Preterm Birth: What Happens When You Go into Labour Too Soon

Preterm birth refers to the delivery of a baby before 37 completed weeks of pregnancy. It can happen due to several medical reasons, such as infections, complications in the uterus or cervix, or chronic conditions in the mother. At times, it may occur without any clear cause, even in pregnancies that seemed otherwise healthy. As preterm labour can begin suddenly and progress quickly, it’s important for all expecting parents - not just those with high-risk pregnancies - to be aware of its warning signs and potential outcomes. With that in mind, this blog offers a detailed guide on preterm birth, covering its causes, symptoms, treatment options, and tips for at-risk parents. Let’s begin by understanding what preterm birth actually means.

What is Preterm Birth?

Preterm birth refers to the delivery of a baby before 37 completed weeks of pregnancy. A full-term pregnancy typically lasts about 40 weeks, so when birth occurs early, the baby may not have had enough time to fully develop in the womb. Preterm birth can happen for a variety of reasons, and in many cases, the exact cause is clear. 

Preterm births are classified based on how early the baby is born: late preterm (34 to 36 weeks), very preterm (28 to 33 weeks), and extremely preterm (before 28 weeks). The earlier the birth, the higher the risk of health complications, especially related to the lungs, brain, and digestive system. 

What are the Most Common Causes of Preterm Birth?

Preterm birth can result from a wide range of factors, some of which are known and others that remain unclear. In many cases, it is not caused by a single issue but rather a combination of conditions that affect the pregnancy. These include:

Infections and Inflammation

Infections are one of the most well-established causes of preterm birth. These may affect the amniotic fluid, placenta, uterus, vagina, or urinary tract. When the body detects infection, it can trigger an inflammatory response that leads to the release of chemicals associated with labour. This may result in premature contractions, rupture of membranes, or cervical changes. Conditions such as bacterial vaginosis, urinary tract infections, or chorioamnionitis (infection of the fetal membranes) are particularly linked to early delivery.

Cervical Insufficiency

In some pregnancies, the cervix begins to shorten or open too early without any pain or contractions. This condition, known as cervical insufficiency or incompetent cervix, may go unnoticed until routine scans reveal changes. If the cervix cannot stay closed under the pressure of the growing baby, it can lead to early labour or loss of the pregnancy. Women with a history of cervical surgery, uterine abnormalities, or previous preterm births may be at higher risk.

Multiple Pregnancy (Twins or More)

Carrying more than one baby increases the likelihood of preterm birth. The uterus becomes more distended earlier in the pregnancy, which can trigger contractions or premature rupture of membranes. Additionally, the placenta may struggle to support the growth needs of more than one baby, contributing to early delivery. In many twin or triplet pregnancies, doctors closely monitor cervical length and may plan an early delivery if risks are identified.

Placental Complications

Problems with the placenta can interfere with the baby's growth or trigger early labour. Placental abruption, where the placenta separates from the uterus too soon, is a medical emergency that often results in preterm birth. Placenta previa, where the placenta covers the cervix, can also lead to early delivery due to bleeding risks. These complications may be detected through routine ultrasounds or may present suddenly.

Uterine or Structural Abnormalities

Some women have congenital abnormalities in the shape or size of the uterus, which may limit its ability to carry a pregnancy to term. Fibroids or previous surgeries involving the uterus can also interfere with its function. In such cases, the uterus may not stretch properly or may contract too early, increasing the risk of preterm birth.

Chronic Maternal Health Conditions

Underlying medical conditions can impact pregnancy in various ways. High blood pressure, gestational diabetes, autoimmune disorders, and thyroid imbalances are all associated with higher rates of early delivery. These conditions may affect the placenta, restrict foetal growth, or trigger complications that make early delivery necessary.

Lifestyle and Environmental Factors

Several lifestyle-related factors may contribute to preterm birth. These include:

• Smoking: Reduces oxygen supply to the baby
• Poor nutrition: Affects foetal development and placental function
• High levels of stress: May lead to hormonal changes that influence labour
• Excessive physical strain or injury: Can sometimes bring on contractions

Maintaining a healthy lifestyle during pregnancy is important, especially for those with known risk factors.

