Preterm Labor and Birth

Last Updated April 2022 | This article was created by editorial staff and reviewed by Deepak S. Patel, MD, FAAFP, FACSM

Every patient who is pregnant longs for a dream pregnancy—a 40-week, worry-free time where everything goes as planned. But some women have complications. One common complication is preterm (premature) labor. Preterm labor is when a patient who is pregnant goes into labor too early. Doctors consider this to be before 37 weeks of pregnancy.

Many of the symptoms of full-term labor are the same for preterm labor. If you have not reached 37 weeks of pregnancy and you experience any of these symptoms, call your doctor right away.

  • Contractions (painful tightening of stomach muscles) every 10 minutes or less
  • Vaginal bleeding
  • A trickle or gush of fluid leaking from your vagina
  • Pressure in the pelvic area
  • Low, dull backache
  • Cramps that feel like your period
  • Stomach cramps, with or without diarrhea

 What causes preterm labor?

Doctors do not know what causes preterm labor in most women. Some things put you at higher risk of going into preterm labor. The top 3 are:

  • Having a premature baby in the past
  • Being pregnant with twins or multiples
  • Having problems with your uterus or cervix, such as a short cervix

Other risk factors include:

  • A history of cervical surgery
  • Having an infection or chronic condition, such as diabetes
  • Certain birth defects in the baby
  • High blood pressure
  • Bleeding during your first trimester
  • Tobacco, alcohol, or drugs use while pregnant
  • Getting prenatal care late in your pregnancy
  • Going through a stressful event while pregnant

Path to Improved Health

Can preterm labor be treated?

If you are experiencing symptoms of labor before you are 37 weeks along, your doctor may recommend some treatments. These include:

  • Medicine for the baby. Your doctor can give you steroid medicines to speed up your baby’s lung development. The lungs are still developing in the last weeks of pregnancy. These medicines can help make up for the time the baby will not be in the womb.
  • Medicine to stop labor. Some medicines can slow or stop contractions. They usually only delay birth by a few days. But that can give the baby a little more time to develop. It can give you time to get the steroid medicine for the baby. It can also give you time to get to a hospital that can take care of a premature baby.
  • Antibiotics to kill bacteria that cause infections. Your doctor may want to give you antibiotics to prevent a Group B strep infection. You may need antibiotics if your water breaks before 37 weeks of pregnancy. This is called preterm premature rupture of membranes (PPROM).

 Can preterm labor be prevented?

Some risk factors for preterm labor can’t be changed. But you can take certain steps to lower your risk of having a premature birth.

  • Don’t smoke. If you do, quit now. For help, talk to your doctor for support.
  • Don’t use alcohol or drugs.
  • Go to your doctor for prenatal care as soon as you suspect you’re pregnant. Keep all your appointments throughout your pregnancy.
  • Get treated for any chronic conditions you may have before and during pregnancy.
  • Know the signs. If you think you may be in labor, call your doctor right away.

If you are at high risk of going into preterm labor, there are some things your doctor could suggest to prevent it. They include:

  • This is a hormone involved with pregnancy. Some women at higher risk for preterm labor receive this therapy starting at 16 weeks of pregnancy. It can prevent premature birth.
  • Bed rest.This could be just resting more or lying down all day. Recent research has shown that bed rest does not help you stay pregnant longer. It can actually increase the risk of some complications. Many doctors now avoid prescribing bed rest.

Things to Consider

It can be hard for doctors to predict which women who go into preterm labor will have their baby prematurely. For some women, preterm labor stops on its own. Some have theirs stopped with medicine. A smaller number go on to have a preterm birth.

Preterm, or premature, birth is defined as babies born alive before the completion of 37 weeks of pregnancy. Premature birth is broken down into 3 categories.

  • Extremely preterm (born before 28 weeks).
  • Very preterm (born from 28 to before 32 weeks).
  • Moderate to late preterm (born from 32 to before 37 weeks).

