Preterm labor

• Preterm labor and delivery can happen to any pregnant woman.
• Women can take steps to reduce the risk of preterm labor.
• Know the signs of preterm labor and what to do about them.

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What happens if a woman goes into preterm labor and it doesn't stop on its own? Even though a woman may carefully follow her health care provider's instructions, preterm labor sometimes continues. Drug therapy and restricted activity are two common treatments for preterm labor.

Drug treatment
Women who develop preterm labor are often treated with one of several drugs (called tocolytics). The names of these drugs include calcium channel blockers,  terbutaline, ritodrine, magnesium sulfate, indomethacin, ketorolac and sulindac. These drugs can stop contractions. They are given intravenously, orally or rectally depending upon the drug.

Tocolytics may delay delivery 2-7 days, buying some extra time to treat the pregnant women with steroid drugs. Steroids (such as betamethasone and dexamethasone) speed the growth of the baby's lungs and organs. These drugs reduce infant deaths by about 30 percent. They also reduce the two most serious complications of premature birth, respiratory distress syndrome (by about 50 percent) and bleeding in the brain (by about 70 percent). The extra time also makes it possible to treat the mother with antibiotics in case she has an infection or to transfer her to a better-equipped health care facility.

Restricted activity
Some health care providers recommend that women restrict their activities to prevent preterm labor. Bedrest is often advised, despite conflicting research evidence about its effectiveness. While decreasing a hectic schedule may help a pregnant woman to relax, bedrest has not been shown to reduce the rate of preterm birth.

Recommendations vary. Some women are told to rest several times a day. Others are told to stay in bed. Some providers advise women to identify activities that appear to increase contractions and to avoid those activities.

Restricted activity affects the woman physically. The woman may lose muscle tone and become short of breath. After delivery, she will need to regain muscle strength. Extended periods of time in bed also increase the risk of blood clots. In some cases, the health care provider may recommend that the woman not have sex. While a woman is on bedrest, it's best for her not to stay completely still. With the guidance of her doctor, she can do some stretching and other relaxed movements.

With their activities restricted, some women feel bored, depressed or anxious; others feel isolated. It's not unusual for a woman or her partner to feel frustrated, angry or resentful. This is a time for the couple to support each other, get outside help if they need it. Remember: A few weeks of rest and boredom may help the baby have a normal birth and finish developing.

A woman may feel guilty during this time. Even if she did the best she could to have a healthy pregnancy, the woman may wonder, "What did I do wrong?" Talking to professional counselors, spiritual advisors or others who have been in the same situation can be helpful during this trying time.

Some women are unable to work when their activity is restricted, and the family may suffer financially. Within the family, roles and responsibilities may change. Childcare, meal preparation and other household tasks may need to be handled differently. Friends and relatives can run errands, provide meals and care for children. It helps to "spread the burden" across the woman's support network. Women who live alone need extra help during this time.

Some women may qualify for medical leave. Under the Family Medical Leave Act, a woman's job is protected for 12 weeks of unpaid medical leave. Check with the human resources department where you work to find out.

Staying occupied
Even though activity may be restricted, it's helpful to stay occupied, under the guidance of a health care provider. Some women find this a good time to catch up on things they've been wanting to do. They may be able to work from home. Some women pay bills, read for themselves or to their children, sew, play games, keep a journal or use a computer to pass the time. Many women like to receive visits from friends. Each woman should speak to her health care provider before undertaking any activities.

To minimize movement, it's helpful if the woman keeps what she needs nearby (for instance, medications, food and beverages, a telephone, reading materials, the computer, a radio or TV).

Hospitalization
Depending upon the circumstances, the health care provider may recommend that the woman enter a hospital. If she is hospitalized for weeks or months, the concerns and issues are similar to long periods of restricted activity at home.

For more information

Sidelines National Support Network provides assistance to women who are experiencing preterm labor.

January 2008

This article is based in part on American College of Obstetricians and Gynecologists Practice Bulletin, number 43 (May 2003).