Signs and symptoms of premature (preterm) labour

What are the signs of premature (preterm) labour?

Braxton Hicks (practice contractions)

What happens at the hospital?

What happens if I am in preterm labour?

What happens if I am not in labour?

Your mental health

Premature (or preterm) labour means going into labour before 37 weeks.

If you think you may be going into premature labour, call your hospital or your maternity unit straight away for advice. They will usually tell you to go straight to hospital, and they may send an ambulance for you or tell you to call one.

It’s difficult, but try not to panic. Most people who have preterm contractions or other signs of labour do not go on to have a preterm labour and birth.      

What are the signs of premature labour?

You may have some signs labour has started, but not others.  

Call your hospital maternity unit or midwife straight away if you have any of the following symptoms. If you are less than 37 weeks pregnant you could be in early labour.

• Regular contractions. This is your womb tightening then relaxing.
• Period-type pains or pressure in your vaginal area.
• A “show” – when the plug of mucus that has sealed the cervix during pregnancy comes away and out of the vagina. This may be a sticky, jelly-like blob with sometimes streaks of pinkish or brown blood. It may also come out bit by bit.
• A gush or trickle of fluid from your vagina – this may be your waters breaking. If your waters are smelly or have any colour in them (green, brown or black especially) - this may be a sign of infection.
• Backache that comes and goes – this may be labour contractions.

Call your hospital maternity unit or midwife immediately if you have any of the following symptoms at any time during your pregnancy.  

• Bleeding from your vagina.  
• You notice a change or reduction in your baby’s movements.  
• You think your waters have broken – there is a risk of infection when this happens. 

Braxton Hicks (practice contractions)

Many people have Braxton Hicks, sometimes known as practice contractions. These can be quite strong during the third trimester, and it's easy to mistake them for the real thing.  

Braxton Hicks contractions usually:

• are uncomfortable rather than painful
• do not last long
• do not happen often
• do not build up.

Contact your hospital maternity unit or midwife if you are having painful contractions. 

Find out what contractions really feel like.

What happens at the hospital?

The doctor or midwife at the hospital will ​examine you and ​offer you tests to find out if:

• your waters have broken  
• you’re in labour
• you have an infection.

These tests may include:

• a ​​vaginal examination to check if your cervix is opening
• blood tests to check for infection
• urine tests to check for infection (or protein, which can be a sign of pre-eclampsia)
• checking your pulse, blood pressure and temperature
• feeling your bump to check the baby’s position
• monitoring and recording any contractions
• a check of your baby’s heartbeat
• a ​vaginal swab ​to see if your body is preparing to give birth.

Your baby’s movements

Your healthcare team should also ask you about your baby’s movements in the last 24 hours. Tell them if you’ve noticed any changes. You should feel your baby​ move ​right up to the time you go into labour and during labour.

Call your hospital maternity unit or midwife immediately if you think your baby’s movements have slowed down, stopped or changed. 

If your waters have broken early (preterm pre-labour rupture of membranes – PPROM) 

Normally your waters break shortly before or during labour. If your waters break before labour at less than 37 weeks of pregnancy, this is called preterm prelabour rupture of membranes or PPROM. If this happens, you have a higher chance of giving birth prematurely. You and your baby are also more likely to get an infection that could make you ill. You’ll be offered antibiotics to reduce that risk and help your pregnancy to carry on.

If you and your baby are well, and depending on your circumstances and preferences, it may be best to let your pregnancy carry on until 37 weeks. You will be monitored closely until you give birth.

Find out more about what to expect when your waters break.

How will I know if my waters have broken?

This may feel like a mild popping sensation​ and/or a​ trickle or gush of fluid that you can’t stop, unlike when you we​e​. You may not have any sensation of the actual ‘breaking’, and then the only sign that your waters have broken is the trickle of fluid.  

Find out more about what to expect when your waters break.

What happens if I am in preterm labour?

The midwife or doctor will talk to you about whether it’s best to ​birth​ your baby now or try to slow down labour​ using medication​.

They will consider:

• how many weeks pregnant you are
• ​​whether​ it might be safest for your baby to be born now
• what neonatal facilities are available and whether you need to be moved to another hospital
• what you want to do.

Your healthcare team will talk to you about whether it would be best to have a c-section or vaginal birth and will explain the risks and benefits of each. Your preferences and any worries you have will be an important part of making this decision together.

​​​​​You may need to be moved to a hospital that has facilities for premature births.

Removing a stitch (cerclage) if you have one

If you are going to give birth and have had a transvaginal cervical stitch, you will need to have it removed before your baby is born. This is because there is a risk of it injuring your cervix if it is left in place.  

Your stitch will be taken out at the hospital. This is usually done at 36 or 37 weeks. If you go into labour with the stitch still in place, contact your maternity unit straight away.

If your waters break early but you are not in labour, the stitch will probably be removed because of the risk of infection if it stays.

If you had a transabdominal stitch, the stitch is not removed and you will need to have your baby by c-section.

Medications

​Sadly, babies born prematurely are more likely to have some health problems. If you’re in early premature labour, you may be offered medication to try to slow down labour and delay the birth or to improve your baby’s health before they are born. 

Read more about treatments to prevent premature birth.

After your premature baby is born

Your healthcare team will assess your baby's health and start treating them if needed. They will tell you how your baby is doing and what they’re doing to care for them. You may not be able to hold your baby straight away and we know this can be upsetting. It may be possible for you to have a cuddle with your baby before they are transferred to the neonatal unit.   

What happens if I am not in labour?

If labour hasn't started, your midwife or doctor will ​​look into what ​may be​ causing your symptoms and ​i​f there is any treatment that would help you​ and your baby.​​     ​

They may sometimes ​advise that you stay in​ hospital so they can monitor you and your baby. 

Your mental health

Every parent hopes for a healthy, uncomplicated pregnancy, labour and birth. It can be very upsetting when this doesn’t happen. Around 1 in 5 people have mental health problems during pregnancy and in the first year after having a baby. Don’t be afraid to tell your healthcare professional how you feel. They won’t judge you.  

You can also talk to a Tommy’s midwife for free from 9am–5pm, Monday to Friday on 0800 0147 800 or email them at [email protected]. Tommy’s Midwives also run a specialist Black and Black-Mixed Heritage Helpline too – you can book a call with them.