PRETERM (PREMATURE) LABOR

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WHAT IS LABOR AND WHY IS IT DIFFERENT FROM PRETERM LABOR?

Labor is the process by which the uterus contracts or tightens up regularly and causes the cervix (the opening of the uterus) to open and prepare for delivery. When labor starts before the baby is fully developed, it is called preterm labor. The cause of preterm labor is not well known but some conditions, such as having had a preterm baby before or carrying twins, are known causes.

Your baby is usually fully developed after you have been pregnant for 37 weeks (almost 9 months). Preterm babies may have more problems than babies who are born after 37 weeks, therefore it is best to prevent preterm labor whenever possible. This information sheet has been given to you because there is a higher than usual chance you could go into preterm labor sometime in this pregnancy.

WHAT CAN I DO TO LESSEN MY CHANCES OF HAVING A PRETERM BABY?

· Make sure you keep your appointments - women who get prenatal care carry their babies to full term more often.

· Eat right so you gain the right amount of weight for you.

· Take your vitamins and iron as instructed.

· Quit smoking!

· Avoid all drugs (especially recreational drugs like cocaine).

· Of course, medicine prescribed by your doctor should be taken.

Your doctor may give you a steroid medication to cut down the chances of your baby having complications. The medicine is given as several shots over 1 or 2 days. Be sure to follow all directions for receiving these shots.

If you had a past pregnancy where your baby was preterm, your doctor may start you on progesterone medicine to improve the chances this baby will be born after 37 weeks. This may mean you will need to get a shot every week beginning at around the 4^th or 5^th month and continuing until you reach 36 weeks. Be sure to follow all instructions and keep appointments to get the medicine (shots).

WHAT SIGNS SHOULD I WATCH FOR THAT CAN WARN ME THAT PRETERM LABOR MAY BE STARTING?

Preterm labor is not at all like the usual labor at the normal end of pregnancy. The warning signs when it begins may seem very mild. It's wise to be safe and report any of the following to your doctor immediately:

· regular contractions or cramping of the uterus, with or without pain, lasting more than an hour

· dull low back ache (constant or coming and going)

· pelvic pressure or pressure very low in the abdomen or belly

· lower abdominal (belly) or thigh pain

· intestinal cramps, with or without diarrhea

· a change in vaginal fluid (discharge), especially an increase of mucous or water leaking from the vagina

· any vaginal bleeding or spotting

· change in color of vaginal discharge to pink or brown

Remember - preterm labor contractions are often painless and can occur every 15 minutes or closer.

HOW WILL THIS MAKE A DIFFERENCE IN MY CARE DURING THE PREGNANCY?

If you have a high chance of going into preterm labor, you may need to come to the office or clinic every week to be examined. This may include an internal vaginal examination. These frequent visits may need to begin in the middle of your pregnancy or when problems occur.

WHAT ABOUT MY ACTIVITIES AT WORK AND HOME?

If you have a high chance of going into preterm labor, you may be told to cut back your activities as much as possible. This may mean working only half days or not working at all. You should try to arrange for help with the housework and care of your other children. Making these changes in your lifestyle could decrease the need to keep you in the hospital to control the preterm labor. Discuss these changes with your doctor or staff.

WHAT OTHER THINGS ARE IMPORTANT FOR ME?

You may be advised not to have intercourse or orgasms. If sex is allowed, the doctor may suggest you pay close attention to any signs of labor starting for the first few hours after sex and may also tell you to use condoms.

You should prepare yourself and your family for the possibility of emergency hospitalization and/or early delivery. Be sure you know how you will get to the hospital and who will watch your children (or pets). It is sometimes helpful to have a relative come and stay at your home.

IF I AM ADMITTED TO A HOSPITAL FOR CONTRACTIONS, WHAT WILL HAPPEN?

Your restrictions and treatment will depend on how far along you are in your pregnancy and how much your cervix is open. You may be given a medication to help stop the contractions.

IF I AM SENT HOME FROM THE HOSPITAL, WHAT DO I NEED TO DO?

If you have been given medication to help stop the contractions, be sure to take it exactly as instructed!

Read the front of this sheet again, it is still important. Rest - take it easy. At first you should do nothing except bed rest and eat. Later your doctor may allow you to increase your activities to being up around the house, briefly going shopping or out to eat.

Watch for the signs of preterm labor listed on the front of this sheet and the other signs you had before you were admitted to the hospital. Don't delay in calling your doctor and coming back to be seen if you think the preterm labor is coming back.

IS MY BABY GOING TO BE NORMAL?

Most babies born after 34 weeks do very well with modern medical care. Most babies born after 28 weeks survive. There is, however, an increased risk of physical and mental problems and an increased risk of death for all preterm babies. That is why it is best for the baby to remain in the uterus for as long as possible. During the entire pregnancy, follow all of the doctor's instructions very carefully so you know that you did the best you could to have a healthy baby. Your doctor can give you more information about this.

IF I DELIVER EARLY, WILL MY BABY STAY IN THE HOSPITAL WITH ME OR BE TRANSFERRED SOMEWHERE ELSE?

This depends on the size of the baby and the ability of your hospital to care for preterm babies. Now is a good time to visit the nursery and ask your doctor about any special arrangements that may be needed should you deliver early. Your husband or partner may need to do this while you stay in bed.

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A good book to help you understand your pregnancy and treatment is:

The Preterm Labor Handbook: Successfully Sustaining Your High Risk Pregnancy, by P.A. Robertson and P.H. Berlin, published by Doubleday, Inc., in 1986.

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