Preventing and Detecting Preterm Labor

The womb is the best place for babies to grow until they reach full term, which is usually between 37 and 40 weeks from the mom's last menstrual period. However, preterm births - those under 37 weeks gestation - have been increasing in the United States. In 1990, 10.6 percent of all births were preterm deliveries. This figure jumped to 11.6 percent in 2000 and 12.6 percent in 2005; far from reaching the March of Dimes goal of 7.6 percent by 2010.

Some preemies suffer short-term problems that go away, while others have lifelong problems including respiratory difficulties, mental retardation, physical impairments, or blindness.

Causes of Preterm Labor. While the cause of preterm labor and delivery is often unknown, many controllable lifestyle habits can be the cause, including smoking, alcohol and drug abuse, poor nutrition, and lack of prenatal care. Carrying twins, or problems such as uterine fibroids, cervical abnormalities, obesity, and infections, can also cause premature delivery. New studies indicate that moms with serious gum disease have a greater risk of giving birth to a preterm baby.

However, Phyllis Rattey, CNM, points out that "moms often blame themselves for preterm labor, but in more than two-thirds of the cases, there is no obvious cause, and the mother did nothing wrong." The best ways to prevent the complications of an early delivery and a low-birthweight baby are to recognize the signs of preterm labor and to seek care from your midwife or doctor if the following signs occur between 20 and 37 weeks gestation:

• Regular contractions or tightening (even if not particularly painful) of your uterus every 10 minutes or more often
• Any spotting or bleeding from the vagina
• Menstrual-type or abdominal cramps
• Low, dull back pain
• Clear, pink, or brown vaginal discharge
• Pelvic pressure, as if baby is pressing down

Slowing Preterm Labor. If you suspect you are in preterm labor, drink two to three big glasses of water, lie down on your left side, and call your midwife or doctor. If detected early, preterm labor can often be slowed; and every additional day that the baby is in the womb can be important. There are medicines to give the mother that can help the baby's lungs mature, and once born, a treatment containing the substance surfactant can be given to the baby.

Testing for Preterm Labor. There are new tests available to help determine the risk of a preterm delivery. The fetal fibronectin exam tests the cervical secretions for a protein that attaches the amniotic membrane to the uterus; when this is present, it indicates that labor could start within two weeks. The salivary estriol test looks for a type of estrogen in the saliva which surges in the weeks before labor. These tests may help determine if a woman is at risk of a premature delivery. While not used routinely in all settings, these tests are more and more likely to be offered to women, especially those with a history of preterm delivery or those carrying twins or more.

For women with a history of preterm delivery, additional good news might be on the horizon. The results of a new study presented at the last meeting of the Society for Maternal Fetal Medicine showed that women with a history of delivering a premature baby could reduce the risk of having another preemie with weekly progesterone injections.

*taken from "Ahead of Schedule," by Lois Wessel, Every Baby magazine, Issue Four.