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.