If you go into labour earlier than you had expected, you'll have to think on your feet. However, fewer than 20 percent of cases of suspected premature labour actually result in the baby being born. In the remaining 80 percent, the symptoms turn out to be something else, or the contractions simply stop of their own accord and the baby is delivered later in the pregnancy, or at term.
If you're in any doubt, phone the hospital or midwife straight away for advice. If you are less than 37 weeks pregnant they will usually tell you to go straight to hospital, and they may send an ambulance for you.
What are the signs of premature labour?
If you have any of the following symptoms, phone the hospital or midwife straight away, as you could be in labour:
- either a slow trickle or a gush of clear or pinkish fluid from your vagina or any increase in vaginal discharge
- cramps like strong period pains
- a frequent need to urinate
- a feeling of pressure in your pelvis
- nausea, vomiting or diarrhoea.
Don't delay if you have strong pain, a smelly discharge or bleeding from your vagina, or if you are feeling feverish, sick or have a temperature, call immediately as you may need urgent medical attention.
What happens when you are showing signs of labour?
You may have some of the symptoms but not others. For example, your waters may have broken but with no contractions, or vice versa. Contractions don't always indicate that you're in labour, so the healthcare team will carry out checks to find out.
Many women experience Braxton Hicks, sometimes known as practice contractions. These can become quite strong and painful during the third trimester, and it's easy to mistake them for the real thing.
The healthcare team will check
- whether you are actually in labour
- if labour hasn't started, whether your symptoms are due to some other cause that needs treating
- if you are definitely in labour, whether this has been caused by something (such as an infection) that needs treating, and how far the labour is progressing, so they can line up the facilities you need, either to delay the birth or to deliver the baby.
If your waters have broken early (Preterm premature rupture of the membranes - PPROM)
It is possible for your waters to break without any contractions. Where this happens early, it is known as preterm premature rupture of the membranes (PPROM).
How will I know if my waters have broken?
You will notice either a gush or a slow trickle of watery fluid, which is often pinkish or clear in colour.
The healthcare team will examine you. If you are not having contractions, and if you and the baby are otherwise healthy, they may treat you with antibiotics to prevent infection and help you continue the pregnancy for as long as possible.
You may also have the following tests:
- Blood tests. These check for high levels of white blood cells (which can indicate that you're fighting off an infection) and haemoglobin levels (which could indicate haemorrhage), along with other tests for inflammation.
- Urine samples. These enable the healthcare team to check for urinary tract infections and conditions such as pre-eclampsia.
- Your baby's heart rate. This will be monitored regularly. If it is unusually fast, this may be a sign of chorioamnionitis, which can be life-threatening to you and the baby. In this case, your baby may need to be delivered as soon as possible, often by caesarean.
If your waters haven't broken
The healthcare team will examine you to see if they can feel the contractions. This will include an internal examination to check whether the cervix is changing. If they think you are having contractions, you may then have a fetal fibronectin test to see if your body is preparing to give birth and an ultrasound scan to check the length and shape of your cervix. Fibronectin is a substance found in the amniotic fluid and vaginal secretions. It is only present in the vaginas of women up to 20 weeks or over 35 weeks pregnant, or whose bodies are getting ready to give birth.
These can be good predictors that labour is imminent. The team will probably also do some blood and urine tests. If you have symptoms of infection, or are considered high risk, they may also take swabs for infections such as bacterial vaginosis and group B streptococcus.
Tests for your baby
As well as carrying out various tests on you, the healthcare team will need to assess how your baby is doing. They will check his heartbeat and may also:
- run a scan to check his weight
- carry out electronic fetal monitoting to check his heart rate
- perform a scan to check that the placenta is functioning normally.
In labour or not... what happens next
Even if it is a false alarm, the team may want to keep you in hospital to monitor you and your baby.
If you are in labour and less than 35 weeks pregnant, they may try to stop the contractions, or to slow down the birth enough to give you injections of steroids to help your baby breathe when he is born. Find out more here about what happens if you are definitely in labour.
If you are 35 weeks or over, the team will usually let the birth go ahead.
Removing a stitch (cerclage) if you have one
If you have had a cervical stitch (cerclage), you will need to have it removed before your baby is born, as there is a risk of it tearing if it is still in place while you are having contractions. If you don't go into labour early, the stitches will usually be removed at between 36 and 40 weeks.
Frequently asked questions about premature labour and birth
Moving you both to a specialist neonatal unit may be the safest option if your baby is likely to be born very prematurely. This is known as 'in utero transfer' as they are effectively making sure your baby is in the best place for her care while she is still in your womb.
Giving birth is one of the most life-changing experiences you'll ever have, but it doesn't always go as planned, especially when your baby is premature.
- BAPM (2008) Management of acute in-utero transfers: a framework for practice. London, British Association of Perinatal Medicine
- Giraldo-Isaza MA BV (2011) Cervical cerclage and preterm PPROM, Clinical Obstetrics and Gynecology, Vol 54, No 2, p313-20
ℹLast reviewed on July 1st, 2014. Next review date July 1st, 2017.
By Anonymous (not verified) on 12 Feb 2017 - 08:38
Hi I'm 30 +2 weeks pregnant I'm getting sharp pains and it feels like something is stabbing me and I have been dripping for about 2 weeks now what does it mean
By Midwife @Tommys on 13 Feb 2017 - 09:10
As a matter of urgency, you need to be seen at your local labour ward/ triage to be reviewed by a midwife and an obstetric doctor. Sharp abdominal pains at any stage of pregnancy needs to be reviewed urgently. In addition, you say you have been "dripping for about two weeks now", if your waters have broken or you are bleeding and you have not been seen in this time, you really do need to get yourself into hospital with your pregnancy notes very urgently.
