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DESCRIPTION
Premature labor is labor that begins before the 37th week of pregnancy. Most pregnancies last 38 to 42 weeks; your due date is 40 weeks after the first day of your last period. Premature birth frequently follows premature labor.
FREQUENT SIGNS & SYMPTOMS
Preterm labor is any labor that occurs between 20 weeks and 37 weeks of pregnancy. Prior to 20 weeks, it is considered a miscarriage (spontaneous abortion). If you start to have any of these symptoms between 20 weeks and 37 weeks of pregnancy, follow the instructions in the section below What to do if you have symptoms of preterm labor.
Don't let anyone tell you that these symptoms are "normal discomforts of pregnancy"! If any of them (you don't need to have all of them) happen before your 37th week of pregnancy, you need to do something about it. Here are the symptoms:
Uterine contractions at regular intervals that begin before the fetus is mature, usually before the due date of delivery. Contractions are when your abdomen tightens like a fist every 10 minutes or more often. Low, dull backache. Abdominal cramps that feel like your period, with or without diarrhea.
Change in vaginal discharge. Passage of bloody mucus (sometimes).
A sensation of pelvic pressure. The feeling that your baby is pushing down.
Flow of fluid (amniotic fluid) from the uterus (sometimes). This may occur with a gush or may only a continuous watery discharge.
Some degree of vaginal bleeding or spotting.
MoonDragon's Obgyn Information: Miscarriage
CAUSES
In most cases, the exact mechanisms that cause premature labor are not well identified. Many obstetric, medical and anatomic disorders are associated with premature labor.
Preterm birth is any birth that occurs before the 37th week of pregnancy. It is the cause of many infant deaths and lingering infant illnesses in the United States. Every pregnant woman needs to know about preterm labor and birth - why it happens and what she can do to help prevent it.
Preterm birth occurs in about 12 percent of all pregnancies in the United States, often for reasons we just don't understand. A normal pregnancy should last about 40 weeks. That amount of time gives the baby the best chance to be healthy. A pregnancy that ends between 20 weeks and 37 weeks is considered preterm, and all preterm babies are at significant risk for health problems. The earlier the birth, the greater the risk.
You might have read in the newspapers about babies who are born really early and do very well. But it's important for you to know that those babies are the exceptions. Babies who are born very preterm are at a very high risk for brain problems, breathing problems, digestive problems, and death in the first few days of life. Unfortunately, they also are at risk for problems later in their lives in the form of delayed development and learning problems in school. The effects of premature birth can be devastating throughout the child's life. The earlier in pregnancy a baby is born, the more health problems it is likely to have.
There are no easy answers as to why preterm labor happens. Stress might play a part for some women, personal health history or infection for others, or smoking or drug use for others. Researchers are studying how various factors contribute to the complex problem of premature labor and birth.
RISK INCREASES WITH
Preterm labor and delivery can happen to any pregnant woman. But they happen more often to some women than to others. Researchers continue to study preterm labor and birth. They have identified some risk factors, but still cannot generally predict which women will give birth too early. Having a risk factor does not mean a woman will have preterm labor or preterm birth. It just means that she is at greater risk than other women. Three groups of women are at greatest risk of preterm labor and birth:
- Women who have had a previous preterm birth.
- Women who are pregnant with twins, triplets or more.
- Women with certain uterine or cervical abnormalities.
If you have any of these three risk factors, it's especially important for you to know the signs and symptoms of preterm labor and what to do if they occur.
LIFESTYLE-ENVIRONMENTAL RISK FACTORS
Some studies have found that certain lifestyle and environmental factors may put a woman at greater risk of preterm labor. These factors include:
- Late or no prenatal care.
- Exposure to the medication DES.
- Smoking
- Excessive alcohol consumption.
- Use of mind-altering drugs, e.g., narcotics, psychedelics, hallucinogens, marijuana, sedatives, hypnotics or cocaine. Use of Medications contraindicated for use during pregnancy.
- Domestic violence, including physical, sexual or emotional abuse.
- Injury to the uterus.
- Lack of social support.
- Stress.
- Long working hours with long periods of standing.
MEDICAL RISKS
Certain medical conditions during pregnancy may increase the likelihood that a woman will have preterm labor. These conditions include:
- Previous premature labor.
- Urinary tract infection, especially kidney infection (pyelonephritis).
- Sexually transmitted infections (Vaginal infections) that spreads to the uterus.
- Possibly other types of infections.
- Illness of the mother, including preeclampsia/eclampsia (toxemia), high blood pressure (hypertension), diabetes mellitus.
- Clotting disorders (thrombophilia).
- Bleeding from the vagina. Abnormalities of the placenta, such as placenta previa or placenta abruption.
- Excessive amniotic fluid.
- Premature rupture of the membranes (PROM) also known as the "water breaking".
- Abnormal shape or size of the uterus.
- Weak cervix (incompetent cervix).
- Hormone imbalance.
