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Preterm Labor – Know the signs and symptoms

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Preterm labor is defined as labor that begins before completion of 36 weeks of pregnancy.

Early warning signs of preterm labor may be subtle and develop slowly. Many symptoms are present during a normal pregnancy. You may not always be able to identify a specific problem; you may just feel that something is different from what you have previously experienced.

As you read the list of signs and symptoms, the question to keep in mind is whether a change has appeared from what has been usual for you:

  • Menstrual-like cramps -You may feel dull, aching cramps in the lower part of your abdomen. They may be continuous or come and go in a rhythmic pattern.
  • Low backache - The backache you experience in preterm labor is usually located in the lower back. It may come in waves and may travel to the front of your abdomen. This ache is not relieved by changing your position. It may come and go, or seem different from the normal backache you have felt at other times during your pregnancy.
  • Abdominal cramps: Abdominal or intestinal cramps, with or without diarrhea. Persistent diarrhea may cause irritation of the uterus, which can lead to excessive uterine contractions.
  • Pelvic pressure: Sometimes described as a feeling that the baby will “fall out”. You may feel you need to move your bowels, but with no result. This feeling of pressure may be constant or may come and go. You also may need to urinate more frequently.
  • Increase or change in vaginal discharge: Any of the following changes may be a sign of preterm labor:
    • Change in type of discharge
    • Change in consistency or feel of discharge
    • Increased amount of discharge
    • Change in color, especially to a brown or pink
  • Contractions: A contraction is the tightening of the uterine muscle. The type of contractions that you feel in preterm labor may be different from those felt in term labor. You may feel only a tightening of the muscle. Sometimes, you may feel the contraction only if you have your fingers on the uterus to feel for the tightening.
    Occasionally, you may see the uterus tighten and appear to rise up like a ball. ​Contractions are normal during pregnancy, but you need to watch for an increase in frequency or contractions that come at regular intervals.
    You should not have five or more contractions or tightenings in 1 hour, or contractions should not be less than 15 minutes apart while you are lying down. If you have fewer than five contractions an hour, this uterine activity is probably normal and needs only your careful observation.

How to monitor:

  • Lie down
  • Tilt toward your left side
  • Put a small pillow under your hip to support your back, if needed
  • Using your fingertips, gently feel your uterus for tightening. (Ask your provider to work with you in practicing the steps until you have learned “the feel” of your own uterus and its contractions)
    • Think of your uterus as divided into four sections, and feel over each of the four sections. You are monitoring especially to detect contractions that feel uniformly firm over all four sections of your uterus.
    • When the uterus is relaxed, you will be able to indent it with your fingers.
    • During a contraction, the uterus will feel firm to the touch. You will notice a definite pressure change.
    • Sometimes you may feel the baby move.
    • ​​The uterus may feel firm on one side while the opposite side remains soft. You may also have localized contractions that cause a bulging on only one side of the uterus. This type of contraction does not cause equal pressure within the uterus and does not cause your cervix to change.
      If you feel uterine tightening, try to determine how often it is coming and how long it lasts. Start counting minutes from the time the uterus begins to tighten. The time from the beginning of a tightening until the uterus becomes soft again is the length, or duration, of a single contraction. The number of contractions in any given time period (for example, one hour) is the frequency of contractions.

What to do if you have frequent contractions

If you have five or more contractions in an hour, or the time between the beginning of one contraction and the beginning of the next is less than 15 minutes, do the following:

  • Empty your bladder
  • Drink some fluids
  • Rest on your left side for an hour while re-checking your uterine activity.

If this uterine activity persists while you are resting, then you may be in preterm labor and you should contact your provider.

Remember, it is often not possible to determine true labor from false labor over the phone, so you may be asked to come into the clinic or hospital for observation and/or to have your cervix checked.

Adapted from: Preventing Preterm Birth: A Parent’s Guide, Editors: Michael Katz, Pamela Gill, Judith Turiel (Pages 28 – 32)