Pre-term and overdue deliveries

Only five percent of babies actually arrive on their due date. In case your baby isn’t one of them, you may want to prepare yourself with information about pre-term and overdue deliveries.

Pre-term Birth
Babies born before 37 completed weeks of pregnancy are considered to have been born prematurely. About 10 percent of pregnancies are pre-term. While some women will stop labouring and complete a full-term pregnancy, five to seven percent will deliver a premature baby and 80 percent of infants born prematurely survive with no long-term effects. Infants who are at the most risk are those who are born extremely early – less than 27 weeks gestation – and who are of extremely low birth weight – less than 1,000 grams (two pounds).

Causes of Pre-term Labour
The cause of 50 to 60 percent of pre-term labours and deliveries is unknown. However, there are some conditions that are known to increase the risk of pre-term labour:

• maternal conditions, such as diabetes, toxemia, infection or hemorrhage. 
• premature rupture of the amniotic sac (the bag of fluid surrounding the fetus).
• multiple pregnancy (twins, triplets).
• cogenital malformations.
• heavy smoking during pregnancy.
• alcohol or drug abuse, especially cocaine.
• adolescent pregnancy.
• a previous premature labour.

After the delivery of a premature infant, many women feel guilty. “What did I do wrong?” they commonly wonder. Understand that in all likelihood you did not do anything to cause the premature labour. Pre-term labour is not caused by normal physical exercise or healthy activity such as carrying the groceries or climbing the stairs. Discuss your concerns with your doctor and/or nurse, as these concerns are generally unfounded.

Know Your Body
Many women don’t recognize the symptoms of labour and do not contact their caregiver immediately. Early detection may lead to actions that can prevent an early delivery. Many of the signs of early labour are subtle, so get to know your body and understand what is normal for you. Learn the symptoms listed below and do not hesitate to contact your caregiver if you have any concerns.

Do not ignore these signs. Contact your physician or go immediately to a hospital for an assessment. If you learn that you are in labour, you will be in the hands of the professionals who can ensure the appropriate medical action is taken. You may be upset, anxious or confused. Ask for a consultation with a pediatrician or neonatologist who works at the hospital. You will be provided with information about the outcome of babies born at a similar age to your baby. If time allows, you can also take a tour of the Neonatal Intensive Care Unit (NICU) where your baby may be transferred, so that you are well prepared. You may also seek the services of a clinical nurse specialist or a social worker who will provide support.

Preventing Premature Delivery
The treatment provided for preventing premature labour depends on a variety of factors. If your contractions are not too advanced and your cervix has not dilated too much, there is a chance that labour can be stopped. Bed rest controls preterm labour in 50 percent of cases. Complete bed rest means going to bed and staying there in a flat position– not even getting up for the bathroom. Partial bed rest allows a woman to get up for a few hours during the day. Sometimes a woman is admitted to the hospital for bed rest and sometimes this can be accomplished at home.

Medications may be used if bed rest alone does not control labour, but you’ll need to discuss these with your doctor. These drugs have been effective in some instances in preventing pre-term birth – they act by relaxing the uterus and stopping contractions. However, they are not useful if labour has progressed too far. 

There are some medical conditions that prevent the use of these drugs because they may cause side effects for the mother.

Other conditions
There are instances other than premature labour that can lead to the early delivery of an infant. These include maternal conditions such as diabetes, high blood pressure or premature rupture of membranes that can lead to uterine infection. Fetal conditions include lack of growth or fetal distress. Once identified, you will be carefully monitored by your physician. It may be decided that it is in your or your baby’s best interest to be delivered early.

Pre-term Delivery
Whether you are three weeks early or 10 weeks early, both you and your partner will experience a variety of emotions – fear, sadness, guilt, inadequacy, anger.

• Share your emotions with your partner.
• Accept counselling by nurses, social workers or physicians.
• Join a parent support group to meet with other parents who are experiencing the same emotions.
• Meet with a parent who has already taken their premature baby home.

Post-term births
As the projected due date approaches and then passes, most women get anxious. For a small percentage of women who go past their due date, their physician will carefully reassess the information at hand. This will include reviewing the date of the first day of the last menstrual cycle, the detection of the fetal heart rate at 18 to 20 weeks, the fundal height at the navel at 20 weeks and the results of the early ultrasound. This will help to determine the accuracy of the due date. The recalculation often shows that the baby is not overdue, but that the due date was incorrect. 

However, any pregnancy that truly continues for more than 42 weeks is known as a post-term pregnancy. This condition affects approximately eight to 11 percent of pregnant women. The fetus is at risk because of the placenta – the organ containing the blood vessels that exchange nutrients from the mother to the fetus – begins to age. This leads to a decrease in the amount of oxygen and nutrients that the fetus receives. Birth may be more difficult because the fetus can stress more easily during delivery, or because of the size of your baby. 

Your caregiver will monitor you and your baby very carefully during this period. You may be:

• instructed to keep a record of daily fetal movement.
• given a non-stress test that indicates potential problems (this measures the fetus’s reaction to the stress of labour).
• given an ultrasound to assess the baby’s breathing, movements, muscle tone, heart rate and amount of amniotic fluid.

If any of these tests suggest that your baby is at risk, you doctor may decide to induce labour rather than waiting for labour to begin on its own. You and your partner should discuss the results and the options that are being suggested. 

You may find yourself overwhelmed with emotions, fear for the baby’s safety and not hear all that is being discussed.Repeat your questions until you have a good understanding. Either the doctor or the labour nurse will clarify the information for you. Both the mother and the baby will be carefully monitored during induction.

Induction
Induction can be accomplished in a variety of ways:

• breaking the membranes surrounding the amniotic fluid.
• intravenous administration of a hormone, oxytocin, that stimulates contractions.
• use of a suppository containing prostaglandin that stimulates contractions.

If there are no complications, you may hold your baby and put him to your breast following this post-term delivery. This is the beautiful beginning of parenthood.

Symptoms of Early Labour

• Uterine contraction (these may be painless) that occur at frequent intervals (more than four per hour or less than 15 minutes apart)
• Menstrual-like cramps that are wave-like or rhythmical
• Dull pain in the back not helped by a position change
• Pelvic pressure
• Persistant diarrhea
• Increased vaginal discharge, especially if pink, green or bloody
• A general feeling that something is wrong