Preterm Labor

 

 

Warning Signs For Potential Complications During Pregnancy 

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Compiled by Sidelines High-Risk Pregnancy Support

Most women only experience the normal discomforts that take place during pregnancy. However, sometimes there can be complications that need immediate medical attention.

If you experience any of the symptoms listed below, contact your health care provider immediately, or go to the hospital or emergency room.

  • Vaginal bleeding
  • Vaginal discharge that is unusual
  • Severe, persistent, frequent headaches
  • Pain or burning upon urination, or decrease in urination
  • Persistent nausea or vomiting
  • Leakage of fluid from the vagina
  • Sharp pelvic pain or severe cramping
  • Frequent dizzy spells or fainting
  • Visual disturbances such as blurred vision, white lights or flashes, dots in front of the eyes
  • Sudden swelling in hands, feet, and face
  • Falling or sustaining a blow to your abdomen
  • Noticeable decrease or absence of fetal movement
  • High fever with chills, over 100.4° Fahrenheit orally
  • Contractions more often than four times an hour if you are less than 37 weeks
  • Low back pain that comes and goes
  • Any other problem that feels unusual
  • A feeling that something is not right

The bottom line: if you are worried, call your health care provider! Chances are, someone from your practice is awake and working in labor and delivery at any given moment. It's better to call and check than stay at home and worry alone. Almost all hospitals provide an all-call nurse that can speak with you on the phone and provide advice. If you feel that your questions are not being answered fully, never hesitate to get a second opinion or go the emergency room.

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Staying In Touch With Your Body

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By Sidelines High-Risk Pregnancy Support

When it comes to protecting yourself and your baby from pregnancy complications, early detection is the key to successful treatment. Being informed and aware of early warnings signs can make all the difference. Pay attention to your body, learn what is "normal" for you, and do not hesitate to report even one of these symptoms to your doctor; be persistent and always have the problem checked out!

Signs and Symptoms of Preterm Labor

  • Regular uterine contractions or tightening sensation in stomach (often painless)
  • Continuous or intermittent menstrual-like cramps (constant or occasional)
  • Low, dull backache
  • Pelvic pressure
  • Abdominal cramping, with or without diarrhea
  • Increase or change in vaginal discharge
  • A nagging feeling that something is not right

Symptoms of Gestational Diabetes

  • Excessive thirst or hunger
  • Unusual frequency of urination
  • Chronic fatigue
  • Blurred vision

Symptoms of Hypertension or Preeclampsia

  • Persistent strong headaches or dizziness
  • Visual disturbances, blurred vision, flashing spots or silver waterfalls
  • Rapid weight gain (two or more pounds in one week) accompanied by swelling in hands, feet, ankles or face (called edema)
  • Inability to urinate or infrequent urination
  • Stomach pains
  • Decrease in fetal movement

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Braxton Hicks or Preterm Labor?

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by Tracy Hoogenboom

Do you think you might be having contractions before your due date and are wondering what you should do? These may be harmless and ineffective contractions, but they may also be a sign of preterm labor. So how do you tell the difference?

Preterm labor is most often felt as a vague, painless tightening of the abdomen, and may or may not be accompanied by one or more signs and symptoms of preterm labor. Preterm labor contractions usually occur in a regular pattern and may cause changes to occur in the cervix.

All pregnant women should self-monitor to see if they are having regular contractions. This process is called "self-palpation". It is important to self-palpate to determine whether or not your contractions are occurring in a regular pattern and to count how many you are having each hour.

Your doctor may recommend self-palpation twice a day to keep track of contractions that may lead to preterm labor. Self-palpation is also a good way to monitor yourself and become familiar with your normal pattern of uterine activity. Ideally, follow these steps once a day or anytime you have signs of preterm labor. If you are in preterm labor, your doctor may prescribe bed rest, drugs to halt the labor (called tocolytics), and/or a device called a home uterine activity monitor. This device allows you to monitor contractions at home without being hospitalized.

"It's Just Braxton Hicks."

Braxton Hicks contractions occur in most normal pregnancies, and are felt as painless and infrequent tightening of the uterus. These contractions usually don't occur more than once per hour and do not make any changes to the cervix.

Never heed the advice of a well-meaning friend who tells you, "Don't worry...those are just Braxton Hicks!" Many healthcare professionals consider the term Braxton Hicks outdated, overused, and even dangerous. Always report painless tightening to your doctor.

The vast majority of contractions occur in the evening hours, so that is the recommended time to monitor. Drink 1-2 cups of water or other fluids. Go to the bathroom and empty your bladder. Have a note pad nearby to take notes, as well as phone, clock, and other items you may need during the hour. Minimize distractions. Have young children watch a video or go for a walk with a neighbor. Turn off the TV.

