In October, I outlined the nature of premature labor—what it is and how to recognize the signs and symptoms. I also discussed the methods health care providers employ to correctly identify premature labor and some of the primary methods to stop labor.
If these initial treatments of bed rest, pelvic rest, and hydration do not stop labor-inducing contractions, further treatment may be required. Your health care provider will take many factors into consideration when deciding when and how to intervene to try and stop labor and prevent a premature birth.
Stopping early labor can greatly benefit an infant’s health but many variables must be considered when deciding how and when to stop labor including the health of both mother and baby. The unique nature of pregnancy requires that a health care provider simultaneously treat two patients at once, and this is particularly evident in the treatment of premature labor. Balancing the health of mother and infant can often make treatment of premature labor a delicate situation.
Contractions that cause the cervix to thin and dilate more than 2 centimeters between the 23rd and 37th week of pregnancy is considered premature labor. Whether to stop labor will depend of the baby’s age and weight and the health of the mother. Ideally, the longer a fetus has to develop and mature in-utero, the healthier he or she will be at birth and after. Labor is not stopped before 23 weeks because survival is unlikely. Premature labor after 34 weeks may also not be stopped because statistically these babies do quite well with current neonatal interventions available today. This middle ground between 23 and 34 weeks is where the health of mother and baby is evaluated to come up with the best-case scenario.
Health care providers will use several diagnostic tools to try and measure the maturity of a fetus, including fetal monitoring, ultrasound, amniocentesis, and blood tests to help estimate the age and weight of the baby. These tests can also help to determine whether the premature labor is putting stress on the baby. Sometimes, if the stress is great, it is better to deliver than to try to stop labor.
In some instances, delaying labor for just a few hours can be enough to insure that delivery will occur at a hospital with a neonatal intensive care unit (NICU). Healthcare providers are also concerned about the infant’s lung maturity and may give a mother glucocorticoid injections, such as betamethasone or dexamethasone, to help the fetus produce surfactant. These steroids, given preferably 24 to 48 hours prior to delivery can help with infant breathing and may reduce the incidence of respiratory distress.
Besides the infant’s health, providers must also weigh the health concerns of mother. Premature labor may be brought on by health problems of pregnant women such as hypertension in pregnancy and its related conditions: severe pre-eclampsia and HELLP syndrome. Likewise, women who experience complications from chronic conditions like diabetes, severe asthma, heart conditions, and infection among others may also need to deliver rather than risk complications from stopping labor.
Once a decision has been made to try to stop labor, several options are available and each depends on the suspected reason for the premature labor. If it is believed that premature labor is a result of an underlying infection, antibiotics may be given to clear up an infection as in the case of urinary tract infections. Antibiotics will also be given if a woman experiences premature rupture of membranes during premature labor. Treatment can help limit the risk of developing infections, which can risk the health of both mother and baby.
Other medications that can be given include tocolytic agents such as terbutaline, Indomethacin, or Nifedipine, which are given by injection or intravenously to slow uterine contractions during preterm labor. These medications work to relax the smooth muscles and blood vessels of the uterus. Generally, these mediations work for a short time and generally their effectiveness wanes over time. Sometimes, these medicines can stop labor long enough to intervene with other treatments like the corticosteroids previously discussed.
Women who have previously delivered a premature child are considered high risk for a subsequent premature labor event. These women may benefit from a progesterone treatment plan beginning in the fourth month of pregnancy. Studies have recently shown that these high-risk women, when treated with progesterone, carried a subsequent fetus longer. Another prophylactic technique used to prevent premature labor is the cervical cerclage, which is the stitching of the cervix to keep it closed. This procedure is usually done between 12 and 14 weeks preventively or later in the case of an emergency. While not usual, this is an option for women who may have an incompetent cervix as a result of defect or damage to the cervix to possibly prevent premature labor.
For many decades, preterm labor was treated with “strict bed rest” most likely because few other options were available. Studies have shown that long term bed rest does not lower the risk of premature labor and may pose a risk of blood clots for pregnant women. That said, health care providers may advise what is called expectant management, where a pregnancy is closely monitored for problems. Expectant management may occur at home or in a hospital setting and may involve stopping work, limiting activities, and spending varying amounts of time resting.
Luckily, premature labor only affects around 12 percent of pregnancies. Of course if you are in that 12 percent it can be tremendously frightening. Knowing the early warning signs, communicating with your health care provider, and maintaining a positive attitude will carry you and your baby far if you experience preterm labor. The fields of obstetrics and neonatalogy have made remarkable strides over the past few decades to ensure that even the earliest babies have a fighting chance to grow up healthy and strong.