Previous History of Preterm Birth

Women who have experienced a preterm birth before are more likely to face it again in future pregnancies. The risk increases if the previous birth occurred very early or resulted from spontaneous labour. In such cases, doctors often recommend additional monitoring, cervical length scans, and preventive treatments like progesterone therapy or cervical cerclage.

Unknown Causes

Despite thorough investigations, a significant number of preterm births occur without a clearly identifiable cause. These are referred to as spontaneous preterm births and may be linked to a complex interaction of genetic, hormonal, and environmental factors that are not yet fully understood. This unpredictability is why regular prenatal care remains essential throughout pregnancy.

What Signs Suggest You are Going into Labour Too Soon?

Preterm labour can start with signs that seem mild or resemble common pregnancy discomforts. However, certain symptoms may indicate that the body is preparing for birth earlier than expected. If any of the following signs appear before 37 weeks, it’s important to contact a doctor without delay:

• Regular or frequent contractions: These may feel like tightening across the belly or low, cramp-like pain. If contractions occur more than four times in an hour, continue over time, or increase in intensity, they could be a sign that labour is beginning.
• Persistent lower back pain: A constant, dull ache in the lower back—especially if it doesn't ease with rest, changing positions, or lying down—may be an early signal of labour. This type of pain is often similar to what is experienced during menstruation.
• Increased pelvic pressure: A feeling that the baby is pressing down or a sense of heaviness in the lower pelvis may suggest that the cervix is starting to open or thin out. This sensation may increase when standing or walking.
• Changes in vaginal discharge: A noticeable increase in discharge—especially if it becomes watery, sticky like mucus, or contains streaks of pink or brown—can be a sign of cervical changes. Any fluid that appears unusual in colour or consistency should be checked.
• Menstrual-like cramps or abdominal discomfort: Mild but persistent cramps in the lower abdomen, often accompanied by diarrhoea or a feeling of tightness, may indicate that the uterus is beginning to contract.
• Vaginal bleeding or spotting: Light bleeding or spotting—particularly when combined with other symptoms like backache or pelvic pressure—should be evaluated. Although some spotting can occur after physical activity or exams, unexpected bleeding can signal a problem.
  
• Rupture of membranes (water breaking): A sudden gush or slow, continuous leak of fluid from the vagina may mean that the amniotic sac has broken. This can occur with or without contractions and always requires immediate medical attention.

Even if these symptoms appear mild or uncertain, they should never be ignored. Prompt medical evaluation can help determine if labour has started and whether interventions are needed to protect both the mother and the baby.

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Can Preterm Labour be Stopped or Delayed?

In many cases, preterm labour can be delayed long enough to reduce health risks for the baby, especially if detected early. Although it may not always be possible to stop labour completely, medical treatment can help slow its progression, allowing more time for the baby to mature inside the womb. Here are the most commonly used approaches:

Medications 

Tocolytic medicines are used to suppress uterine contractions for a short period, usually up to 48 hours. This temporary delay can provide enough time to administer other treatments, such as steroids for lung development. These medications are typically given in hospital settings and are closely monitored for effectiveness and side effects.

Steroid Injections 

Corticosteroid injections are given to the mother to speed up the baby’s lung development in preparation for early birth. These are most effective between 24 and 34 weeks of pregnancy and significantly lower the risk of respiratory problems and other complications in premature babies. They may be repeated based on the doctor’s assessment.

Magnesium Sulphate for Brain Protection

In pregnancies at risk of very early delivery (usually before 32 weeks), magnesium sulphate may be administered to reduce the risk of cerebral palsy and other brain-related complications in the baby. This treatment is typically given through an IV and may be used alongside other interventions.

