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    Premature Labor

    Occasionally, labor may begin prematurely. Though you may not be at risk for premature labor, it is important to know the signs and symptoms that may indicate an early onset of labor and its implications. Many pregnancy symptoms such as backache are common discomforts and may or may not be indicative of premature labor. The following information will help you understand what is normal and when you need to call for assistance.

    What is Premature Labor?

    Premature labor is labor that occurs more than three weeks before your due date in which uterine contractions cause the cervix (mouth of the uterus) to open earlier than normal. This can result in the birth of a premature baby.

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    What is a Contraction?

    When any muscle in your body contracts, it becomes tight and hard to the touch. As muscles of your uterus contract, you will feel your abdomen harden. As the contraction goes away, your uterus becomes soft.

    It is normal for your uterus to contract during your pregnancy. The muscle layers of the uterus (womb) tighten irregularly from the early weeks and throughout pregnancy. You may feel them as early as four months but many women don't notice them until seven or eight months. Usually, these contractions are not painful. You may notice more contractions when you first lie down, after orgasm, if you have a full bladder, or after you walk up and down stairs. These normal contractions (sometimes called Braxton-Hicks) are usually irregular and do not open the cervix. If these contractions become regular (i.e., every 10-12 minutes for at least one hour, they may be preterm labor contractions which can cause the cervix to open.

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    How Do I Check for Contractions?

    Lie down and place your fingertips on your uterus to feel the tightening and softening. Usually during contractions your entire abdomen will feel hard, not just one area. Sometimes you may confuse the baby's movement with contractions, especially as the baby grows. It is common for your abdomen to be firm over the baby's head and buttocks, but in the absence of uterine contractions, your abdomen should be soft in all other areas.

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    Timing Contractions

    If your uterus is tightening and softening at regular intervals, you may want to time these contractions. Start timing from the beginning of one tightening to the start of the next tightening for about one hour. Some tightenings feel harder or stronger than others. It is not normal to have frequent contractions (more than five in an hour) before your baby is due. Call your health care provider immediately if you think you may be in premature labor.

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    Warning Signals of Premature Labor

    Following are signs and symptoms of premature labor. If you suspect you may be in premature labor, call your health care provider. Waiting too long to call for help could result in your baby being born too early.

    Premature Labor Signs & Symptoms:

    • A contraction every 10 minutes or more frequently within one hour (five or more uterine contractions in an hour).
    • Watery fluid leaking from your vagina (this could indicate that your bag of water is broken)
    • Menstrual-like cramps
    • Low, dull backache
    • Pelvic pressure that feels like the baby is pushing down
    • Abdominal cramps that may occur with or without diarrhea
    • Unusual or sudden increase of vaginal discharge
    • Blood from your vagina

    If you suspect you're in premature labor, call your healthcare provider immediately. Also:

    • Empty your bladder
    • Lie down on your left side and drink fluids
    • If you health care provider instructs you to go to the office or hospital, lie down on your left side in the back seat of the car while being transported.

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    Risk Factors Associated with Premature Labor

    Some risk factors have been associated with a higher incidence of premature labor. However, just because you have some risk does not mean you will experience premature labor. On the other hand, you cannot be assured that you will not experience preterm labor if you do not have any of these risk factors. Review the following risk factors and alert your health care professional of any that apply to your pregnancy.

    A history of having any of the below has been associated with being a possible risk factor for premature labor:

    • Premature labor or delivery
    • Misshapen uterus
    • DES (Diethylstillbestrol) daughter - If your mother was prescribed this medication during her pregnancy to prevent miscarriage, you are considered a DES daughter. DES has been linked to shortening of the cervix.
    • Abdominal surgery during pregnancy and/or cerclage (a stitch in your cervix)
    • More than two second-trimester abortions (miscarriage or elective abortion)
    • Previous Cone Biopsy
    • Carrying twins, triplets, etc.
    • History of cervical change and/or excessive uterine contractions at less than 33 weeks in a previous pregnancy
    • Serious infections with fever during this pregnancy
    • Excessive amount of amniotic fluid
    • Unexplained vaginal bleeding after 20 weeks of pregnancy
    • Using recreational drugs such as cocaine or amphetamines

    Minor Risk Factors:

    • More than two first-trimester abortions
    • Bleeding after the first 12 weeks of pregnancy
    • Bladder infection during this pregnancy
    • Smoking more than 10 cigarettes per day
    • Extreme emotional or physical stress

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    Other Potential Problems

    Other pregnancy complications may occur unexpectedly. The following list outlines these warning signals.

    If you have any of the following physical discomforts that is severe or does not go away, contact your health care provider as soon as possible. Do not ignore it.

    • Severe and/or lasting pain in any part of your body
    • Blurred vision, spots, or light flashes with or without a headache
    • A hot, reddened, painful area on your calf or behind your knee
    • Pain or burning when you urinate, or unusually frequent urination
    • Temperature above 100 degrees F that persists more than 24 hours
    • Unusual swelling or puffiness, especially in your face or hands
    • Sudden weight gain
    • A blister in your vaginal area (possibly herpes)
    • Decreased fetal movement (See section on Fetal Movement Counting). If you notice decreased or absent movement, call your healthcare provider immediately.

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    Kick Counts - How to Count Your Baby's Movements

    A simple way to check your baby's well-being is to pay attention to how much your baby is moving. Most babies move at least ten (10) times within two hours. See our instructions on counting your baby's movement.

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    Further Information

    If you need more information, Preventing Preterm Birth: A Parent's Guide by Michael Katz, MD, Pam Gill, RN, and Judith Turiel is a valuable reference book and is available for loan or purchase at Newborn Connections.

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