- Large fetus or more than one fetus.
- Congenital fetal birth defects.
- Being pregnant with a single fetus after in vitro fertilization (IVF).
- Poor nutrition, especially associated with weight loss. Eating disorders such as Bulimia and Anorexia
- Being underweight before pregnancy.
- Obesity.
- Adolescent mothers.
- Short time period between pregnancies (less than 6-9 months between birth and the beginning of the next pregnancy).
Researchers also have identified other risk factors. For instance, African-American women, women younger than 17 or older than 35, and poor women are at greater risk than other women. Experts do not fully understand why and how these factors increase the risk that a woman will have preterm labor or birth.
PREVENTIVE MEASURES
You can help prevent preterm birth by learning the symptoms of preterm labor and following some simple instructions. The first thing to do is to get medical care both before and during pregnancy. If you do have preterm labor, get medical help quickly. This will improve the chances that you and your baby will do well.
- Obtain good prenatal care throughout pregnancy.
- Don't smoke, use mind-altering drugs or drink alcohol during pregnancy.
- Eat a normal, well-balanced diet during pregnancy. Take prenatal vitamins, minerals and herbal supplements recommended by your midwife.
- Don't use medications of any kind, including non-prescription drugs without advice from your midwife.
- If you have a weak cervix, which is sometimes evident before pregnancy, get medical advice about a minor operation to strengthen the cervix.
- Rest more and decrease activity in the 3rd trimester, especially if you have blood spotting or irregular contractions.
HERBAL AIDS TO PREVENT CHRONIC MISCARRIAGE:
Inverted yoga postures - headstand and shoulder stand - are recommended for women carrying twins who are threatening to make an early appearance.
Black Haw root bark is taken as a miscarriage preventative. Drink one or two cups of tea or half cup of the infusion daily as soon as you are pregnant. Black Haw may be used throughout the entire pregnancy.
False Unicorn root may help when the cervix is too loose to hold the pregnancy as a powerful tonic. Use 3 drops of the tincture four to five times daily, beginning a month before conception and continuing for the entire first trimester.
HERBAL AIDS TO PREVENT THREATENED MISCARRIAGE:
Along with bed rest and relaxation, take vitamin E (up to 2000 IU a day) during the crisis period.
Alcohol (shot of whiskey or other spirits) relaxes the smooth muscles and can be used to slow or stop uterine contractions if sipped when cramping is felt. Intravenous alcohol is still used in hospitals to help forestall threatened miscarriage.
Wild Yam root is the source material for hormonal birth control pills. It contains glycosides from which the body can manufacture the hormones progesterone and cortisone, which are needed to maintain the pregnancy. The infusion is the strongest preparation. Take 2-4 ounces of infusion every half hour. Results should be evident by the second dose. The tincture is less effective and may cause nausea or vomiting. Use 10 drops every half hour as needed.
Lobelia herb is used in two ways: it will aid the miscarriage if the fetus is weak or malformed, but prevent it if the fetus is healthy and strong. Take the leaf and seed tea in sips every few minutes throughout a full hour. After an hour's rest, repeat. Lobelia tea causes nausea or vomiting in some women. The tincture is usually less nauseating. Take no more than 15 drops in a small glass of water as often as every 15 minutes, for several days, if needed.
For bleeding near term from possible abruption of the placenta, take 1500 IU vitamin E (3 doses of 500 IU), 50,000 IU vitamin A (2 doses of 25,000 IU), 6,000 mg of vitamin C (6 doses of 1,000 mg), 50 mg zinc (with food) daily for up to 2 weeks or until the pregnancy is stabilized. Although the vitamin E is supposed to "glue" the placenta back onto the uterus and hold it until the pregnancy is full term, however, large doses of vitamin E taken within 1 week of term may cause abnormal adhesion of the placenta to the uterus.
Threatened Miscarriage Brew 1 tablespoon dried Black Haw root bark or Cramp bark
3 tablespoon dried Raspberry leaf
10 drops Wild Yam root tincture
10 drops False Unicorn root tincture
60 drops Lobelia herb tincture
Put herbs in quart jar and add four cups of boiling water. Steep until cool enough to drink. Add tinctures to one cupful of tea and drink. If contractions continue for more than 30 minutes, add 60 drops of Lobelia tincture to a second cup of tea. Drink a cup every 3 hours, adding tinctures as needed, until miscarriage no longer threatens. Increase the effectiveness of the brew by resting in bed and taking 500 IU of vitamin E every six hours.
These remedies are found in Susan Weed's Wise Woman's Herbal "Childbearing Year"
EXPECTED OUTCOME
In about 50% of cases, the premature labor ceases, either with treatment or spontaneously.
Labor can often be stopped with treatment to allow more time for the fetus to mature. However, if the membranes have ruptured or the placenta has separated from the uterus, labor must proceed sometimes by cesarean section. The outcome depends on fetal maturity.
POSSIBLE COMPLICATIONS
Premature infant.
