What to expect when you're expecting (212 page)

What are the signs and symptoms?
Signs of premature labor can include all or some of the following:

Menstrual-like cramps

Regular contractions that intensify and become more frequent even if you change positions

Back pressure

Unusual pressure in your pelvis

Bloody discharge from your vagina

Rupture of membranes

Changes in the cervix (thinning, opening, or shortening) as measured by ultrasound

What can you and your practitioner do?
Because each day a baby remains in the womb improves the chances of both survival and good health, holding off labor as long as possible will be the primary goal. Unfortunately, however, there isn’t much that can be done to stop early labor. The measures that were once routinely recommended (bed rest, hydration, home uterine activity monitoring) don’t seem to work to stop or prevent contractions, though many doctors still prescribe them. Other steps your practitioner may advise if you’re experiencing early contractions include progesterone supplementation to decrease uterine activity (usually reserved only for women with a prior preterm delivery or with a short cervix who are not carrying multiples or receiving tocolytics); antibiotics (if a GBS culture—see
page 326
—is positive); or tocolytics (that can temporarily halt contractions, and give your practitioner time to administer steroids to help your baby’s lungs mature more quickly, so that he or she will fare better should a preterm birth become inevitable or necessary). If at any point your practitioner determines that the risk to you or your baby from continuing the pregnancy outweighs the risk of preterm birth, no attempt will be made to postpone delivery.

You’ll Want to Know …

A baby born prematurely will likely need to spend time in a neonatal intensive care unit (NICU) for the first few days, weeks, or, in some cases, months of his or her life. Though prematurity has been linked to slow growth and developmental delays, most babies who arrive too early catch up and have no lasting problems at all. Thanks to advances in medical care, your chances of bringing home a normal, healthy infant after a premature birth are very good.

Can it be prevented?
Not all preterm births can be avoided, since not all are due to preventable risk factors. However, all the following measures may reduce the risk of preterm delivery (while boosting your chances of having the healthiest pregnancy possible): taking folic acid before pregnancy; getting early prenatal care; eating well (and getting enough vitamins, especially vitamin D); getting good dental care; avoiding smoking, cocaine, alcohol, and other drugs not prescribed by your doctor; getting tested for and, if necessary, treated for any infections such as BV and UTIs; and following your practitioner’s recommendations as to limitations on strenuous activity, including sexual intercourse and hours spent standing or walking on the job, especially if you have had previous preterm deliveries. The good news is that 80 percent of women who go into preterm labor will deliver at term without any interventions at all.

Predicting Preterm Labor

Even among women who are at high risk for preterm labor, most will carry to term. One way to predict preterm labor is to examine cervical or vaginal secretions for a substance known as fetal fibronectin (fFN). Studies show that some women who test positive for fFN stand a good chance of going into preterm labor within one to two weeks of the test. The test, however, is better at diagnosing women who are not at risk for going into preterm labor (by detecting no fFN) than as an accurate predictor of women who are at risk. When fFN is detected, steps should be taken to reduce the chances of preterm labor. The test is now widely available, but is usually reserved for high-risk women only. If you aren’t considered high risk for preterm birth, you don’t need to be tested.

Another screening test is one for cervical length. Via ultrasound before 30 weeks, the length of your cervix is measured to see if there are any signs that the cervix is shortening or opening. A short cervix puts you at an increased risk of going into early labor, especially if it began shortening early in pregnancy.

What is it?
Symphysis pubis dysfunction, or SPD, means the ligaments that normally keep your pelvic bone aligned become too relaxed and stretchy too soon before birth (as delivery nears, things are supposed to start loosening up). This, in turn, can make the pelvic joint—aka the symphysis pubis—unstable, causing mild to severe pain.

How common is it?
The incidence of diagnosed SPD is about 1 in 300 pregnancies, though some experts think that more than 2 percent of all pregnant women will experience SPD (but not all will have it diagnosed).

What are the signs and symptoms?
The most common symptom is a wrenching pain (as though your pelvis is coming apart) and difficulty when walking. Typically, the pain is focused on the pubic area, but in some women it radiates to the upper thighs and perineum. The pain can worsen when you’re walking and doing any weight-bearing activity, particularly one that involves lifting one leg, such as when you’re climbing up stairs, getting dressed, getting in and out of a car, even turning over in bed. In very rare cases, the joint may gape apart, a condition called diastasis symphysis pubis or symphyseal separation, which can cause more serious pain in your pelvis, groin, hips, and buttocks.

What can you and your practitioner do?
Avoid aggravating the condition by limiting weight-bearing positions and minimizing as best you can any activity that involves lifting or separating your legs—even walking, if it’s very uncomfortable. Try stabilizing those floppy ligaments by wearing a pelvic support belt, which “corsets” the bones back into place. Kegels and pelvic tilts can help to strengthen the muscles of the pelvis. If the pain is severe, ask your practitioner about pain relievers or turn to CAM techniques, such as acupuncture or chiropractic.

Very rarely, SPD can make a vaginal delivery impossible and your practitioner may opt for a C-section instead. And in even rarer cases, SPD can worsen after delivery, requiring medical intervention. But for most moms, once your baby is born and production of relaxin (that ligament-relaxing hormone) stops, your ligaments will return to normal.

What is it?
Once in a while, the umbilical cord becomes knotted, tangled, or wrapped around a fetus, often at the neck (when it is known as a nuchal cord). Some knots form during delivery; others form during pregnancy when the baby moves around. As long as the knot remains loose, it’s not likely to cause any problems at all. But if the knot becomes tight, it could interfere with the circulation of blood from the placenta to the baby and cause oxygen deprivation. Such an event happens only rarely, but when it does, it is most likely to occur during your baby’s descent through the birth canal.

How common is it?
True umbilical cord knots occur in about 1 in every 100 pregnancies, but only in 1 in 2,000 deliveries will a knot be tight enough to present problems for the baby. The more common nuchal cords occur in as many as a quarter of all pregnancies but very rarely pose risks to the baby. Babies with long cords and those who are large-for-gestational age are at greater risk for developing true knots. Researchers speculate that nutritional deficiencies that affect the structure and protective barrier of the cord, or other risk factors, such as smoking or drug use, carrying multiples, or having hydramnios, may make a woman more prone to having a pregnancy with a cord knot.