Preterm Labor & Birth
A premature birth is a birth that takes place more than three weeks before the baby is due. In other words, a premature birth is one that occurs before the start of the 37th week of pregnancy. Normally, a pregnancy usually lasts about 40 weeks.
Premature birth gives the baby less time to develop in the womb. Premature babies, especially those born earliest, often have complicated medical problems. Depending on how early a baby is born, he or she may be:
- Late preterm, born between 34 and 36 weeks of pregnancy
- Moderately preterm, born between 32 and 34 weeks of pregnancy
- Very preterm, born at less than 32 weeks of pregnancy
- Extremely preterm, born at or before 25 weeks of pregnancy
Call your doctor right away if you’re having any of the following symptoms before 37 weeks:
- More vaginal discharge than usual
- A change in the type of discharge – if you’re leaking watery fluid or your discharge becomes watery, mucus-like, or bloody (even if it’s pink or just tinged with blood)
- Any vaginal bleeding or spotting
- Abdominal pain, menstrual-like cramping, or more than four contractions in one hour (even if they don’t hurt)
- More pressure in the pelvic area (a feeling that your baby is pushing down)
- Low back pain, especially if it’s dull or rhythmic, or you didn’t previously have back pain
But it’s always better to be safe than sorry, so call your healthcare provider right away if you’re experiencing anything unusual at any time during your pregnancy. To catch any potential problems early on, it’s a good idea to familiarize yourself with symptoms you should never ignore during pregnancy.
Lots of different things can increase your risk of premature labor. Some of them are:
- Being very overweight or underweight before pregnancy
- Not getting good prenatal care
- Drinking alcohol or using street drugs during pregnancy
- Having health conditions, such as high blood pressure, preeclampsia, diabetes, blood clotting disorders, or infections
- Being pregnant with a baby that has certain birth defects
- Being pregnant with a baby from in vitro fertilization
- Being pregnant with twins or other multiples
- A family or personal history of premature labor
- Getting pregnant too soon after having a baby
Checking for contractions is a key way of spotting early labor.
- Place your fingertips on your abdomen.
- If you feel your uterus tightening and softening, that’s a contraction.
- Time your contractions. Write down the time when a contraction starts, and write down the time at the start of the next contraction.
- Try to stop the contractions. Get off your feet. Change your position. Relax. Drink two or three glasses of water.
- Call your doctor or midwife if you continue to have contractions every 10 minutes or more often, if any of your symptoms get worse, or if you have pain that’s severe and doesn’t go away.
While not all premature babies experience complications, being born too early can cause short-term and long-term health problems for preemies. Generally, the earlier a baby is born, the higher the risk of complications. Birth weight plays an important role, too.
Some problems may be apparent at birth, while others may not develop until later. In the first weeks, the complications of premature birth may include:
- Breathing problems: A premature baby may have trouble breathing due to an immature respiratory system. If the baby’s lungs lack surfactant — a substance that allows the lungs to expand — he or she may develop respiratory distress syndrome because the lungs can’t expand and contract normally. Preemies may also develop chronic lung disease known as bronchopulmonary dysplasia. In addition, some preemies experience prolonged pauses in their breathing, known as apnea.
- Heart problems: The most common heart problems premature babies experience are patent ductus arteriosus (PDA) and low blood pressure (hypotension). PDA is a persistent opening between two major blood vessels leading from the heart.While this heart defect often closes on its own, left untreated it can cause too much blood to flow through the heart and cause heart failure as well as other complications. Low blood pressure may require adjustments in intravenous fluids, medicines and sometimes blood transfusions.
- Brain problems: The earlier a baby is born, the greater the risk of bleeding in the brain, known as an intraventricular hemorrhage. Most hemorrhages are mild and resolve with little short-term impact. But some babies may have larger brain bleeding which causes permanent brain injury.Larger brain bleeds may lead to fluid accumulation in the brain (hydrocephalus) over a number of weeks. Some babies who develop hydrocephalus will require an operation to relieve the fluid accumulation.
- Temperature control problems: Premature babies can lose body heat rapidly; they don’t have the stored body fat of a full-term infant and they can’t generate enough heat to counteract what’s lost through the surface of their bodies. If body temperature dips too low, hypothermia can result.Hypothermia in a preemie can lead to breathing problems and low blood sugar levels. In addition, a preemie may use up all of the energy gained from feedings just to stay warm, not to grow bigger. That’s why smaller preemies require additional heat from a warmer or an incubator until they’re larger and able to maintain body temperature without assistance.
- Gastrointestinal problems: Preemies are more likely to have immature gastrointestinal systems, leaving them predisposed to complications such as necrotizing enterocolitis (NEC). This potentially serious condition, in which the cells lining the bowel wall are injured, can occur in premature babies after they start feeding. Premature babies who receive only breast milk have a much lower risk of developing NEC.
- Blood problems: Preemies are at risk of blood problems such as anemia and infant jaundice. Anemia is a common condition in which the body doesn’t have enough red blood cells. While all newborns experience a slow drop in red blood cell count during the first months of life, the decrease may be greater in preemies, especially if your baby has a lot of blood taken for lab tests.Infant jaundice is a yellow discoloration in a newborn baby’s skin and eyes that occurs because the baby’s blood contains an excess of a yellow-colored pigment from the liver or red blood cells (bilirubin).
- Metabolism problems: Premature babies often have problems with their metabolism. Some preemies may develop an abnormally low level of blood sugar (hypoglycemia). This can happen because preemies typically have smaller stores of glycogen (stored glucose) than do full-term babies and because preemies’ immature livers have trouble converting stored glycogen into glucose.
- Immune system problems: An underdeveloped immune system, common in premature babies, can lead to infection. Infection in a premature baby can quickly spread to the bloodstream causing sepsis, a life-threatening complication.
In the long term, premature birth may lead to these complications:
- Cerebral palsy: Cerebral palsy is a disorder of movement, muscle tone or posture that can be caused by infection, inadequate blood flow or injury to a preemie’s developing brain either during pregnancy or while the baby is still young and immature.
- Impaired cognitive skills: Premature babies are more likely to lag behind their full-term counterparts on various developmental milestones. Upon school age, a child who was born prematurely might be more likely to have learning disabilities.
- Vision problems. : Premature infants may develop retinopathy of prematurity, a disease that occurs when blood vessels swell and overgrow in the light-sensitive layer of nerves at the back of the eye (retina). Sometimes the abnormal retinal vessels gradually scar the retina, pulling it out of position. When the retina is pulled away from the back of the eye, it’s called retinal detachment, a condition that, if undetected, can impair vision and cause blindness.
- Hearing problems: Premature babies are at increased risk of some degree of hearing loss. All babies will have their hearing checked before going home.
- Dental problems: Preemies who have been critically ill are at increased risk of developing dental problems, such as delayed tooth eruption, tooth discoloration and improperly aligned teeth.
- Behavioural and psychological problems: Children who experienced premature birth may be more likely than full-term infants to have certain behavioural or psychological problems, such as attention-deficit/hyperactivity disorder (ADHD). However, more recent research suggests that — at least for late preterm babies — the risk of ADHD may be the same as it is for children who were born at full term.
- Chronic health issues : Premature babies are more likely to have chronic health issues — some of which may require hospital care — than are full-term infants. Infections, asthma and feeding problems are more likely to develop or persist. Premature infants are also at increased risk of sudden infant death syndrome (SIDS).