Uterine infection after delivery.
Fetal death.
TREATMENT
GENERAL MEASURES
DIAGNOSIS
Diagnostic tests may include amniocentesis to determine fetal maturity and to check for infection inside the uterus that could be causing the symptoms. Ultrasound is used to determine fetal weight, age, growth and position (although this is known to be somewhat inaccurate). Laboratory blood and urine studies on the mother are used to check for infection.
TREATMENT
Hospitalization and treatment may be necessary for any underlying risk factors (infections, dehydration). Treatment will depend on the cause, if known.
Preterm labor can happen to any woman: Only about half the women who have preterm labor fall into any known risk group. About 12 percent of births (1 in 8) in the United States are preterm. Babies who are born preterm are at higher risk of needing hospitalization, having long-term health problems and of dying than babies born at the right time.
Three groups of women are at greatest risk of preterm labor and birth:
- Women who have had a previous preterm birth.
- Women who are pregnant with twins, triplets or more.
- Women with certain uterine or cervical abnormalities.
Preterm labor may sometimes be stopped with a combination of medication and rest. More often, birth can be delayed just long enough to transport the woman to a hospital with a neonatal intensive care unit (NICU) and to give her a drug to help speed up her baby's lung development.
Treatment with a form of the hormone progesterone may help prevent premature birth in some women who have already had a premature baby.
WHAT TO DO IF YOU THINK YOU ARE IN LABOR PREMATURELY:
Call your midwife or health care provider and let her know what is happening. You may be advised to go to the hospital right away if you think you are having preterm labor. The signs of preterm labor include:
- Contractions (your abdomen tightens like a fist) every 10 minutes or more often.
- Change in vaginal discharge (leaking fluid or bleeding from your vagina).
- Pelvic pressure - the feeling that your baby is pushing down.
- Low, dull backache.
- Cramps that feel like your period.
- Abdominal cramps with or without diarrhea.
Your midwife or health care provider may tell you to:
Come into the office or go to the hospital. If you are planning a homebirth, your midwife may make arrangements to come to your home and check you there.
Stop what you're doing. Rest on your left side for one hour.
Drink 2-3 glasses of water or juice (not coffee or soda).
If the symptoms get worse or do not go away after one hour, call your midwife or health care provider again or go to the hospital. If the symptoms go away, relax for the rest of the day. If the symptoms stop but come back, call your midwife or health care provider again or go to the hospital.
You don't need to have all the symptoms to have preterm labor. Take action even if you have only one.
If you have already had a premature baby, ask your midwife or health care provider if progesterone treatment might help prevent another early birth.
MEDICATION
Medications sometimes slow or stop labor if they are given early enough. This can prevent some of the worst health problems a preterm baby has. Only if a woman receives medical care quickly can drugs be helpful. Knowing what to look for is essential.
- Treatment with a form of the hormone progesterone may help prevent premature birth in some women who have already had a premature baby. Medication used to stop labor include terbutaline, ritocrine and magnesium; less frequently used are indomethacin and nifedipine.
- Antibiotics to fight infection, if it develops. Antibiotics may also be used to help protect the fetus from infection.
- Drugs called corticosteroids, if given 24 hours before birth, can help the baby's lungs and brain mature. Corticosteroid therapy may be considered to accelerate fetal lung maturity.
- Sedatives and pain relievers are used if needed.
ACTIVITY
Complete bed rest is necessary once signs of premature labor begin. Discontinue work or other physical activities. Avoid any sexual activity.
DIET
Once labor begins, drink only clear liquids until after the delivery.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or a family member has symptoms of premature labor. Call your midwife immediately. This is an emergency! If you are planning an out-of-hospital birth, you may need to be transported to a medical facility, depending upon just how early you are in your gestational dating. Follow your midwife's or health care provider's instructions. If the symptoms get worse, or don't go away after one hour, call your midwife or health care provider again or go to the hospital. If the symptoms go away, take it easy for the rest of the day. If the symptoms stop but come back, call your midwife or health care provider again or go to the hospital.
When you call your midwife or health care provider, be sure to tell the person on the phone that you are concerned about the possibility of preterm labor. The only way your midwife or health care provider can know if preterm labor is starting is by doing an internal examination of your cervix (the bottom of your uterus). If your cervix is opening up (dilating), preterm labor could be beginning.
You and your midwife and/or health care provider are a team, working together to have a healthy pregnancy and healthy baby. Your team works best when both of you participate fully, so your knowledge about preterm labor can be essential in helping to prevent a preterm birth. Talk to your health care provider about all of this, and be sure to keep all of your prenatal care appointments. Preterm birth is one of the complications of pregnancy that health care providers are working hard to eliminate. Your participation in this effort is just as important as theirs!
During pregnancy, you think you have a urinary tract infection.
After delivery, you have abdominal pain, chills and fever, headache, muscle aches or a bad-smelling vaginal discharge.
New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
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