Delaying Pre-term Birth
by Susan Miller, BScN
Most pregnant women anticipate giving birth between 37 and 41 weeks of pregnancy. However, about two per cent of babies are born before 32 weeks gestation and another four to five per cent are born between 33 and 37 weeks gestation. It is frightening and bewildering to learn that your baby may be at risk of a preterm birth. Modern medicine has significantly increased the positive outcomes for babies born early, but the longer a baby can grow and thrive within its mother’s womb, the better it is for the baby and the mother as well.
A number of conditions can put a mother at more risk for a preterm birth. The most common factors are:
• Multiple pregnancy such as twins, triplets or more
• An early dilating cervix referred to as an “incompetent” or “insufficient” cervix
• An abnormally shaped uterus
• Problems with the amniotic fluid (too much or too little) or the sac such as ruptured or leaking membranes
• Infections, including vaginal, intrauterine, urinary tract, gum disease or pneumonia
• Problems with the placenta such as placenta previa or placental abruption
• Pre-existing medical conditions such as asthma, irritable bowel syndrome, hypertension, diabetes, heart, liver, kidney disease or clotting disorders
• Increased blood pressure due to pregnancy
• A history of preterm labour, preterm birth, miscarriage or abortions, or
• Being a heavy smoker or consuming drugs and/or alcohol
Having any of these risk factors does not always lead to a preterm delivery. On the other hand, a pregnant woman with no risk factors at all may unexpectedly develop preterm labour and deliver her baby before 37 weeks. Indeed, about half of all preterm deliveries are unexplained.
When a pregnant woman has symptoms of preterm labour such as leaking or rupture of the membranes, bleeding, persistent cramping or contractions, low back pain or pelvic pressure, she will be admitted to the hospital for observation and assessment. If the mother is between 23 and 36 weeks gestation, a Fetal Fibronectin Test (fFN) can be done to determine the likelihood of a premature delivery within the next two weeks. If this test is positive the mother will likely remain in the hospital and be monitored closely. If the test is negative the mother will be able to go home and rest, and will be asked to contact her caregiver if anything changes in her symptoms or condition.
In the hospital medications and intravenous fluids may be given to try to stop the preterm labour. If the baby is between 24 and 34 weeks gestation, corticosteroid medications such as betamethasone and dexamethasone can be given to the mother by injection to help mature the baby’s lungs. If the baby is born early, there is less chance that he will have breathing difficulties if his mother received this medication in the days or hours prior to his birth.
In order to help delay preterm labour either at home or in the hospital, the mother will need to go on immediate and total bed rest. Total bed rest in the last trimester of pregnancy has specific benefits:
• Bed rest decreases the pressure of the baby on the cervix and reduces cervical stretching, which may cause premature contractions,
• Bed rest increases blood flow to the placenta, thus helping the baby to receive maximal nutrition and oxygen, and
• Bed rest helps the mother’s organs such are the heart and kidneys to function more efficiently. This is especially important for a mother who may be suffering from problems with high blood pressure during pregnancy.
Some women on bed rest will spend the remainder of their pregnancy in the hospital. Others will be able to go home to be on bed rest and keep in close contact with their caregiver. In both cases there are significant challenges in dealing with bed rest in pregnancy. For those in the hospital, the most frustrating aspect is usually boredom. Even though it is reassuring to be in the hospital where help is close at hand, the hospital is an unfamiliar environment where it may be hard to sleep and relax. Many of the distractions and conveniences of home cannot be replicated in a hospital room. It is especially hard for mothers with other young children at home to be away from them for long periods of time.
For mothers on bed rest at home, the challenge is to be disciplined enough not to get up and “just do a few things.” If there are other young children in the home, someone else will need to look after them. A mother on bed rest at home needs just as much rest and quiet as the mother in the hospital.
Bed rest in pregnancy is not something anyone plans for, and when it is prescribed, it can be hard to accept. The causes of high-risk pregnancy are usually unavoidable or unknown. As a mother, you may find it easier to cope with the situation by:
• Accepting your angry and negative feelings that are likely to arise
• Learning about the particular pregnancy problem that you and your baby are experiencing
• Asking your doctor, midwife or nurses to explain what to expect if your baby is born early
• Voicing your concerns openly and honestly, and
• Becoming involved in your care as much as is possible
Setting short-term goals can help make bed rest in pregnancy more acceptable. Each week, day and hour that goes by contributes to your baby’s overall well being and future healthy development. Take comfort in the knowledge that you are giving your baby the very best as you continue your bed rest during the last days and weeks of your pregnancy.
Susan Miller, R.N. BScN, is a Perinatal Educator and Certified Breastfeeding Counsellor. She works with prenatal and post-natal families in the Greater Victoria area and is now the proud grandmother of Meredith born July 2008.