• Pregnancy Conditions that Can Cause Premature Labor and Birth

    Most pregnancies, 89% of pregnancies, are full-term. This means babies are born healthier when they are near their due date. Many factors are within your control when it comes to having a full-term baby.

    Knowing what you can control during your pregnancy and being aware of the things you can’t control will help you plan for a healthy baby. Here are 9 things you should know about labor, and why it can begin prematurely.

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    What is Premature Labor and Birth?

    A full-term pregnancy lasts about 40 weeks. A normal pregnancy lasts 37 to 42 weeks. A pregnancy that goes beyond 37 weeks is a full-term pregnancy. This is measured from the first day of the last period or 38 weeks after fertilization. Premature labor is defined as uterine contractions and dilation of the cervix before the 37th week of pregnancy.

    Babies born before the 37th week of pregnancy are called premature babies. However, going into preterm labor does not mean you will deliver prematurely. Up to half of the women who go into premature labor will deliver their babies at 37 weeks or later. Approximately 12 percent of babies in the United States are born prematurely, with about 80 percent due to premature fetal membrane ruptures.

    20 percent of births are planned because of maternal or fetal complications; that’s about a quarter of premature births. If you or your baby has a problem during the pregnancy, your health care provider might recommend inducing labor early or performing a cesarean section before 37 weeks. This might happen if you have a serious medical condition such as a heart problem, diabetes mellitus, renal disease (usually associated with hypertension), lung disease, or preeclampsia.

    An induction might also be advised if your baby has stopped growing or has other complications,such as low amniotic fluid volume if your membranes haven't ruptured. Other reasons for induction include problems with the baby's heart rate.

    Women can better their odds of not having premature labor and birth in several ways. Ending substance abuse is a good start. Women can also make lifestyle changes involving sexual health, physical health, and by following good prenatal care, and nutrition. However, being careful to avoid substance abuse, taking care of your physical and sexual health, getting good prenatal care, and being careful about your nutrition will not guarantee a full-term pregnancy. A full-term pregnancy is a complex situation with many factors.

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    Signs of Premature Labor

    It is critical to know the signs of premature labor so you can quickly get medical attention when you and your baby need it. Symptoms of premature labor are pelvic or lower abdominal pressure or pain, bloody vaginal discharge, or mild or menstrual-like abdominal cramps with or without diarrhea.

    Also, pay attention to a constant dull backache, frequent uterine contractions that may not cause you any pain, or ruptured membranes (broken waters). If you have any of these symptoms, get emergency help immediately.

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    Who is at Risk for Premature Labor

    There are many reasons women are at risk for premature labor and delivery. While there is not one profile of a woman who gives birth prematurely, some aspects are consistent. The age of the mother is important.

    Women younger than 16 or over the age of 35 are more likely to give birth prematurely. Women who are pregnant with twins, triplets, or more have a higher risk of premature birth. Women who have previously had preterm births or who have not waited a year to have another child are at higher risk for prematurity.

    Race is, unfortunately, a factor in premature births. African-American women have higher risks of having premature babies than White, Hispanic, or Asian women. Primarily, this is because of a lack of early prenatal care for minority women and the lower socioeconomic status obstructing access to prenatal care.

    Globally, preterm birth rates are rising. Premature birth is the leading cause of death in children under the age of five. Providing early and good quality prenatal care to all women, as well as pregnancy education, is crucial to full-term pregnancies and healthy babies. 

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    Why Full-Term Birth is Important

    Premature babies can have many physical and mental problems. A premature baby is more likely to have breathing problems because of an immature respiratory system. An immature baby's lungs can lack something called surfactant, a substance that permits the lungs to expand and contract normally. Preemies can also develop lung diseases, heart problems, and brain bleeding.

    One common problem of premature babies is hypothermia (being too cold). They have difficulties regulating their temperatures because they don't have enough body fat. Babies who are born too early often spend time in heated incubators so their bodies can develop enough body mass to keep them warm. Also, preemie babies may have gastrointestinal problems, metabolism problems, a predisposition to being jaundiced, immature immune systems, and anemia.

    Long-term complicationsof premature birth can be cerebral palsy, delayed cognitive and physical skills, vision and hearing problems, including blindness, behavioral problems, and chronic health issues such as asthma. Premature babies are at higher risk of dying from Sudden Infant Death Syndrome (SIDS).

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    Uterine and Cervical Disorders

    While many factors are lifestyle-related in preventing premature labor, some women have risks of premature labor and birth because of genetic or other physical reasons. Fibroids, for example, are a common condition that can lead to preterm birth. Fibroid tumors are usually non-cancerous masses that grow in the uterus. These can interfere with the implantation of an embryo, and can cause, especially to women with multiple fibroids, premature labor.

    There are several procedures for removing fibroids before a woman tries to become pregnant. If a woman wants to preserve fertility, her options are myomectomy surgery to remove the tumors from the uterus, embolization that cuts off the blood supply to fibroids, and myolysis that uses an electric shock to shrink the fibroids.

