Preterm Labor: What You Need To Know

What is preterm labor?

Pregnancy can feel like a series of weird/annoying/icky physical sensations from headaches to swollen feet. As the weeks go by, you might be introduced to Braxton-Hicks contractions, lower back pain, those round ligaments you never knew you had, and more. The joy of growing your little one isn’t always well, joyful. But it’s important to know when something you’re feeling isn’t just a normal pregnancy challenge and might be a sign of preterm labor. 

Since pregnancy is usually about 40 weeks long, labor is considered premature or preterm when it starts any time before week 37. About 10% of babies in the U.S. are born preterm. Many are perfectly healthy, but some will need special care in a newborn intensive care unit (NICU), and some may be at risk for long-term developmental and health problems. Detecting signs of preterm labor early can be crucial to help your baby stay put and develop as much as possible before birth. 

Talk to your doula about any pregnancy discomfort – nothing is TMI! And always mention new or more intense symptoms since you may need to contact your maternity care provider. 

What are the signs of preterm labor?

Call your OB-GYN or midwife or go to the nearest emergency room if you notice any of these symptoms:

  • Regular contractions or cramps (more than 5 in an hour) that become more frequent or painful and don’t go away with rest
  • Vaginal bleeding or discharge of bloody mucus
  • A sudden gush of fluid, which could be your water breaking
  • Constant low, dull back pain
  • Intense pressure or fullness in your pelvis, like your baby is moving down
  • Stomach cramps with or without diarrhea

What happens if preterm labor starts?

How far along you are in your pregnancy and any health issues you or your baby may have will impact how preterm labor is managed. If your contractions are triggered by dehydration, which is common, or by an infection like a UTI, also common, getting fluids, rest, and antibiotics, if necessary, might be all you need. But there are also medications that can stop labor and other treatment options. 

If the length of your cervix is shorter than usual, making it more likely to open, your OB-GYN or midwife might suggest a procedure called cerclage where the cervix is closed with stitches. Your provider might also recommend pelvic rest, which means putting nothing into the vagina – no sex or vaginal exams – and limiting certain types of exercise. Pelvic rest is not the same thing as bed rest, which used to be the go-to medical advice for preterm labor. There is actually no evidence that strict bed rest lowers the risk of preterm birth, and it can increase the risk of blood clots. 

In some cases, managing preterm labor might only delay birth for a short time. If it’s clear that delivery is coming soon, steroid shots can help your baby’s lungs develop more quickly and reduce the risk of breathing problems.

What causes preterm labor?

Preterm labor can happen during any pregnancy. But there are some factors that mean your risk may be higher. These include:

  • A preterm birth in a previous pregnancy
  • Having a shorter cervix
  • Carrying more than one fetus
  • Complications like diabetes, preeclampsia, or high blood pressure
  • Problems with the uterus, cervix, or placenta
  • Infections, including sexually transmitted diseases
  • Being younger than 17 or older than 35
  • Smoking, alcohol, or drug abuse
  • Being underweight or overweight
  • Less than a 12-month interval between pregnancies

The racism factor

As with a lot of maternal health issues, we have to talk about racism. Medical racism and racism-related stress absolutely play a role in the higher rates of preterm birth among people of color. Black people in the U.S. are 50% more likely to have a preterm birth than white people. And studies show that education and socio-economic status don’t change this disparity. A growing body of research suggests that preterm labor can be linked to the physical and psychological stress of discrimination. From the lack of social support, to the food deserts in Black and Brown communities, to constant overt and implicit racism, this cumulative effect on the health of people of color is known as “weathering.” It produces chronically elevated stress hormones that are physically damaging and can lead to preterm labor. Ensuring that pregnant people of color have access to safe, culturally competent, and trauma informed maternity care has also been shown to reduce rates of preterm birth. 


Like many pregnancy complications, staying in tune with your body can help to avoid or manage preterm labor. Pay attention to any new symptoms and call your OB-GYN or midwife with any concerns. However, not all preterm births can be prevented, and giving birth to an early baby does not mean that you failed. Having a preterm baby who may be in the NICU can be very stressful, so make sure you have support from a doula, or family and friends, as well as the NICU social worker. Whenever your birth happens, you and your baby have the right to quality, evidence-based, and respectful care. 

Interested in how a doula can help you prevent preterm labor? Connect with an expert at

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