Threatened premature labour
The signs of preterm labour can be very similar to labour at term, but for a few women may not be as painful. It is well recognised that a woman's intuition about being in preterm labour is often correct. So, if you suspect you may be experiencing regular contractions, or that your waters may have broken and you are less than 37 weeks pregnant, trust your instincts and contact your caregiver or hospital as soon as possible.
Preterm contractions are usually regular and consistent in length (every 5, 10, 15, 20 or 30 minutes, lasting 40 to 60 seconds) and will continue over a period of time. Braxton Hicks (or practise contractions) are usually erratic or irregular and shorter or longer (less than 30 seconds or up to 2 minutes).
The contractions can be cramp-like or feel like an ache in the lower belly, or back, that come and go. However, sometimes the preterm labour contractions can be relatively painless until close to the birth. Be aware that the regularity of your contractions can provide clearer indication that you may be in preterm labour (before 37 weeks) than how much pain you are in when having the contractions.
For some women there will be no contractions but the waters will break. This could be an unmistakeable large gush of fluid, or a harder to identify 'slow leak' or a 'watery vaginal discharge'. If you think you have broken your waters, you should contact your caregiver as soon as possible.
Other signs that can be of concern before 37 weeks are vaginal bleeding or a thick mucous 'show' passed vaginally. The mucous can be tinged with red or brown blood.
Threatened premature labour
Some women experience what is called 'threatened premature labour' (often written as 'TPL' by caregivers). This is when the woman has contractions between 20 and 37 weeks of the pregnancy that are regular and sometimes painful, like labour, but the waters have not broken and the birth does not eventuate. If the birth does start to become apparent and the 'threat' becomes more of a reality, it is called 'premature or preterm labour'.
Research of women who alerted their caregiver to the possibility of them being in preterm labour showed that:
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Over 60% of women who thought they were in preterm labour stopped labouring on their own without any form of medical treatments and the pregnancy continued. |
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About 25% of women had their baby(s) within 48 hours, regardless of medical attempts to slow or stop the labour, and |
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About 13% continued the pregnancy because they were (rightly or wrongly) given medications to suppress the contractions. |
When the contractions are happening it can be very difficult for the caregiver (and the woman) to know whether it is 'just a threat' or whether it will increase and intensify, resulting in a preterm birth. This has been an ongoing problem in the treatment and prevention of preterm births and one of the reasons why preterm births continue to happen.
Of the many treatments available, their use and effectiveness can vary. In addition, the side effects of some treatments could be considered as possibly unreasonable due to their low success rate. Many women can be 'treated unnecessarily' although this may be hard to evaluate at the time and in some cases the treatments will make little difference to the eventual outcome.
Caregivers may try to discern whether the contractions are working towards a preterm birth by examining the woman's cervix at regular intervals (every few hours) to see if the cervix is thinning and dilating. This will be effective once the labour is advancing (often too late) but may not help in trying to prevent preterm labour in the early stages.
Other methods used in the past to try and detect preterm labour have included blood tests for hormone levels, ultrasounds for measuring the cervix, checking the baby's breathing movements with ultrasound and testing vaginal mucous. The overall results of using many of these tests has been the giving of medications to suppress contraction to up to 40% of women who did not need it, without significantly preventing any preterm births.
Many women who experience threatened premature labour will find that their baby ends up being born on time (or even frustratingly overdue!). A few women will experience episodes of threatened premature labour many times, on and off, for the last few months of their pregnancy. If this happens caregivers may refer to the woman as having an 'irritable uterus'.