Preterm labour means labour that happens before 37 weeks of pregnancy. Babies born this early can have lifelong health problems because many organs, like the brain, lungs, and gut, are still not yet mature and developed. They have low birth weight, breathing and feeding difficulties and low body temperature.

Very premature newborns are also more likely to experience long-term issues, particularly learning disabilities, cerebral palsy, and delayed development. Preterm labour not only affects the baby but also the mother.

Mothers who go into preterm labor are more likely to have:

  • Anxiety
  • Postpartum depression
  • Post-traumatic stress disorder
  • Problems bonding with their baby
  • Breastfeeding difficulties

 
Preterm birth rate in India is 3.9 million in 2020. In 2020, India had the highest number of preterm births in the world, accounting for more than 20 percent of all preterm births worldwide, which is the leading cause of mortality in children under 5 years of age

The incidence of preterm labour is increasing because more people are becoming pregnant after age 35 and by assisted reproductive technologies (like IVF), resulting in multiple gestations and high-risk pregnancies.

Signs and symptoms of preterm labour

  • Watery, mucus- or bloody-vaginal discharge than usual
  • Pressure in your pelvis or lower abdomen as if your baby is pushing down
  • Constant low, dull backache and menstrual cramp-like pain.
  • Regular or frequent uterine contractions that make your belly hard. The contractions could be painful or non-painful.

Risk factors for preterm labour

  • Women who have previously gone through preterm labour are thought to be at a higher risk of having preterm labour and delivery.
  • Being pregnant with twins, triplets, or more is associated with a higher risk of preterm labour and birth.
  • Women with certain anomalies of the uterus, like a bicornuate uterus or short cervix, are at greater risk for preterm labour and birth than are women who do not have these anomalies.

Certain medical conditions also place a woman at higher risk for preterm labour and delivery. Some of these conditions include,

  • Urinary tract infections
  • Sexually transmitted infections and certain vaginal infections such as bacterial vaginosis and trichomoniasis
  • High blood pressure in pregnancy
  • Bleeding from the vagina like placenta previa
  • Pregnancy resulting from in vitro fertilisation
  • Being underweight or obese in pregnancy
  • short interval between pregnancies (less than six months from the time of a birth to the start of the subsequent pregnancy)
  • Pre-existing fibroids in the uterus
  • Diabetes
  • Blood clotting disorders.

The following are other variables that may raise the risk of early birth and preterm labour:

  • Age of the mother: Women younger than age 18 or older than 35 are more likely to have a preterm delivery.
  • Certain lifestyle and environmental factors, including: Late or no antenatal care during pregnancy
  • Smoking
  • Drinking alcohol
  • Using illegal drugs
  • Domestic violence, including physical, sexual, or emotional abuse
  • Lack of social support
  • Stress
  • Long working hours with long periods of standing
  • Exposure to certain environmental pollutants

Can you prevent preterm birth?

There's no single way to prevent premature birth.

To reduce the chances of premature labour, follow these steps, as there isn't a sole method to prevent early birth.

  • Planning pregnancy at an early age, preferably less than 30 years. Ensuring optimum weight before pregnancy 
  • Starting folic acid supplementation while planning pregnancy
  • Wait at least 18 months between pregnancies.
  • Avoid tobacco, alcohol, or other substances while pregnant.
  • Eat nutritious, well-balanced foods during pregnancy.
  • Cut out high-fat snacks, oily, spicy, and processed foods.
  • Take a diet with high-protein and low-calorie foods. Avoid white sugar and consume plenty of boiled vegetables with your meals.
  • Hydration is very important to improve the blood supply to a growing foetus and also to maintain a healthy pregnancy. Consume at least 2.5 to 3 ltrs of liquids every day.
  • Start prenatal care in the first trimester so that your doctor can identify health risks as early as possible.
  • Manage medical disorders like DM and hypertension in pregnancy using a multi-disciplinary approach.
  • Sleeping position—always lying on the side, preferably the left—improves the blood supply to the foetus and thereby its growth.
  • In women with an incompetent cervix, activity restriction and lying down with legs in an elevated slope is beneficial. (Trendelenburg position)
  • Get plenty of rest. Sleep for at least 7 to 8 hrs a day with a small nap in the mid-day.
  • Reduce your stress level with yoga and meditation.

Yoga is a proven method for improving both physical and mental health. When you include a regular yoga practice, you can reduce anxiety and improve your sleep. Practicing yoga regularly helps improve your immunity. Yoga hence reduces stress and aids in the prevention of preterm labour.  Certain asanas that could be done are shashank asana, dandasan, sukhasan, and vajrasan.

Slow breathing practices like anulom vilom reduce the stress and anxiety and improve oxygenation to the mother and the baby.

Knowing the signs and symptoms of preterm labour and contacting your healthcare provider immediately if you think you are in labour.
 
- Dr. Vidyashree Kamath is a Consultant OBG at KMC Hospital, Dr. BR Ambedkar Circle, Mangalore