Preterm Labor and Birth
At this point in my path of helping women during pregnancy and birth, I’ve seen three instances of preterm birth. One was a twin mama who worked a lot and didn’t eat enough and also had high emotional stress in her relationship with the babies’ dad, one was a woman who had a high stress job and lots of sitting/inactivity all day as she worked and drove back and forth to her office, and the third was a young woman who seemed perpetually dehydrated and had a bladder infection!
I think these three cases really illustrate the main causes of preterm labor and birth: stress, infection, and poor diet/lifestyle choices (like inadequate diet/water consumption, etc..)
If you’re looking for ways of avoiding preterm birth, please check out some of my other blog posts about setting the stage for an ideal birth, diet, and spiritual/emotional preparation in pregnancy/for birth.
So, with that being said, let’s talk about this topic!
What is preterm labor?
Preterm labor is defined as a pregnant mother past 24/25 weeks of gestation (signs of labor before this point are categorized as a threatened miscarriage) but before 36 weeks gestation, who starts experiencing signs that may lead to the birth of an immature baby.
Preterm labor can begin with waters opening or with other symptoms of impending labor, like regular contractions.
Symptoms of preterm labor:
Either the uterus will contract and feel firm all over in a regular pattern (different from Braxton Hicks or practice contractions throughout pregnancy, which do not have a regular pattern and do not cause changes in the cervix), or fluid may leak from the yoni if waters have ruptured, or there may be bloody mucus coming from the yoni or in the underwear or on toilet paper when she wipes, and the cervix will begin to change/ripen/dilate. This, as I said earlier, happens after 24 weeks and before 36 weeks gestation.
Possible complications from or with preterm labor:
Signs and symptoms of preterm labor may combine with other complications like placental abruption (this is usually accompanied by bleeding from the yoni), urinary tract infections, or uterine rupture (very rare).
Risk factors that can contribute to preterm labor:
Inadequate maternal nutrition (even if food choices are good, there is sometimes not ENOUGH food taken in to sustain a pregnancy full term. High protein, high fat/calorie diets are optimal for pregnancy, and getting protein and fats/calories from foods and not from supplements or powders is best).
Normal weight gain is important during pregnancy. Women can expect/aim to gain 1 pound per week in the second 20 weeks of pregnancy. Women who begin pregnancy underweight have a higher risk of preterm birth, and women who have a poor weight gain in the last trimester double their risk of preterm birth.
Dehydration, severe illness, infection of the urinary tract or some other systemic infection in the body/yoni/uterus, undetected multiple gestation, physical differences like musculature or cervical issues or a differently shaped uterus (very rare) are all also risk factors for preterm labor.
Diagnosis of preterm labor:
If the uterus is getting hard at the same time that rhythmic achiness, cramps, or pulling sensations are occurring, or there is a sensation of increased pressure inside the yoni, an internal exam can be performed to check if there are changes in the cervix.
If she has lost fluid out of her yoni, we can test the fluid to determine if it’s amniotic fluid or some other fluid. Depending on the color of the fluid, there are different paths of action. Greenish or brownish stained fluid indicates meconium staining of the fluid, which could mean there is long-standing and severe staining of the amniotic fluid within the uterus, which is not a good sign. Port wine colored fluid indicates placental bleeding from higher up in the uterus, which is also not a good sign.
Sometimes the sensations and symptoms of a uterine infection, the flu, intestinal cramps, urinary tract infection, or pain from an ovarian cyst can be mistaken for sensations of labor. We can do a physical exam plus a test called an APT at home to try to rule out all of these options or to determine the health and wellbeing of the baby.
Action plan for preterm labor:
If the waters have ruptured, we must weigh the risk of infection against the risk of the baby’s lungs not being fully mature. When no infection is present, trying to stall the beginning of labor might be in the best interest of the baby because the longer the membranes are ruptured, the more surfactant the baby’s body produces in the baby’s lungs which will help the baby to breathe normally after birth even if it is preterm. If the waters are open and there are flakes of vernix in the fluid, chances are great that the baby’s lungs are mature.
