Preterm labour: the signs that mean hospital now

The signs

Before 37 weeks, any of these needs same-day assessment: regular tightenings that come at intervals and keep coming (whether painful or not), period-like cramping, a dull low backache that comes in waves, pelvic pressure as though the baby is pushing down, and increased or changed vaginal discharge.

And these mean going to hospital immediately: any bleeding, a gush or steady trickle of watery fluid (waters breaking), severe abdominal pain, or reduced fetal movements.

The distinguishing feature of practice contractions (Braxton Hicks) is that they are irregular, do not build, and ease with rest, water and a change of position. Anything rhythmic that persists is not practice, and at this stage the cost of checking unnecessarily is very low.

Who is at higher risk

Previous preterm birth is the strongest predictor. Others: twins or triplets, a short cervix found on scan, infections (particularly urinary and vaginal infections, which are treatable), high blood pressure or pre-eclampsia, diabetes, bleeding in pregnancy, and a very short gap since the last pregnancy.

Also: anaemia and undernutrition, heavy physical work, smoking and tobacco use including chewed tobacco, and — worth naming in the Indian context — untreated dental infection and severe anaemia, both common and both correctable.

If you have any of these, ask your obstetrician directly what your monitoring plan is. Cervical length measurement, progesterone treatment or a cervical stitch are options in specific situations, and they work best when planned early rather than in an emergency.

What hospitals can do

Steroid injections to the mother — usually two doses 24 hours apart — dramatically accelerate the baby's lung maturity and reduce breathing problems, brain bleeds and death in babies born preterm. This is the single most valuable intervention, and it is why reaching hospital before delivery matters so much.

Medicines to delay labour (tocolytics) can buy 48 hours — enough for the steroids to work and for transfer to a hospital with newborn intensive care if needed.

Magnesium sulphate given before very preterm birth protects the baby's brain. Antibiotics are given if the waters have broken to reduce infection risk.

Transfer before birth to a facility with a NICU is far better for the baby than transferring afterwards. If you are at a hospital without newborn intensive care and preterm labour is confirmed, ask about transfer.

When to see a doctor

Go to hospital immediately, before 37 weeks, for: regular contractions or tightenings, cramping or wave-like backache, pelvic pressure, any bleeding, any watery leaking, severe abdominal pain, fever, or reduced fetal movements. Use 108 for an ambulance if you do not have transport — this is exactly what it is for.

Do not wait for morning, do not wait to see if it settles, and do not let anyone talk you into waiting. Every hour before delivery counts if the steroids can be given.

This article is general information, not medical advice, and is no substitute for personal medical advice. For any decision about your or your child's health, please consult your doctor.

Frequently asked questions

Q: I went in twice and it was a false alarm both times. Should I stop going? — No. Hospitals would far rather assess ten false alarms than miss one preterm labour, and staff who sound weary are not the point. Keep going.

Q: Can bed rest prevent preterm birth? — Strict bed rest is no longer routinely recommended — it has not been shown to prevent preterm birth and carries its own risks including clots and muscle loss. Follow your own doctor's specific advice for your situation rather than general family instruction to lie down.

Q: What are the chances if my baby is born early? — They improve dramatically with each week. Babies born after 34 weeks usually do very well with modest support; those born earlier need more, and outcomes at Indian NICUs for babies over 28 weeks are now good. See our premature baby guide for what NICU care involves.

Q: I had a preterm birth last time. What can be done differently? — A great deal: early booking, cervical length monitoring, progesterone treatment where indicated, a cervical stitch in some cases, treatment of infections and anaemia, and a plan for delivery at a hospital with a NICU. Raise it at your very first antenatal visit, not in the third trimester.