Written by Jade | Midwife, Mama of 3 & Tiny Hearts Educator

Preterm labour often begins unexpectedly, meaning a lot of parents aren't prepared for it, aren't informed of what can happen and are unsure of what it means for them or bub. So, we've written this blog in the hopes that if you go into preterm labour or bub is born preterm, you've got some level of understanding + knowledge to support you to make the best decisions and to be able to understand what's happening around you. 🤍

what is preterm labour?

Preterm labour is when a mama begins contracting, and the cervix begins changing [opening, softening, moving to the front + thinning out] before 37 weeks in pregnancy. Preterm labour + birth is classified in severity based on how pregnant you are at the time of bub's birth: 

Less than 28 weeks = extremely preterm 

28 - 32 weeks = very preterm 

32 - 36+6 weeks = moderate to late preterm

risk factors for preterm labour + birth

Sometimes there's no obvious cause for preterm labour, but there are certain factors that can increase the likelihood of bub being born preterm, such as: 

-  Being pregnant with more than one bub [twins, triplets etc.] 

- Bleeding from the placenta 

- The cervix opening or changing during pregnancy 

- Infection [such as a UTI] 

- Smoking, violence, drug use + violence during pregnancy 

- Previous preterm labour 

- Differences in the uterus, such as fibroids + a bicornate uterus 

 In some cases, it may be recommended that bub is purposely born early by induction or a c-section, such as: 

-  A mama develops a health complication, like Pre-eclampsia or HELLP syndrome 

- A bub isn't growing on ultrasound 

- There are problems with the placenta or blood flow to bub 

- There are signs of infection developing in bub's sac 

- Mamas aged <20 or >40 years 

- Mamas who are Indigenous 

- Too much or too little fluid around bub 

- A mama broke their waters early + infection is developing 

- Bub is showing signs of being stressed 

- A mama is bleeding from the placenta 

- A mama develops cholestasis

signs + symptoms of preterm labour

 Signs + symptoms of preterm labour are similar to that of labour at full term, which may include: 

-  Lower abdo cramps 

- Back pain that comes + goes 

- Your whole belly goes tight, accompanied by discomfort in your belly or back 

- A heavy feeling/ lots of pressure in your vagina or rectum 

- Diarrhea, nausea + vomiting 

- Losing your mucous plug/ a bloody show 

- 'Braxton Hicks' becoming painful, regular + closer together 

Some mamas report that their preterm labour contractions didn't begin as intense as what occurred when they laboured at full term, so if you see any of these signs, it's important to reach out to your OB or Midwife for individualised medical advice.

what happens if you turn up at the hospital in preterm labour?

If you arrive at the hospital and think you're in preterm labour, the Midwife will take you into an assessment room or birth suite. They will check your vital signs [blood pressure, heart rate, temp etc.], ask you to put on a pad and feel your belly for 10 minutes to see how strong + regular your contractions are coming. If you are at or over 28 weeks, they will apply a CTG monitor to continuously monitor bub's heart rate in relation to your contractions, but if you're under 28 weeks, they may listen in with a doppler intermittently. If you are having contractions, the Midwife will ask the Doctor to meet you + come up with a management plan you're both happy with. 

The Doctor may offer you some pain relief [such as Oxycodone, known as Endone] and recommend other interventions to try and slow down or stop your preterm labour altogether. Some of these interventions include collecting bloods, a urine sample and vaginal swabs to check for infection or other causes of preterm labour, a speculum examination to see if [and by how much] the cervix is changing, a formal ultrasound to check on bub, the placenta + the cervix from the inside, performing a test called a Fetal Fibronectin which gives us a rough indication of how likely it is that birth may occur within the next fortnight, and inserting a cannula to give you some fluid. The Obstetric team may recommend an injection of steroids [known as Betamethosone] if you're under 35 weeks, with another dose given 24 hours later [or 12 hours later if it looks like bub will be born very soon] to help mature + develop bub's lungs. To give you time for these steroids to work, they may recommend a drug called Nifedipine, which works to help relax the uterus and try to stop it from contracting. Once your bub has received steroids, the Obstetric team may no longer recommend Nifedipine if you're still contracting despite all of this medication and may allow the labour to progress. If this is the case, the Doctor may also recommend starting IV antibiotics to help protect bub from infection, and if you're under 34 weeks pregnant, particularly under 30 weeks, they may recommend an infusion via the drip of Magnesium Sulfate to help protect bub's brain. 

