Women who know they want to deliver early may plan an induction of labour or a caesarean section with their healthcare team. You can learn about these procedures on Unii’s Giving Birth Journey with obstetrician Dr. Keith Duncan.

These mums will certainly have hospital bags ready and can usually have the preferences in their birth plans honoured.

In most cases, however, premature labour starts unexpectedly, with mums delivering by the method that they and their doctors agree is best at the time. They may not have written a birth plan or packed bags. If you know you’re at risk of giving birth before 37 weeks, the charity Birthrights UK recommends working with your doctor to write a birth plan for unexpected circumstances. While it won’t be your ideal, anything happening as you planned can increase your sense of wellbeing in an unpredictable situation.

How do I know I’m in premature labour?

It is sometimes hard to tell you are in labour and you should always call your hospital or midwife if something feels wrong. Premature labours can be short. The symptoms are usually similar to the usual early signs of labour. You may feel regular contractions, period-like pain, or pressure in your vaginal area. The mucus plug that seals your cervix during pregnancy may come away and out of the vagina, appearing as a jelly-like blob with streaks of pinkish or brown blood. A gush or trickle of fluid from your vagina could be your waters breaking. You should also call about any backache that is unusual for you, especially if it comes and goes—this could be labour contractions. Call the hospital or midwife immediately if your vagina is bleeding or your baby’s movements change or stop.

Remember, showing some of the signs of preterm labour does not mean you will definitely have your baby before 37 weeks. If you do go into labour suddenly, it may be possible to delay it. Your doctor or midwife will take steps to find out exactly what’s happening.

How is premature labour diagnosed?

Diagnosing premature labour can also be challenging. Your doctor or midwife will check your baby’s position and contractions, if you’re having them. You may also be given blood and urine tests, an ultrasound, and a pelvic exam.

It is not always clear that your waters have broken prematurely. The doctor will confirm through an examination, swab, or scan. If your waters have broken, you and your baby will be monitored for signs of infection with blood tests, pulse, blood pressure, and temperature checks.

The amount of a protein called foetal fibronectin in the cervix and vagina increases when a woman is about to go into labour, and you may be swabbed for it. Most pregnant women will have negative foetal fibronectin swab results, which is very reassuring, as less than one in 100 people with a negative test will go into labour within the next two weeks (though the accuracy of the test is affected by vaginal bleeding and recent sexual intercourse). A positive swab means you’re 20% more likely to go into labour within 10 days.

Remember, even in an emergency situation, your consent will always be required for anything that is done to you. If you are in the UK, we recommend reading the Birthrights website to fully understand your rights during labour and birth.

How might my doctor try to stop premature labour?

In some cases, premature labour stops on its own. If your contractions are mild, for example, bed rest alone may halt the beginnings of labour and you will probably be able to go home when they cease, though you may need to take it easy and avoid sex for the remainder of your pregnancy.

If this does not happen and there are no contraindications, you may be given drugs to slow or stop your labour.

Drugs called tocolytics are used to attempt to stop contractions and may be given orally or via a drip. They can delay labour for several days. It is important to understand that, while tocolytics can prolong a pregnancy, they do not make a baby healthier and come with many potential side effects for the mother’s health.

Tocolytics can delay labour enough for doctors to inject mum with drugs that will support the baby’s health and development. Steroids called corticosteroids can protect their lungs and some other organs and help them grow. These are usually given through two injections in the arm, backside, or thigh. A large dose of magnesium sulphate (injected into your hand or arm) protects your baby’s brain and can help prevent cerebral palsy if they are born early.

How is premature labour managed?

If your contractions are established and your cervix is dilating, it is difficult to delay labour by more than 48 hours, even with the drugs we’ve mentioned above. At this stage, you will either progress to a vaginal delivery, if you prefer it, or, if the baby is breech or showing signs of distress, a caesarean section. The good news is that premature labour is often relatively short because your baby’s head and body are a bit smaller. A smaller head also means you are less likely to need an episiotomy, unless your doctor is using forceps to try to control the speed of delivery and protect your baby’s skull.

A baby delivered through an emergency caesarean section can be delivered remarkably quickly. While it is a significant surgery, it is also widely considered safe, and you will likely be awake and have your partner with you throughout.

What can the birth partner do?

It is normal for the birth partner to feel helpless and shocked in this situation, and reassuring the birthing mother factually when you are uncertain what’s happening is a challenge. Information gathering is extremely useful. If you feel unable to communicate effectively, remember that yours will be the most—and potentially the only—familiar face for the birthing mother in a stressful situation that she may not have planned. Her mind will be on the baby, so keeping your focus on her, reassuring through a hand squeeze, and making quiet affirmations are positive, proactive steps. Your presence is really important.

Remember, too, that parents have the right to be fully briefed on what happens in labour and birth afterwards, even months after the event. This information is especially useful if you plan on having more children.

What will a premature labour and birth be like?

Unii talks you through the sometimes unexpected experience of premature delivery.