    Other but rarer forms of uterine problems involve the uterine structure. Some women are born with misshaped uteri, such as with a uterus didelphys where the uterus has two inner cavities. Each may lead to a separate cervix and vagina. This means a woman with this condition has two cervices and two vaginas.Another uterine abnormality is a bicornuate uterus that looks more like a heart with a deep indentation at the top of the uterus. Women who have these rare conditions often have difficulties conceiving and keeping a full-term pregnancy.

    A more common problem with women is a short cervix. The cervix is the “neck” of the uterus that closes to keep your baby inside. It also dilates so your baby can come out of the uterus. A short cervix means exactly that your cervix is shorter than normal and can't hold a pregnancy to term. It is in the same category as a soft or weak cervix. The medical term is “incompetent cervix.”

    Incompetent cervices are genetic conditions from birth that can be managed with proper medical intervention. If you have an incompetent cervix, your doctor will place a stitch called a cerclage in your cervix until the 37th week of your pregnancy to keep the cervix closed.

    She or he will also advise you to remain in bed and not have sex for what is called a “pelvic rest.” The best time for a cervical cerclage is in the third month of pregnancy. However, some women may need a cerclage later in pregnancy. This is called an emergent cerclage when the cervix opens too early without warning. Future pregnancies will often require a cervical cerclage.

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    Toxic Substances

    While genetic and physical reasons for premature labor are uncommon, lifestyle changes can help you avoid preterm birth. The top factors women can control to help prevent premature labor and birth are quitting smoking, stopping alcohol consumption, and not abusing drugs.

    The toxins from smoking, drinking alcohol, and abusing drugs can all cross through to the placenta and harm the developing baby. Women who smoke, drink alcohol or take illegal drugs are at a greater risk of miscarriages, stillbirths, premature labor, and preterm births.

    More importantly, children born to women who have substance abuse problems have greater risks of mental and physical developmental delays. Alcohol, for example, is a toxin that can destroy an unborn baby's liver and brain.

    The Centers for Disease Control (CDC) has recently come out with a statement that women of childbearing age should absolutely stop drinking alcohol if they intend to become pregnant. Women should use birth control to prevent pregnancy if they do not intend to become pregnant.

    Alcohol and pregnancy, according to the CDC, is not only costly in terms of lives; the care of children born with FASDs costs financially on both a personal and a national level. The lifetime cost of caring for a child with FASD is $2 million, with the national cost being close to $6 billion. Heeding the CDC's warning on alcohol and pregnancy is essential to preventing premature labor, preterm birth, and alcohol-related birth defects.

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    Sexually Transmitted Diseases

    It is critical for both you and your partner to be tested for sexually transmitted diseases (STDs) before you begin an intimate relationship. STDs can be transmitted from one sexual partner to the other regardless of gender.

    If you are planning to get pregnant or you are already pregnant, you need to be tested forSTDs. Sexually transmitted diseases include chlamydia, hepatitis B, human immunodeficiency virus (HIV), genital herpes, syphilis, bacterial vaginosis (BV), gonorrhea, trichomoniasis, and genital warts. STDs are associated with miscarriages, stillbirths, and premature labor.

    The CDC has recently announced that the Zika virus is sexually transmitted. Use precautions such as condoms when having sex with someone who has visited Zika-affected areas. Zika has been linked to maternally-transmitted microcephaly which is an abnormal smallness of the baby's head at birth. It’s also been linked to Guillain-Barré Syndrome, a disorder where the body's immune system attacks part of the peripheral nervous system.

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    You can prevent several diseases with vaccination. Being vaccinated before pregnancy is essential to prevent premature birth and birth defects. Women should get the measles, mumps, and rubella (MMR) vaccinations before they become pregnant. You should wait at least one month after this vaccination before becoming pregnant. If a rubella test shows you are not immune to rubella, wait until you have had your baby to get the vaccine.

    You should also have a varicella (chickenpox) shot if you have not had the disease. You should wait one month after the shot to attempt pregnancy. Other vaccines you should have before or after pregnancy are oral polio, hepatitis A, pneumococcal, and HPV.

    Vaccines that are safe for women to have during pregnancy are hepatitis B, the inactivated form of the influenza (flu) vaccine and the Tdap (tetanus/diphtheria/pertussis) vaccine.

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    Another factor in preterm births is weight. Women who are overweight or underweight have premature labor and birth risks. It is important to talk to your health care provider about a healthy pregnancy weight before you try to become pregnant.

    Women who are underweight are at risk for low birth weight babies, but not at risk for other maternal complications. Overweight women risk heart disease, gestational diabetes, and preeclampsia. Preeclampsia is a condition that may include high blood pressure and protein in the urine, preceded by gestational hypertension.

    Mild preeclampsia symptoms are high blood pressure, water retention, and protein in the urine. Severe preeclampsia symptoms are headaches, inability to tolerate bright light, fatigue, nausea, and vomiting, blurred vision, not being able to urinate, pain in the upper right abdomen, shortness of breath, and a tendency to bruise easily.

    Contact your health care provider immediately if you have any of these symptoms during pregnancy. Your health care provider at every stage of your pregnancy is your best adviser to prevent premature labor.

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