Cervical Cerclage

For women diagnosed with cervical insufficiency (where the cervix begins to shorten or open too soon), cervical cerclage may be recommended. This involves placing a stitch around the cervix to help keep it closed. The procedure is most effective when done early, often between 12 and 24 weeks of pregnancy, and is typically removed around 37 weeks or earlier if labour begins.

Bed Rest and Activity Modification

Depending on the condition of the cervix and uterus, doctors may advise reduced physical activity or bed rest. Although not proven to prevent preterm birth in all cases, limiting movement may help reduce uterine irritability or pressure on the cervix in some women. Each case is considered individually before this recommendation is made.

Hydration and Nutritional Support

Staying well-hydrated is important, as even mild dehydration can sometimes trigger uterine contractions. Nutritional support and monitoring may also be advised if poor diet or weight loss is suspected to be contributing to early labour signs.

Hospital Monitoring and Observation

In many cases, hospital admission is recommended for closer monitoring of contractions, cervical changes, and the baby’s heart rate. Continuous observation allows healthcare providers to respond quickly if labour progresses or if the baby shows any signs of distress. It also ensures immediate access to neonatal care if delivery becomes unavoidable.

What are the Complications Associated with Preterm Birth?

Babies born before 37 weeks of pregnancy often face health challenges because many of their organs are not yet fully developed. The risks increase the earlier the birth occurs, with babies born before 28 weeks being the most vulnerable. Preterm complications can affect several body systems and may have short-term effects immediately after birth or lead to long-term difficulties that require ongoing support. Here’s a more comprehensive look at the key complications:

Breathing Difficulties

The lungs are among the last organs to mature. Babies born early may not have enough surfactants, a substance that keeps the lungs open, leading to respiratory distress syndrome (RDS). These babies may need oxygen therapy, CPAP, or even mechanical ventilation in severe cases. In some cases, they may later develop bronchopulmonary dysplasia (BPD), a chronic lung disease resulting from prolonged oxygen use or ventilation.

Feeding and Digestive Problems

Feeding can be a challenge because the muscles and reflexes required to suck, swallow, and breathe in a coordinated way may not be fully developed. Many preterm infants rely on tube feeding until they can feed orally. In addition, the gut is immature and more prone to serious conditions like necrotising enterocolitis (NEC), which causes inflammation and damage to the intestinal walls. NEC can require surgery and carries a risk of long-term digestive issues.

Body Temperature Regulation

Preterm babies have less body fat and thinner skin, which makes it difficult to stay warm. They are also unable to shiver or regulate temperature efficiently. As a result, they are at risk of hypothermia, which can interfere with breathing and growth. These babies often need to be cared for in incubators to maintain a stable body temperature.

Infections and Sepsis

The immune system in premature infants is underdeveloped, making them more prone to infections, including pneumonia, meningitis, urinary tract infections, and sepsis. Even routine procedures can increase the risk of infection, and illnesses can progress quickly in newborns, sometimes becoming life-threatening without early intervention.

Brain and Nervous System Complications

Preterm birth increases the risk of intraventricular haemorrhage (IVH), which is bleeding in the brain, especially in babies born before 32 weeks. Some babies may also develop periventricular leukomalacia (PVL), a type of white matter damage. These conditions can lead to cerebral palsy, learning difficulties, or developmental delays. Seizures and problems with muscle tone and coordination are also possible.

Heart Issues

One of the most common heart-related complications in premature babies is patent ductus arteriosus (PDA), a condition where a fetal blood vessel remains open after birth. If not treated, it can lead to poor blood flow, heart failure, and lung problems. Some babies may require medications or surgery to close the duct.

Jaundice

The liver of a preterm baby may not process bilirubin efficiently, leading to neonatal jaundice, a yellowing of the skin and eyes. In severe cases, high bilirubin levels can lead to kernicterus, a rare type of brain damage. Phototherapy is commonly used to lower bilirubin levels safely.

Vision Problems

Retinopathy of prematurity (ROP) occurs when abnormal blood vessels grow in the retina. It mostly affects babies born before 31 weeks or those with very low birth weight. If not monitored and treated early, ROP can cause scarring, retinal detachment, or even blindness.