Lie comfortably on your left side, using pillows for support. Using your fingertips, gently feel the top of the uterus. When the uterus is relaxed it will feel soft; a contraction will cause the uterus to become firm and hard and will effect the entire muscle, top to bottom. You are monitoring to detect those contractions that cause the entire uterine area to become firm.

If you feel a contraction, check the clock and count how long it takes for the uterus to become soft again. Write it down.
Write down the time between contractions.
Write down any other symptoms that you have been having, as well as your level of activity, medications, and any other information that may help your doctor.

When to Call Your Doctor

If you have more than three contractions per hour, or there is less than 15 minutes between any contraction, you may be in preterm labor and need to call your healthcare provider. Always call if you are confused or concerned about what you are feeling. Watch for signs of preterm labor and do everything you can to prevent a premature delivery.

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Communicating With Your Healthcare Team

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By Ann Marie Ronsman, MSN, RN (and 15-Week Bed Rest Survivor)

No woman is happy to hear the news that she will be placed on bed rest for a portion of her pregnancy. Gone instantly is her hope for an idyllic pregnancy, where she can work up until the day before the birth, feeling energetic and looking glowing the whole way through.

As for my experience with having bed rest prescribed, I had called the doctor’s office around 10 a.m. on a Monday because my blood pressure had been up over the weekend. The nurse told me to come in right away. I can remember asking, “How long will this appointment take?” The nurse replied, "Clear your calendar for the rest of the day." This should have been a clue to me, but I did not pick up on it. When I went into the doctor's office, I was informed that I would be on bed rest for the remainder of my pregnancy. I was 22 weeks pregnant at the time. I was told that we would try bed rest at home first, and then bed rest in the hospital if home treatment wasn’t sufficient. I learned that my baby would probably not survive if I delivered at 22 weeks. If the baby or I got very sick, I would need to deliver immediately. The doctor hoped I could make it at least two more weeks so the baby had a chance at survival.

After the shock wore off, I realized how important it would be for me to understand - specifically - the bed rest plan that was laid out by my doctor. My advice as a bed rest survivor is to ask questions and get specific answers. Here are some common questions you may need to ask in order to understand your situation:

  • What does your health care provider mean by "bed rest?"
  • Do you need to be in bed at all times?
  • Can you sit up?
  • Do you need to lie on your left side for a certain amount of the time?
  • Will you have restrictions on visitors or stimuli?
  • What about activity restrictions? Will you be permitted to: shower? If so, how often and for how long each time?
  • Sit up to eat?
  • Talk on the phone?
  • Use the computer?
  • Watch TV?
  • Walk to the refrigerator, bathroom, up and down stairs, etc.?
  • Drive?
  • How long can you expect to be on bed rest?
  • Until the end of your pregnancy?
  • Until a certain gestational age is reached, at which time delivery would be induced?
  • Can you be home alone?
    Once you understand what your care provider means by bed rest, then it is time to ask some questions about the treatment plan. For example:
  • How will you know if bed rest and/or medications are working?
  • How often will you be seen in the doctor’s office?
  • What testing will be done, and how often?
  • At what hospital will you deliver? (It may not be the one you originally planned on if they do not have a NICU there.)
  • Do you need to see a specialist (maternal-fetal medicine doctor or perinatologist)?
  • How will you know when it is time to deliver?
  • What is the likelihood that your baby will survive?
  • What can you expect if the baby is born at, for example, 24, 30, or 32 weeks gestation?
    It is critical during this time to communicate your concerns to your health care team, and to be able to ask the questions that will help you to take good care of yourself and your baby. Some general tips for communicating with your health care team are:
  • Write down your questions before each appointment.
  • Remember that no question is silly or unimportant.
  • Don't be afraid to ask too many questions.
  • If you don't feel comfortable talking with your doctor, find one with whom you can communicate openly.
  • Share how you're feeling, not only physically but also emotionally.
  • Share your fears with your doctor. He or she will address them and tell you if your fears are founded or not.
  • Bring someone along to your appointments to give you moral support.

Communicating with your healthcare team will decrease your anxiety and, therefore, improve the outcome for you and your baby. You become a parent long before you give birth to your child. By taking good care of yourself through communicating with your healthcare team, you are advocating for your child.

Ann Marie Ronsman is a NICU nurse in Menomonee Falls, Wisconsin. After being on bed rest for 15 weeks, she delivered a healthy boy at 37 weeks. Ann Marie says, "Bed rest is by far the hardest thing I have ever done, but it has also brought the greatest rewards."

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