Medical experts do not know all the reasons why labour may start too early. Preterm labour can happen in any pregnancy, but certain factors can increase the chances of preterm labour for some women.

Women who may be more likely to have a preterm birth:

• Have had a preterm baby before
• Are carrying more than one baby (twins)
• Are smokers
• Are underweight
• Are not getting enough healthy food
• Have a lot of stress in their life
• Have a vaginal or bladder infection
• Have had several miscarriages
• Do strenuous work or have long work hours while standing
• Experience domestic violence/abuse

Signs of Preterm Labour:
It is not always easy for a woman to tell if she is having preterm labour. Many of the signs of preterm labour can feel like some of the normal things that happen in the second half of pregnancy. There are important signs to watch for, especially if they are new or different from before.

Signs & Symptoms of Preterm Labour:

• Bad cramps or stomach pains that don't go away
• Bleeding from the vagina
• A trickle or gush of fluid from the vagina
• Lower back pain/pressure or a change in lower backache
• A feeling that the baby is pushing down
• Contractions or a change in the strength/number of them
• An increase in the amount of vaginal discharge
• A feeling that 'something just is not right'

What to do if you suspect Preterm Labour:
If you have any of the signs of preterm labour, 
GO TO THE HOSPITAL RIGHT AWAY!
You need to be assessed by a doctor/midwife to confirm if you are in preterm labour.
You can call your own doctor or midwife once you get to the hospital. If you cannot drive yourself, ask a neighbour or friend to help. If you cannot get to the hospital right away, call the birthing unit at your hospital for advice. 

Prevention of Preterm Labour:
While it is true that many women without any risk factors will have a preterm baby, there are some things you can do to reduce the chance it will happen to you:

• Start prenatal care with your health care provider as early as possible in the pregnancy and go to every appointment
• Go to Prenatal Classes early in your pregnancy
• If you smoke, quit or at least cut down as much as possible; Avoid second hand smoke
• Take time to rest or put your feet up during the day
• Follow Canada's Food Guide for Healthy Eating
• Try to reduce stress in your life
• If you are in an abusive relationship, talk to someone; Abuse often gets worse during pregnancy. Do what you need to do to protect yourself and your baby.
• Listen to your body - notice when things feel 'different' and talk to your doctor/midwife about it.
• Know the signs of preterm labour and what to do if you have any of them

What happens if I am in preterm labour?

When you arrive at the birthing unit in the hospital, the doctor/midwife will check to see if you are in labour.

If there are no changes or only very small changes in the cervix,

• You will probably get to go home and rest
• Your own doctor/midwife will want to see you soon.

If your cervix has started to open or shorten and the doctor/midwife thinks that you might give birth soon, you will be admitted to the hospital for treatment. (You may have to be transferred to a hospital that provides special care for preterm babies.)

If you are less than 34 weeks pregnant you will probably receive two doses of a medication to help your baby's lungs to mature. This medication works best if it is in your body for 48 hours, so you may also receive another medication to delay or stop the labour for this amount of time.

After this second medication,

• Your body may delay labour on its own for a few weeks
• It is also possible that the labour will only be delayed for a short time and that your baby will be born early.

It is important to get to the hospital early if you are in preterm labour - it can make a big difference to your baby's health.

Adapted from: Best Start Resource Centre & March of Dimes

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Prevention of Low Birth Weight:

• Start prenatal care with your health care provider as early as possible in the pregnancy
• Go to Prenatal Classes early in your pregnancy
• Eat according to Canada's Food Guide for Healthy Eating
• Continue to be physically active, but don't push yourself beyond your comfort level
• Avoid smoking and second hand smoke
• Avoid drinking alcohol; there is no known safe amount or time for alcohol use in pregnancy
• Avoid using street drugs
• Rest when you feel tired; try to get 8 hours of sleep at night
• Try to reduce stress in your life
• Check with your doctor before stopping any prescription medication
• Check with your health care provider before taking any over-the-counter medications or herbal supplements
• If you are in an abusive relationship, talk to someone; Abuse often gets worse during pregnancy - Do what you need to do to protect yourself and your baby.
• Talk with your employer if you feel a change in work assignment is needed
• Learn about the signs & symptoms of preterm labour; know what to do if it happens to you

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Diabetes
A small number of non-diabetic women can develop diabetes during their pregnancy. This is called gestational diabetes. One in 20 women will develop gestational diabetes.

People with diabetes do not produce enough insulin. Insulin is a hormone that is produced in the pancreas. Insulin is needed to take the sugar (from the foods you eat) from your blood and move it into your cells for energy. Hormone changes in the second & third trimesters of pregnancy and the growth demands of the fetus increase a pregnant woman's insulin needs by 2 to 3 times that of normal. If your body cannot make this amount of insulin, sugar will stay in the blood stream. This will cause a high blood sugar level. This is gestational diabetes.

Somewhere between 24 and 28 weeks into your pregnancy, your doctor will most likely send you to be screened for gestational diabetes. This screening test involves drinking a sugary drink and having blood drawn one hour later. The test results determine if everything is normal or if further tests are needed to diagnose gestational diabetes.

If gestational diabetes is left untreated, the fetus will receive too much blood sugar and will grow too large. After birth, the baby may have breathing difficulties, low blood sugar, or jaundice.

In most cases, gestational diabetes is managed by diet and exercise to control blood sugar levels. A small number of women will need insulin to make sure the blood sugar levels stay in the acceptable range. In gestational diabetes, blood sugar levels return to normal after the birth of the baby. Women who have gestational diabetes have a greater chance of developing it again with later pregnancies. They may also develop diabetes later in life.

Adapted from: Health Canada, Canadian Diabetes Association, and March of Dimes

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High Blood Pressure (Pre-eclampsia)

Preeclampsia is high blood pressure that occurs as a result of pregnancy. It is characterized by an increase in blood pressure, fluid retention (swelling), and protein excretion in the urine. About 5% of women will have Preeclampsia. The cause of the disorder is not known.

Diagnosis is based on your blood pressure readings. Because it is difficult to tell if you have high blood pressure, it is very important to schedule and attend all prenatal appointments, even if you are feeling fine.

Delivery of the baby is the only 'cure' for Preeclampsia. Women with mild cases are sometimes treated with bed rest at home or in the hospital, especially if the baby needs more time to mature inside the womb. Preeclampsia is a serious condition if left untreated. It may progress to eclampsia, which is a rare, but more severe condition that can result in injury to both mother & baby. Because of improvements in prenatal care, preeclampsia in being detected sooner and has become easier to control. Once the baby is born, blood pressure generally returns to normal.

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Twins/Triplets or more

You've just found out that there is more than one baby on the way. No doubt there are many feelings of excitement and happiness, but also many of worry and concern. A wide range of emotions is normal when the news is received that there will be more than one baby. A pregnancy with multiple babies is considered a high-risk pregnancy, even though it may progress normally from start to finish. There are special considerations for mothers of multiples.

Following a healthy lifestyle is important for all pregnant women, but those carrying twins may need to pay extra attention to those aspects of the pregnancy. Twin pregnancies have a higher risk of preterm labour, so it is important to know the sign & symptoms and what to do if it happens to you. The discomforts of pregnancy may be more challenging to deal with in a multiple pregnancy. There may be activity restrictions if any problems are encountered as the pregnancy progresses. It is important to discuss concerns and options with your caregiver frequently.

There are several excellent support organizations for families of multiples that can provide education, support and service networks.

http://www.multiplebirthscanada.org/english/index.php
http://www.womenshealthmatters.ca/centres/pregnancy/multiples/index.html