When a baby has had less time to develop in the womb, they are often born with problems. That’s because many organs are still developing in the final weeks of pregnancy. These include the brain, lungs, and liver. Problems range from mild to severe. They can include problems with breathing, feeding, vision, or hearing.

The earlier the delivery, the more likely that the baby’s problems will be more severe. Preterm birth is the greatest contributor to infant death. Most deaths occur among babies born before 32 weeks of pregnancy.

 What is the NICU?

Premature babies (also called preemies) may need special care. A neonatal intensive care unit (NICU) is a special nursery in the hospital. It is just for babies that are born prematurely or have problems at birth. The doctors and nurses who work there have specialized training in preemie care. The NICU has equipment designed to provide your baby’s basic needs. These include warmth, nutrition, protection, and help with breathing.

You can be involved in your baby’s care, even if he or she is in the NICU. Premature babies usually can’t feed directly from the breast or bottle until they’re 32 to 34 weeks gestational age. You can pump breast milk that can be given to your baby through a tube. For preemies, breast milk has a distinct advantage over formula. It contains antibodies that help protect your baby from infections. Preemies’ immune systems are often too immature to fight off infections by themselves.

Premature babies need more nutrition than full-term infants. Vitamins and minerals may be added to breast milk or formula.

How long your baby stays in the NICU depends on many things. Typically, healthy babies may only stay a day or two. Babies that were born very early can stay for weeks or months. It all depends on the health challenges your baby is facing. These can include:

  • Breathing problems, including respiratory distress syndrome
  • Underdeveloped organs or organ systems
  • Low birth weight
  • Poor feeding
  • Trouble maintaining body temperature
  • Life-threatening infections
  • Necrotizing enterocolitis, an intestinal disease

 After the NICU

Once your baby’s systems are more developed and can work on their own, they will be able to go home. The baby may still require special care, especially if they were very small at birth.

You may see plenty of specialists when your baby is in the NICU. Be sure to ask them any questions you have. Once your baby is released to go home, you’ll need to see a doctor right away. The doctor will check your baby’s weight and make sure everything is going well at home. At each of your baby’s well visits, the doctor will check on your baby’s growth. They will use a special growth chart for premature babies to track his growth. It may be slower than a full-term baby’s. But don’t worry. Most premature babies catch up with full-term babies after the first 2 years.

Touch base with your doctor about feeding your baby. Breast milk is always best. Premature babies can have issues with sucking or latching on. Ask your doctor for help. They can recommend a lactation consultant, if necessary. If formula is needed, your doctor can help you select the most appropriate one.

Certain vision and hearing issues are more common in premature babies. Your baby could have retinopathy of prematurity (ROP). This condition makes the small blood vessels in the eye grow abnormally. It can occur in babies who were born at or before 32 weeks of pregnancy. Your baby could have crossed eyes (strabismus). This often goes away on its own. Talk to your doctor if you’re concerned about your baby’s sight. They might recommend you take your baby to an eye doctor.

Premature babies are also more likely to have hearing issues. Speak to your doctor if your baby fails to react to loud noises.

Some preemie babies develop health conditions as they grow older. These could include cerebral palsy or intellectual and developmental disabilities. Your doctor will pay careful attention to your baby’s developmental milestones. These include smiling, sitting, walking, and talking.

Questions to Ask Your Doctor

  • Am I at risk for going into preterm labor?
  • Is there anything that can be done to stop preterm labor?
  • If I am experiencing preterm labor, how likely is it that my baby will be born prematurely?
  • Will my baby have to go to the NICU?
  • I have a scheduled C-section. Will I still have a C-section if I go into preterm labor?
  • What is my baby’s gestational age?
  • Is my preemie baby more at risk of getting sick?
  • When can I take my baby out in public?
  • What developmental milestones should I be looking for and when?
  • Are there any special concerns about vaccinations since my baby was born prematurely?