All of the normal precautions to prevent infection should be taken for after waters have opened if there are no contractions, including
not inserting anything into the yoni
taking her temperature first thing in the morning and at least every 4 hours throughout the day (a temp over 100.4 degrees F would be cause for concern)
watching for other signs of infection including elevated pulse, foul yoni discharge, and uterine tenderness
drinking plenty of fluids and keeping healthy salt intake up
eating well
amazing hygiene when using the bathroom including no scented toilet papers, plus showering or rinsing off after each bowel movement
avoiding wearing a pad or underwear if possible
charting fetal movements
checking amniotic fluid volume
taking high doses of vitamin c with bioflavinoids (5000 mg) and echinacea tincture (½ dropper 4x per day) (Women with low levels of vitamin C have a higher risk of premature labor and of premature rupture of membranes.)
We can also check for infection by
Ordering a white blood cell count with differentials frequently over the course of days/weeks that waters are open before labor has begun. Rises in polys or bands may indicate an infection. Lymphocytes may be normally elevated if the mother is taking echinacea.
Ordering a urine culture to check for group B strep colonization and urinary tract infection
Monitoring fetal heart tones daily, as well as mother’s pulse and temperature throughout each day
If contractions are the only symptom of preterm labor, the woman should try correcting dehydration by drinking 2 large glasses of water over the next 1 hour to see if that helps contractions to cease.
If she has tried to correct dehydration and that doesn’t help, she can also try taking herbs that will stop contractions, like false unicorn root tincture (5 drops every 5 to 15 minutes depending on the strength of the contractions) until contractions taper off, then continue taking it, spacing out the dose to every ½ hour, then every hour, then every 3-4 hours for the next several days until she is no longer taking any. False unicorn root tincture has reversed cervical effacement and dilation as well as encouraging the baby to rise in station (away from the cervix) as well.
Other potential herbs are valerian root/skullcap tincture 3x per day or equal parts of cramp bark and wild yam tinctures.
500 mg of magnesium and 1000 mg of calcium can be added as supplements to help with uterine irritation. Adequate calcium supplementation reduces the risk of preterm birth in low risk women by about a third!
Ultimately if there is no infection and no physical issues with the cervix or uterus, we should try to focus on the diet and emotions. If her blood volume is contracted due to inadequate diet, that could cause early labor. Adding calories, protein, and salt can help build the blood volume quickly, which could help deter preterm labor if nutrition is really the cause.
Stress is one of the other main causes of early labor. This can come from a variety of sources, including work, lack of support, concerns about safety or an abusive partner. Processing any emotions that come up and troubleshooting ways to reduce stress can help the baby stay in until term. Once the mother has brought any emotional or stress issues to light, she can talk to her baby and ask him or her to stay put, as well as talking to her uterus and asking it to calm down and remain a safe and nourishing environment for her baby until full term.
If all avenues are explored and labor still progresses, or if there is an active infection of any kind, or baby doesn’t seem to be doing well, transport to allopathic care is the wisest option.
Allopathic care:
Western medicine providers would most likely attempt to stop labor with tocolytic drugs or magnesium sulfate if it seems plausible, though to a certain extent, at what gestational age they try to stop labor has to do with the sophistication of the available NICU. Tocolytic drugs ALL carry a LOT of risk to the health of the baby, so consider this very seriously. If the pregnancy is between 34 and 37 weeks, the labor may be allowed to proceed since babies born in this time frame have extremely high survival rates.
IV fluids may be given if dehydration is an issue, and the woman will be checked for infection. Steroids can be given to attempt to help the baby’s lungs mature (though technically, steroids should be in the mother’s body for about 24 hours prior to baby being born to make any sort of measurable difference in the maturity of the baby’s lungs) and the woman will most likely be transferred to a hospital with a NICU if she is not already at one.
In conclusion:
I think our culture kind of minimizes preterm labor & birth and dismisses it as “sometimes this just happens” (part of the reason our culture does this is because there is such pressure for women to perform/work/go/do, all while maintaining a certain body size while growing a baby within, and there is less focus on ensuring that pregnancy is a deeply restful and nourishing time in women’s lives) when there are really SO many steps we can take before preterm labor begins to try to avoid it altogether.
And these steps are relatively straightforward and nourishing in their own right. Eating lots of nourishing calories and protein, hydrating ourselves well, maintaining nourishing physical activities for ourselves, and keeping up with spiritual and emotional health which will lower stress and maintain a deeply connective bond with the baby and with nature/the Divine/ourselves! Pregnancy can be SO beautiful if we craft it to be so! :)
So, if you have any further questions, feel free to reach out to me via email or book a session with me!
Sources:
Anne Frye’s Holistic Midwifery Vol 1, Gail Hart’s Research Updates for Midwives
