Not all pregnancies go as planned so its important to be prepared.

Pre-term birth       
Babies born before 37 completed weeks of pregnancy are considered to have been born prematurely— about ten percent of pregnancies are preterm. Eighty percent of premature babies survive with no long-term effect.

Those at the most risk are those who are born extremely early—less than 27 weeks gestation—and have extremely low birth weight.

Causes of Pre-term labour             
The cause of pre-term labours is unknown. However, there are some conditions that are known to increase the risk of per-term labour:

• Maternal conditions, such as diabetes or haemorrhage
• Premature rupture of the amniotic sac (the bag of fluid surrounding the fetus)
• Multiple pregnancy (twins, triplets)
• Heavy smoking during pregnancy
• Alcohol or drug abuse
• Adolescent pregnancy
• A previous premature labour

Discuss you concerns with your doctor and/ or nurse, as these concerns are generally unfounded.

Know your body     
Early detection can lead to actions that may prevent an early delivery. Many of the signs of early labour are subtle; so get to know your body and understand what is normal for you. Learn the symptoms listed below and do not hesitate to contact your caregiver if you have any concerns.

Symptoms of early labour  

• Uterine contraction (these may be painless) that occur at frequent intervals (more than four per hour or less than 15 minutes apart)
• Menstrual-like cramps
• Dull pain in the back not helped by a position change
• Pelvic pressure
• Persistant diarrhea
• Increased vaginal discharge, especially if pink, green or bloody

Do not ignore these signs. Contact your physician or go immediately to a hospital for an assessment.

Preventing premature delivery    
If your contractions are not too advanced and your cervix has not dilated too much, there is a chance that labour can be stopped

·       Bedrest controls pre-term labour in 50 percent of cases

o      Complete bedrest means going to bed and staying there in a flat position

o      Partial bedrest allows a woman to get up for a few hours during the day

o      Sometimes a woman is admitted to the hospital for bedrest and sometimes this can be accomplished at home.

Coping with bedrest: 

·       Accept all offers of help

·       Consult a social worker for assistance in applying for sick leave or discuss the situation with your employer

·       Learn how to meditate to decrease stress

·       Concentrate on the reason you’re doing this

Medications may be used if bedrest alone does not control labour, but you’ll need to discuss these with your doctor. These drugs have been effective in some instances in preventing pre-term birth.

Other conditions      
There are instances other than premature labour that can lead to the early delivery of an infant:

·       Maternal conditions that can lead to uterine infection such as:

o      diabetes

o      high blood pressure

o      premature rupture of membranes

·       Fetal conditions include:

o      lack of growth

o      fetal distress

Once identified, you will be carefully monitored by your physician. It may be decided that is in your or your baby’s best interest to be delivered early.

Pre-term Delivery    
Both you and your partner will experience a variety of emotions when delivering a premature baby. Share your emotions with your partner. Join a parent support group to meet with other parents who are experiencing the same emotions and who have had a premature baby.

Post-term births    
As the projected due date approaches and then passes, most women get anxious. For a small percentage of women who go past their due date, their physician will carefully reassess the information at hand. A recalculation of due date often shows that the baby is not overdue, but that the date was incorrect. However, any pregnancy that truly continues for more than 42 weeks is known as a post-term pregnancy. This condition affects approximately eight to eleven percent of pregnant women.

Induction                
Induction can be accomplished in a variety of ways:

·       Breaking the membranes surrounding the amniotic fluid

·       Intravenous administration of oxytocin which stimulates contractions

Susan Inwood is a Clinic Nurse in the Neonatal Follow-up Clinic at Mount Sinai Hospital and The Hospital for Sick Children, in Toronto.