for advice if you experience any of the following signs or symptoms of early preterm labour before 37 weeks of pregnancy.

Signs of premature labour can include:

• Regular contractions or tightening around your bump

• Cramping or period-like pain

• Fluid trickling or gushing from your vagina (this may be your waters breaking)

• An unusual backache

• A ‘show’. This is when the mucus plug that was sealing your cervix during pregnancy falls out.

If you’re less than 37 weeks pregnant and think you might be experiencing signs and symptoms of preterm labour, immediately call your midwife or the maternity unit where you plan to give birth.

I started to get what felt like period pain but thought nothing of it, so carried on as normal. The pain started to get worse, but it never entered our minds that it was labour pains, as I was only 25 weeks.

Sue, Mum of preemie twins at 25 weeks

Braxton Hicks vs Preterm Labour

Keep in mind, not all feelings of contractions indicate that labour has begun. It’s possible you may be experiencing Braxton Hicks practice contractions.

Braxton Hicks contractions usually happen in the second or third trimester of pregnancy and are basically false labour pains. They are your body’s way of helping you prepare for birth by contracting and relaxing your uterine muscles, without opening the cervix like in real labour.

These ‘false’ contractions aren’t painful, but they may be uncomfortable and feel like mild menstrual cramps or a tightening that comes and goes in the stomach. If you’re unsure whether you’re experiencing preterm labour contractions or Braxton Hicks, it’s recommended to contact your midwife or maternity unit for advice. The following table may also help you to distinguish between the two:

What Happens if You’re in Preterm Labour?

If you believe you’re in preterm labour and you’ve contacted your midwife or maternity unit, they may offer you various tests and examinations to check if your waters have broken, to see if labour has begun or if an infection is present. They will then be able to discuss your options and the care that you and your baby may receive.

In some cases, preterm labour can be stopped or slowed down to give your baby a little more time to develop in your uterus or so you can be moved to a hospital with more advanced preterm baby care facilities.

If you do go into preterm labour, you’ll be assessed to determine whether it’s best to go ahead with delivery or give you medicine to try to stop or slow down the labour. Depending on how mature your baby is when labour starts, you may also be offered injections of a steroidal medicine that can help prepare their lungs for life outside the uterus and medicine to help the development of their brain.

Before making the decision, your midwife or doctor will discuss your situation with you, taking various factors into consideration, such as:

• How far along you are in your pregnancy

• Whether giving birth might be safer for your baby (for example, if you have an infection)

• What newborn care facilities are available where you are – in some cases you might need to be moved to a different hospital

• What your preferences are.

I was still in disbelief; my baby wasn't coming and I was going to keep him warm and safe for another ten weeks. I was wrong. A few hours later Archie Michael Smith was born.

Stacey, Preemie mum at 28 weeks

How Can You Reduce the Chances of Preterm Labour?

There is no sure-fire way to prevent preterm labour, however, some measures have been shown to help decrease the likelihood:

• Attend all of your antenatal appointments and inform your doctor or midwife of any conditions or risk factors, such as a prior miscarriage, cervical surgery or a prior premature birth.

• Get vaccinated against illnesses like Covid or the flu, as certain infections can lead to premature birth or other issues. The flu vaccination is typically available from September, and it is safe to take at any period during pregnancy.

• Reconsider smoking as smoking is associated with a heightened risk of preterm labour.

• Aim for a healthy pregnancy weight. Being overweight can also raise your chances of health issues related to preterm birth, such as diabetes or pre-eclampsia. Bear in mind that it is only suggested to attempt losing weight before getting pregnant, while slimming during pregnancy is not advised. Nevertheless, by maintaining a balanced diet and doing light exercise, you can help keep your pregnancy weight gain within a healthy range and reduce the risk of complications.

• Ask about treatment options. If your midwife or doctor believe that you’re at risk of preterm labour, in certain cases, you may be offered treatments to help reduce the likelihood of it happening. These can include a hormonal medicine, typically in a vaginal tablet form, or a cervical stitch. However, this may be based on your individual situation and medical history and is not always an option, so it’s best to discuss it with your midwife or doctor.

The Bottom Line

Premature labour can often be an unexpected condition that can affect both mother and baby. It’s important to be aware of the signs and risk factors of preterm labour and to seek advice and help from your midwife or maternity unit if any of these signs or symptoms appear. Although there is no guaranteed way to prevent premature labour, there are steps you may wish to try that have been shown to help reduce the risk, such as avoiding smoking, adopting a healthy lifestyle and attending all your antenatal appointments. With early diagnosis and appropriate medical care, the outlook for your preterm baby can be significantly improved.

For further information, read our article on premature birth and preemies, as well as coping with the arrival of a preemie to find some helpful tips and advice to help you and your family through this trialing period.

Friends and families of babies born prematurely can now order their Pampers Preemie Protection Nappies online for free home delivery via www.pampers.co.uk. Pampers also continue to donate Pampers Preemie Protection nappies direct to hospitals, and via ASDA pharmacies (in-store only and subject to availability)

_{How We Wrote This Article The information in this article is based on the expert advice found in trusted medical and government sources, such as the National Health Service (NHS). You can find a full list of sources used for this article below. The content on this page should not replace professional medical advice. Always consult medical professionals for full diagnosis and treatment.}