Hearing Loss

Premature infants are at higher risk of sensorineural hearing loss due to the immaturity of auditory structures, exposure to loud NICU sounds, or infections. Regular hearing tests are important to ensure early detection and prompt intervention, such as hearing aids or speech therapy.

Anaemia

Due to rapid growth, frequent blood sampling, and a shorter lifespan of red blood cells, preterm babies may develop anaemia of prematurity. They may need iron supplements or, in some cases, blood transfusions to maintain healthy oxygen levels.

Kidney Immaturity

The kidneys in preterm babies may not work efficiently, leading to problems with fluid and electrolyte balance. This can affect urine output and blood pressure, and requires close monitoring to avoid complications like dehydration or fluid overload.

Delayed Growth and Development

Babies born too soon may gain weight and grow in height more slowly than full-term babies. Developmental delays may be seen in areas such as speech, motor skills, and learning. Early intervention programmes, physiotherapy, and occupational therapy can help support development during infancy and childhood.

Tips for Expecting Parents at Risk of Preterm Labour

Being told there is a risk of preterm labour can be stressful, but there are steps that can help reduce complications and improve outcomes for both the baby and the parent. These tips can offer guidance on how to manage the situation more confidently and protect the health of both mother and baby:

• Attend All Prenatal Appointments: Regular check-ups help monitor the baby’s growth, detect early warning signs, and allow timely intervention if needed.
• Know the Warning Signs: Learn to recognise early symptoms of preterm labour, such as regular contractions, lower back pain, or vaginal discharge. Prompt action can make a difference.
• Manage Chronic Conditions: Conditions such as high blood pressure, diabetes, or thyroid disorders should be carefully managed throughout pregnancy to reduce risks.
• Avoid Smoking, Alcohol, and Substance Use: These significantly increase the chances of preterm labour and birth complications. Seek help if needed to quit safely.
• Limit Stress and Fatigue: Rest adequately and avoid high-stress environments. Support from family and mental health professionals can help lower emotional strain.
• Follow a Balanced Diet: Eat a nutritious diet rich in iron, calcium, folic acid, and protein. Malnutrition or deficiencies can increase the risk of complications.
• Stay Hydrated: Dehydration can cause uterine contractions. Drink plenty of fluids throughout the day, especially in hot or humid weather.
• Avoid Overexertion: Avoid heavy lifting, strenuous work, or activities that strain the body. Light activity may be encouraged, but only with a doctor’s approval.
• Take Prescribed Medications and Supplements: Follow all medical advice regarding medications or supplements, especially if progesterone or other preventive treatments are recommended.
• Get Vaccinated When Recommended: Vaccines like flu and Tdap protect against infections that could contribute to early labour.
• Seek Early Treatment for Infections: Prompt treatment of UTIs, gum infections, or other common conditions reduces the chance of triggering contractions.
• Monitor Weight Gain: Follow the doctor’s guidance to gain weight at a healthy pace based on your pre-pregnancy BMI.
• Avoid Long Travel or High Altitudes (if advised): Travel plans during later stages of pregnancy should be discussed with a doctor, especially if there’s a known risk of early labour.
• Consider Mental Health Counselling: Therapy or counselling can help manage fear, anxiety, or past pregnancy trauma, improving both emotional and physical health.
• Keep Track of Baby’s Movements (After 28 Weeks): Counting kicks and noticing changes in fetal activity can help detect issues early.
• Avoid Exposure to Environmental Risks: Limit contact with second-hand smoke, harmful chemicals, and toxins that could impact pregnancy.

Consult Today

If there is any concern about preterm labour, such as regular contractions, unusual discharge, or past pregnancy complications, it is important to consult an obstetrician without delay. At Max Hospital, specialists can assess symptoms, monitor progress, and offer timely interventions to support both mother and baby. Early medical attention can help manage risks and prepare for what lies ahead. Book an appointment with an obstetrician at Max Hospital and receive the right care at the right time.