Take care of yourself!
By Anonymous (not verified) on 6 Feb 2017 - 20:08
Hi bit gross but have some serious pains in my bottom. Only 23 weeks pregnant but not sure if its contractions or constipation. Can anyone advise. Feel the need to push but scared incase it's the baby
By Midwife @Tommys on 7 Feb 2017 - 15:11
Congratulations on your pregnancy!
It does sound like you may have constipation which is causing you the pain in your bottom. You can become constipated very early on in your pregnancy due to the hormonal changes in your body.
there are ways for you to safely treat constipation without harming you or your baby. Your GP will first advise you to change your diet by increasing fibre and fluid intake. You'll also be advised to do gentle exercise.
If dietary and lifestyle changes don't work, you may be prescribed a laxative safe to take in pregnancy to help you pass stools more regularly.
If however the pain becomes severe or changes, or you begin to experience any other symptoms such as bleeding or cramps, please contact you local maternity unit urgently.
By Anonymous (not verified) on 3 Feb 2017 - 21:48
Hi i am 33 + 6 and I have been so unwell I have had a swab done for infection as u have loads of discharge but nothing has come back over it but I'm now at the point where I have constant lower back ache every now and then it's a sharp pain. I have Braxtons hicks alot that don't stop when changing what I'm doing. But still really irregular. And now I'm feeling like my skin is extremely irritable and have been sick. I haven't really had morning sickness at all but last couple of days have been really bad and just not wanting to eat just drinking loads of ice cold water. I just don't know what to do.
By Midwife @Tommys on 6 Feb 2017 - 10:27
It really does sound as if you need to take yourself (and your pregnancy book)into your local labour ward/triage/day assessment unit for review by a midwife and/or obstetric doctor.
Discharge can be normal in pregnancy, but paired with your extreme nausea, back pain, feeling irritable and generally unwell, it sounds as if you need to be checked over to ensure that there isn't something more serious underlying.
They may need to take some blood tests and monitor your baby on CTG.
Please take care of yourself.
By Anonymous (not verified) on 30 Jan 2017 - 00:20
I've been getting dull period pains for the past couple of days and have felt nauseated a lot. I have constant pressure in my pelvis/vagina area which sometimes makes it hard to walk. My heartburn and restless leg syndrome has gotten worse and I have been getting sharp pains in my side. I have a midwife appointment on the 2nd so not sure whether to just wait till then or to call the triage ward today?
By Midwife @Tommys on 30 Jan 2017 - 09:15
Hi Tara. I would strongly advise you to go into your local labour ward/triage to be checked over as soon as possible today. It is possible that you are going into labour - the dull period like pains and pressure in your pelvis could be small signs of this. There is a possibility that it is not labour and something else that needs to be reviewed. No need to panic, but a review would certainly be sensible. Restless legs and heartburn are fairly common in pregnancy, but should improve once the baby is born.
Look after yourself!
By Anonymous (not verified) on 28 Jan 2017 - 03:29
I am 26weeks and have really bad sharp pains in my rear end and my lower front what does that mean?? And this is my first pregnancy
By Midwife @Tommys on 30 Jan 2017 - 09:10
Any pains in your abdomen (lower front) at any gestation of pregnancy, would need to be investigated as soon as possible at your local labour ward triage by a midwife/obstetric doctor. As regards the pains in your rear end, it would also be worth getting that checked out too. Please take care of yourself
By Anonymous (not verified) on 19 Jan 2017 - 21:55
I'm 38 weeks with my second, I have a lot of nasty pressure in my bum and front parts , I keep getting sharp stabbing pains in my sides and I have been suffering from nasty cramps in my thighs and legs for a few days now, I also have had quite an increase in discharge which is clear and had had no smell , should I go get checked ?
By Midwife @Tommys on 20 Jan 2017 - 10:33
Hi, If you have not already, I think it is important to speak to your midwife or ring your maternity unit. If you are having sharp stabbing pains in your sides then it would be advised for you to go and get checked out. If you have any bleeding or any concerns about your baby's movements then please go to the maternity unit straight away.
By Anonymous (not verified) on 16 Jan 2017 - 11:32
I have sharp pain in my stomach, am using the bathroom more often with diareaha, have felt sick with a fever, and it feels funny in my vaginal area pressure like and am having lower back pain. please can anyone tell me if these are sighns of me getting ready to go into labor or if I am in labor?
By Midwife @Tommys on 16 Jan 2017 - 11:51
Any abdominal pains in pregnancy, at any geatation, needs to be investigated as a matter of urgency at your nearest hospital labour ward/triage. Having a fever/temperature could be the cause of a bug/virus, but it can also be a sign of infection too, which may or may not need urgent treatment with antibiotics.
Feeling pressure in the vagina and lower back pain can be a sign of a urinary tract infection, which would also require antibiotic treatment.
You will need to be assessed as soon as possible today to determine why this is happening. Please take care of yourself and bump!
By Midwife @Tommys on 5 Jan 2017 - 15:08
I would advise that you see your GP or midwife as soon as possible. It may be that you have a urinary tract infection which in pregnancy should be treated with antibiotics. If you are unable to get an appointment today you should call your delivery suite where you are booked and ask for advice.
By Anonymous (not verified) on 4 Jan 2017 - 19:47
What does it mean when i jave rly bad sharp pains and constantly feel like i have to pee after i already went and i am only 25 weeks and four days