Premature labour is labour that happens before the 37th week of pregnancy. About 8 out of 100 babies will be born prematurely.
Urgent advice: Call your midwife or maternity unit if you're less than 37 weeks pregnant and you have:
- regular contractions or tightenings
- period-type pains
- a gush or trickle of fluid from your vagina – this could be your waters breaking
- backache that's not usual for you
You can also call your midwife or maternity unit if you're unsure or worried about anything.
The midwife or hospital will offer checks, tests and monitoring to find out whether:
- your waters have broken
- you're in labour
- you have an infection
These may include a vaginal examination, blood test, urine test and cardiotocography to record contractions and the baby's heartbeat.
They'll need to check you and your baby to find out whether you're in labour and discuss your care choices with you.
Planned premature labour
In some cases, pre-term labour is planned and induced because it's safer for the baby to be born sooner rather than later.
This could be because of a health condition in the mother (such as pre-eclampsia) or in the baby. Your midwife and doctor will discuss with you the benefits and risks of continuing with the pregnancy versus your baby being born premature.
You can still make a birth plan and discuss your wishes with your birth partner, midwife and doctor.
If your waters have broken
If your waters have broken (called preterm pre-labour rupture of membranes, P-PROM), there's an increased risk of infection for you and your baby. You'll be offered:
- antibiotics to take
- tests for infection
P-PROM does not definitely mean you're going into labour but you may be advised to stay in hospital for a few days. When you go home, you'll be advised to call your midwife or maternity unit immediately if:
- your temperature is raised
- you feel hot and shivery
- any fluid coming from your vagina is greenish or smelly
- you bleed from your vagina
- you have pain in your tummy or back
- you have contractions
- your baby's movements slow down or stop or there is a change to their usual pattern of movements
If your pre-term labour is planned or unplanned or if your waters have broken prematurely, you may be offered steroid injections.
You'll be offered immediate induction or a caesarean section if:
- you have P-PROM between weeks 34 and 37 of pregnancy, and
- a test has found group B strep bacteria in your pee or vagina
If your waters have not broken
Your midwife or doctor should discuss with you the symptoms of pre-term labour and offer checks to see if you're in labour. These checks can include asking you about your medical and pregnancy history, and about possible labour signs, such as:
- contractions – how strong and how far apart they are
- any pain
- any fluid coming from your vagina
You may be offered a vaginal examination, and your pulse, blood pressure and temperature may also be checked.
Your midwife or doctor will also check your baby. They'll probably feel your bump to find out the baby's position and how far into your pelvis the baby's head is.
They should also ask about your baby's movements in the last 24 hours. Tell them if you've noticed any changes.
If you're in premature labour
The midwife or doctor may offer:
- medicine to try to slow down or stop your labour
- steroid injections, which can help your baby's lungs
- medicine to help protect your baby's brain and nervous system
Slowing down labour or stopping it is not appropriate in all circumstances – your midwife or doctor can discuss your situation with you. They will consider:
- how many weeks pregnant you are
- whether it might be safer for the baby to be born – for example, if you have an infection or you're bleeding
- local neonatal (newborn) care facilities and whether you might need to be moved to another hospital
- your wishes
You may be offered a course of steroid injections to help your baby's lungs get ready for breathing if they're born prematurely.
Steroids may not be offered after 36 weeks as your baby's lungs are likely to be ready for breathing on their own.
If you're in premature labour and you're 24 to 29 weeks pregnant you should be offered magnesium sulphate (through a drip). This can help protect your baby's brain development.
You may also be offered it if you're in labour and 30 to 33 weeks pregnant. This is to protect your baby against problems linked to being born too soon, such as cerebral palsy.
If you take magnesium sulphate for more than 5 to 7 days or several times during your pregnancy, your newborn baby may be offered extra checks. This is because prolonged use of magnesium sulphate in pregnancy has in rare cases been linked to bone problems in newborn babies. It's very unlikely that you'll be given magnesium sulphate for more than 24 hours.
Treatment to prevent early labour
You may be offered treatment to prevent early labour if:
- you've given birth at less than 34 weeks pregnant before
- you've had a miscarriage from 16 weeks pregnant before
- your waters have broken before 37 weeks in a previous pregnancy
- your cervix has been injured in the past, for example through surgery
You'll usually be offered a vaginal ultrasound scan between 16 and 24 weeks of pregnancy to see if treatment may be helpful. The length of your cervix will also be measured, as having a cervix that is shorter than 25mm has been linked to a higher risk of early labour and birth.
There are 2 treatments that may be offered:
- a small tablet of hormone medicine that you put into your vagina
- an operation to put a stitch in your cervix to help support it
Your midwife or doctor will discuss the risks and benefits with you, depending on your circumstances. Treatment usually starts before 24 weeks of pregnancy.
If you have signs of preterm labour, emergency preventative treatment may be considered. Your doctor will discuss the risks and benefits of emergency treatment with you.
What are the risks to my baby of being born early?
Babies born before full term (before 37 weeks) are vulnerable to problems associated with being born premature. The earlier in the pregnancy a baby is born, the more vulnerable they are.
It's possible for a baby to survive if born around 24 weeks of pregnancy onwards.
Babies born this early need special care in a hospital with specialist facilities for premature babies. This is called a neonatal unit. They may have health and development problems because they have not fully developed in the womb.
If your baby is likely to be delivered early, you should be admitted to a hospital with a neonatal unit.
Not all hospitals have facilities for the care of very premature babies, so it may be necessary to transfer you and your baby to another unit.
Twins and multiples
Twins and triplets are often born prematurely. Find out about giving birth to twins.
If you have any reason to think that your labour may be starting early, contact your hospital straight away.