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Dr Duncan

Pre-term labour

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I still remember a delivery that I oversaw many years ago when I was a country Doctor in NE Victoria. The town was a tourist area and in the holiday season the place was packed with tens of thousands of visitors “up from Melbourne”. One night I was called to the local hospital because a lady had gone into labour, she was from the big city and wouldn’t be able to get back there in time to deliver. As it turned out she was only 32 weeks pregnant and in full labour. At points like this there is nothing you can do but just “go with the flow”. I called in another GP because I knew we would need help with such a small babe, and rang the Air Ambulance so that they could ready to take mother and infant onto appropriate Specialist care facilities back in Melbourne.

The thing about prem babies is that they are so SMALL! And with that smallness comes a fragility that demands the highest level of care to make sure that they survive and mature to healthy Kids and adults.

One of the biggest challenges for prem babies is that up to about 34 weeks their lungs aren’t ready to breath air – they lack a substance called surfactant – and if you cannot breathe properly, then life becomes a serious struggle.

So who is at risk of going into premature labour?

In many cases, there is no pre-existing indication that a Mum might go into early labour, but for others there are certain well-known risk factors that include:

  • Having had a previous Prem labour.
  • Twins or multiple births.
  • Premature rupture of membranes leaving the womb open to infection.
  • Abnormalities of the uterus.
  • The usual suspects of smoking, alcohol, drugs.
  • High blood pressure, Diabetes.
  • Trauma, including domestic violence.
The premature baby faces not only the real challenge of not having fully functioning lungs, but also other complications such as immature internal organs and a decreased ability to fight infections. Later on in childhood they may also have an increased risk of learning disabilities and behavioural problems. So it’s important that whenever we can, we Doctors like babies to go to “full term” before delivery.

What can be done to ensure a full term pregnancy?

The simplistic answer is that if you do your very best for yourself and your baby, then you will give it the maximum chance of starting life in as good a state of health as possible: but no-one can guarantee that by doing everything “by the book” that everything will go according to plan!

Here are some suggestions that will put you and your child in the best position possible:

  • Have regular Ante-Natal check ups.  These are designed to pick up problems before they become a health threat. Always be honest with your Doctor and tell them if you have any concerns.
  • If you are overweight, have high blood pressure or Diabetes then take these issues seriously and keep them under strict control. Again, if you are having any problems or concerns, seek expert advice early.
  • Keep up appropriate physical activities according to the stage of your pregnancy. Eat freshly prepared foods that will be good for you and your baby: if in doubt ask an expert!
  • NO smoking, NO alcohol and NO risk taking - the two of you are too precious!
  • Then there are the less obvious things like sex and brushing your teeth!  If you have had a previous prem labour, then vigorous sex in the later parts of pregnancy might inadvertently “shake things up”. And as for brushing your teeth, the experts tell us that there might be a link between poor gum hygiene and premature labour! So remember to brush and to floss.
If there is a high risk of premature labour, then your treating Doctor will discuss the medical options that are available to help reduce the chances of going into early labour, and these would include the use of hormones either by mouth or intra-vaginally.

If you think that you’ve gone into labour, do remember that it may be a “false labour”: however, if the contractions are regular, getting stronger and more frequent, then it could well be full labour, and you really need to be in a hospital. If you are unsure as to whether it’s real or false, then just go to your Doctor or Maternity Hospital and ask – when it comes to premature labour, it’s always best to be wise before the event!

Once in hospital you will be monitored closely and so will the baby. If it is appropriate you will be given a large dose of steroids that will reach the baby and help speed up the “maturity” of its lungs to prepare them for the outside world.

Giving birth to a prem baby is no different to normal labour in many respects, but depending on the age of your baby, the immediate after effects can prove an emotionally demanding time, because if your baby is very small he/she will be removed for “Special Care” in Hi-Tech Neonatal units dedicated to giving them the best possible chance of leading a healthy life. If this happens to you, surround yourself with people who love you and who will support you and your family. After all, I’m sure you’d do it for them.

Article written by Dr. Duncan Jefferson. More articles here. For more information on health care and private health cover, visit HBF Insurance at www.hbf.com.au.

The content of these articles is not tailored for any particular individual's circumstances. The author does not take into account your physical condition, medical history or any medication you may be taking. Any advice or information provided by the author cannot replace the advice of your health care professional. The views expressed in this article are those of the author and do not represent those of HBF unless clearly indicated.

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