Am I Really in Labor?
The threat of premature labor shouldn't cause panic. The majority of preterm babies are delivered between 34 and 36 weeks, and most of them are healthy and need little or no special care after birth. If a baby is born before 32 weeks, however, the prognosis is less optimistic.
After about 30 weeks of pregnancy, many women notice occasional uterine contractions. Called Braxton Hicks contractions, they're normal and usually painless. They tend to occur when you're tired or have just had physical activity, and they usually stop when you rest. True labor contractions come at regular intervals or progressively become more frequent or more painful; Braxton Hicks contractions don't.
You are considered to be in preterm labor when you have uterine contractions every ten minutes (or more often) as well as cervical changes (dilation, thinning, softening) prior to 37 weeks gestation.
In some cases it can be difficult for even a doctor to determine if a woman truly is in labor. Your doctor will probably tell you to go to the hospital (if you're not already there), where you can be monitored carefully. Some women at high risk for preterm labor are given a belt with electronic sensors. This is strapped around the abdomen to detect early contractions. Once or twice a day, the monitor is hooked up to a telephone so it can relay graphs of uterine activity to a nurse. The goal of home monitoring is to detect preterm labor early, when it's most treatable.
Two tests, one that measures hormones in the saliva and another that measures vaginal secretions, can also aid in diagnosing preterm labor. A vaginal ultrasound, which can accurately assess cervical dilation and other cervical changes, may help too.
If your doctor determines that you are truly in labor, she will probably attempt to halt it, unless for some medical reason it's not advisable. (For instance, if you have very high blood pressure or uterine bleeding due to a problem with the placenta, or if there's fetal distress, such as a slowed heart rate that could indicate a lack of oxygen.)
How Can They Stop the Contractions?
To try to halt your contractions, your doctor will ask you to rest on your left side (this position increases blood flow to the uterus), and if you seem dehydrated, she will give you intravenous fluids. These steps help stop contractions in about 50 percent of women. If your contractions stop and your cervix doesn't dilate during several hours of observation, you will probably be able to go home.
If your cervix is dilating, however, your contractions are unlikely to stop on their own. If you are between 34 and 37 weeks and the baby already is at least 5 pounds, 8 ounces, the doctor may decide not to delay labor. These babies are very likely to do well even if they're born early.
Your obstetrician may decide that postponing the birth through medication is the appropriate course of action. While there is no established "right" time to start treatment with medication, many doctors recommend beginning once your cervix becomes two to three centimeters dilated. While drugs usually don't postpone labor for long (often not more than a couple of days), sometimes even a short delay can make a lifesaving difference to your baby.
For example, it gives your doctor time to begin treatment with corticosteroid drugs aimed at preventing or lessening complications in preterm newborns. Corticosteroids speed maturation of fetal organs, reducing infant deaths by about 30 percent and cutting the incidence of the two most serious complications of preterm birth: respiratory distress syndrome and bleeding in the brain. They are given by injection and are most effective when administered at least 24 hours before delivery.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.