If labour continues on, a CTG monitor will continue being used, and the Obstetric team may recommend that you pass urine using a bedpan or insert a catheter [plastic tube] into your bladder [usually only with an epidural] so that you don't unexpectedly stand up + have bub very quickly. That's because bub may be quite small when preterm, so your cervix doesn't necessarily always have to be dilated to 10cm for bub to be born as they may fit through at smaller dilations. At some stage, the NICU team may come and have a chat with you about what to expect, your choices, what bub's condition at birth may be, and some things to expect long-term. When it looks as though birth is imminent, the NICU team will come to be present in the room at the time of birth. You may be offered a short moment of skin-to-skin while doing delayed cord clamping before passing bub off to the NICU team to stabilise as well, but it's good to always check with your health care team for their policies + standard practices, so you know what to expect.  

 If you present in preterm labour and things settle down with pain relief and Nifedipine, you may be recommended to stay in hospital for a certain amount of time, which your OB or Midwife will be able to discuss with you in more detail.

Birthing at or before 24 weeks

In general, the age of 'viability' is 24 weeks. Viability = bub's ability to survive outside the uterus. When a bub is born around 23-24 weeks, they are very small, fragile + their bodies, particularly their organs, are underdeveloped compared to bubs who are born at full term. Because of this, they will require intensive medical care in the Neonatal Intensive Care Unit [NICU], which may include breathing support, many invasive procedures + surgeries, several medications and long-term support.  

With intensive treatment, at this gestation, the chance of survival is around 50:50. Around 1 in 4-5 bubs have significant health implications that impact their growth + development and will require lifelong support. This risk of disability is higher, as well as complications in the NICU, which may be caused purely by being so preterm when born. Some bubs may go on to have a mild or minimal disability, but there is no way to know which bubs will develop which complication/ disabilities. Some bubs born this early may pass away during the labour + birth process or in the first few days/ weeks after birth. Those that survive may have bruised, shiny, and very thin skin, be unable to open their eyes yet and weigh somewhere around 400-500g.  

 Because of this, parents whose bubs are born around 23-24 weeks may be offered a choice of care for their bub: 

1: Intensive treatment [including breathing tubes, surgeries, medications, cannulas etc.]  

2: Comfort measures [bub will be dried, wrapped and given to their parents to cuddle, hold + be made comfortable during their short time spent earthside].  

 Being faced with this choice as a parent is devastating. It will be one of the hardest decisions you may ever make, and only you know what is right for your family. As a health professionals, please know that we don't pass judgement. For some families, knowing that they did everything they could is the best option for them, while for others, letting their baby go peacefully is the right choice. Both devastating choices; neither right nor wrong. And regardless of what you choose, your baby is so very loved. 

implications on little ones

When born, preterm bubs may face initial health challenges, such as: 

- Breathing problems 

- Jaundice 

- Infection 

- Anaemia 

- Problems with the gut 

- Heart problems 

- Brain bleeds 

 Some long-term things that may be impacted by bub being born preterm include: 

-  Growth + movement delays 

- Varying severity of blindness or deafness 

- Teeth problems 

- Language delays 

- Learning delays 

- Social + emotional differences 

 The health challenges that a bub may experience are so individualised and depend on many things, so it's impossible to predict what will happen. In saying that, generally, the further along you are when bub is born, the more likely it is that there will be good health outcomes for your little one. The best person to talk to about this is a Doctor or Nurse from NICU, which can be organised through your OB or Midwife. 

 I hope this helps you better understand preterm birth. In the comments on the original post, tag your fam + friends, and while you're there  I'd love to read about your experience with preterm labour + birth, so feel free to share if you feel comfortable doing so. ✨