Leading Sydney Gynaecologist and Obstetrician

Labour is the process by which the uterus contracts and causes the cervix to open and prepare for delivery. Preterm labour occurs when this process takes place prior to your 37th week of pregnancy. These changes can be difficult to detect. Your role in the early identification of labour is to monitor your uterine contractions and report the signs and symptoms of preterm labour to our doctors and nurses.

The cause of preterm labour is not completely understood. However, it is known that certain situations are associated with preterm labour and may increase your risk of experiencing a preterm delivery. The most common factors associated with preterm labour include; a current pregnancy of twins or triplets, and/or having experienced a prior preterm delivery.

At this time Preterm labour cannot be prevented. We can only do the next best thing - identify it early and treat it effectively to help prolong the pregnancy. Early recognition of the signs and symptoms of preterm labour can help us better manage your pregnancy.

We feel that because you are the only person who can be aware of your body`s normal activity, you should be the one to identify anything that is not normal including the early signs and symptoms of preterm labour.

• Occasional uterine contractions
• Backache as your baby grows and causes your posture to change.
• Pressure as your growing baby presses on your pubic bone and your legs
• Pulling and stretching of muscles as the uterus grows that may cause pain

• Regular uterine contractions
• Rhythmic, lower abdominal cramps
• Persistent low, dull backache that feels different that what you normally experience
• Persistent diarrhoea or intestinal cramps
• Unusual rhythmic or persistent pelvic pressure
• A large amount of mucous or water leaking from the vagina
• A change in colour of vaginal discharge to pink or brown

Remember it is important to know what is normal for you. Then you will know how to identify what is NOT normal.

The following are signs and symptoms that are associated with preterm labour. However, these signs can also be a part of a normal healthy pregnancy. What you need to keep in mind is what may represent a change from your normal patterns and experiences:

• Uterine contractions

The uterus (womb) is composed of muscle fibres. A uterine contraction is the tightening of the muscles within the uterus. Using your fingertips to feel your uterus, you should be able to slightly indent your uterus when it is relaxed. During a contraction you can feel your uterus tighten and become hard. Contractions occur normally throughout pregnancy. They are usually painless and they can occur at any time. Certain activities such as changing your position or having a full bladder may cause you to have a contraction.

• Menstrual-like cramps

These are felt low in the abdomen, just above the pubic bone. The cramping may be rhythmic, feeling like waves or fluttering. You may also feel a constant cramp.

• Lower, dull backache

This backache is located mainly in the lower back and may radiate to the sides or front. It may be rhythmic or constant. And often is not relieved by changing position.

• Pelvic pressure

 You may feel pressure or fullness in the pelvic area, in your back or thighs. It may feel as though the baby is going to 'fall out'.

• Intestinal cramps

These may occur in the presence or absence of diarrhoea. You may have the feeling of 'gas pains'.

• Increase or change in vaginal discharge

The amount may be more than that which is normal for you. The consistency may change to mucous or watery. The colour may become pink or brown-tinged.

• A general feeling that something is not right

Even without a specific cause.

If you experience any of the above, or if you feel something is different, contact our office.

If our doctors and nurses believe that you are experiencing any of the early warning signs and symptoms of preterm labour, or are at-risk of experiencing preterm labour, you may be asked to do the following:

• Increase your rest

 Resting on your side is a helpful way to keep your uterus relaxed. Also elevating your bed so that your hips are slightly higher than your head will keep the pressure of the baby off your cervix.

• Maintain adequate fluid intake

During your pregnancy, it is important to drink 6 to 8 glasses of fluid per day or as otherwise directed by our doctors and nurses.

• Bed rest

Our doctors and nurses may ask you to take rest periods during the day, or stay in bed all day except for getting up to go to the bathroom and sitting up for meals.

• Decrease strenuous activity

Our doctors and nurses may ask that you do not do any heavy physical activity such as jogging, running, tennis or frequent trips up and down stairs. Our doctors and nurses may also limit heavy lifting, cleaning, and long trips.

• Consider a temporary change in work activities

Work activities may need to be changed or stopped. Our doctors and nurses will tell you about decreasing your activity and what they feel would be best for you.

• Sexual activity

Our doctors and nurses may ask that you stop or limit your sexual activities.

• Be aware of your uterine activity using one or more available methods (ask our doctors and nurses which method is most appropriate for your situation):
  • Use of Self-palpation

You can check for contractions after the 20th week of pregnancy by emptying your bladder and drinking a glass of water. Lie down on your left side. Use pillows to help support yourself so you can find a comfortable position. Do not lie flat on your back. Place your fingers on your stomach on either side of your belly button. Wait for your uterus to contract or tighten. During a contraction, your uterus will feel hard like your forehead. Use a watch to see how long the contraction lasts. After the contraction, your uterus will relax and you can press into it with your fingertips. If you have 4 or more contractions in an hour, call our office right away. Contractions occur normally throughout pregnancy. They are usually painless and they can occur at any time. If you are having difficulty feeling contractions, you may not be having contractions or you may not be aware they are occurring.

• Use of a small recording device similar to the one used in the hospital labour and delivery unit

An electronic monitor may be used in certain situations to help you and our doctors detect the contractions that may be associated with preterm labour. You will wear a belt around your stomach for an hour, most likely twice a day. The belt has a sensing device, which is attached to a small recorder. If you have a contraction while you are wearing the belt, the sensing device records the information about your contraction. Once each day you will be asked to send any information that has been recorded across your telephone line to a monitoring centre so the information can be provided to our doctors and nurses.

Always remember to follow our doctors and nurses instructions about your prenatal care and activities.

What to do if you think you are experiencing preterm labour:

• Call our office
• Go to the bathroom and empty your bladder
• Check to make sure you have not missed a dose of any medication you might be taking
• Maintain adequate fluid intake as instructed by our doctors and nurses
• Rest, lying down on your left side
• Monitor you uterine activity

Content kindly provided by Matria HealthCare.