If you are less than 37 weeks pregnant and think labour may be starting, call your maternity unit or midwife immediately and go to hospital for assessment. Do this for contractions, period-like cramps, new lower backache, pelvic pressure, vaginal bleeding or possible leaking waters. You do not need to wait for strong pain or a particular number of contractions.
If you cannot reach your maternity team, go to the nearest hospital. Call 000 for heavy bleeding, collapse, or if birth seems imminent and you cannot safely get to hospital. Do not drive yourself in an emergency.
An unexpected early arrival can bring a lot of uncertainty. Getting assessed promptly gives the team a chance to understand what is happening and discuss care for you and your baby.
What is preterm labour or premature birth?
Preterm labour is labour starting before 37 completed weeks of pregnancy. “Premature” and “preterm” birth both mean a baby is born before this point. Pregnancy dates matter because a baby born at 35 weeks usually has different needs from one born at 25 weeks.
Health professionals may use these terms:
- Extremely preterm: before 28 weeks.
- Very preterm: 28 weeks to 31 weeks and 6 days.
- Moderately preterm: 32 weeks to 33 weeks and 6 days.
- Late preterm: 34 weeks to 36 weeks and 6 days.
Some early births follow spontaneous labour or waters breaking early. Others are planned because continuing the pregnancy poses a greater risk to the pregnant person or baby.
Signs that need checking now
Preterm labour can be less obvious than the strong contractions people expect at the end of pregnancy. Contact your team straight away for:
- Repeated tightenings or contractions, including ones that are not very painful.
- Period-like cramps, a new low backache or pressure low in your pelvis.
- A change in vaginal discharge, bleeding, or a gush or trickle of watery fluid.
- Fever, feeling unwell or a sense that something is not right.
Reduced, weaker or absent baby movements, or a concerning change in their usual pattern, also need immediate maternity advice. Do not use hiccups, a home Doppler or a drink to reassure yourself.
It can be hard to tell urine, discharge and amniotic fluid apart at home. If you think your waters may have broken, use a sanitary pad, note the fluid’s colour and when it started, and contact the unit. Do not wait for contractions.
Some tightenings turn out to be Braxton Hicks contractions, and some episodes of threatened preterm labour settle. You cannot safely confirm this yourself by timing them, resting or drinking water. Before 37 weeks, ask for assessment rather than using advice intended for early labour at term.
What might happen at hospital?
Your team will ask about your symptoms, pregnancy dates and health history, and check you and your baby. They may assess contractions, your temperature and blood pressure, and your baby’s heartbeat. Tests may include urine or vaginal swabs and an ultrasound to measure the cervix or assess the baby.
A clinician may recommend an examination with a speculum to look for leaking fluid or changes to the cervix. They should explain what each examination or test is for and seek your consent. Ask about an interpreter or support person if that would help.
The results help estimate the likelihood of an early birth; one test cannot predict exactly when a baby will arrive. If you go home, ask for a clear follow-up plan and when to return. New or returning symptoms need another call.
Can early labour be delayed?
Sometimes medicines can delay birth briefly, giving time for other treatments or transfer to a hospital with suitable newborn facilities. Labour cannot always be stopped, and delaying birth is not always the safest option.
Depending on how far along you are and the clinical situation, the team may recommend:
- Corticosteroids to support the baby’s preparation for an early birth, particularly lung function.
- Magnesium sulfate before some very early births to help protect the baby’s developing brain.
- Antibiotics when there is a reason such as infection, ruptured membranes or protection against group B streptococcus around birth.
- Medicine to slow contractions when a short delay is appropriate.
These treatments are tailored to your pregnancy; they are not medicines to start yourself. Ask what each option may help with, its risks and what happens if birth proceeds.
If transfer is needed, the team will discuss the safest arrangement. Moving before birth may be possible; sometimes a baby needs transfer afterwards. Preterm birth does not automatically require a caesarean. The recommended way of giving birth depends on your circumstances and your baby’s needs.
Why does preterm birth happen?
There is often no single explanation. It can happen in a pregnancy that has seemed healthy, and it does not mean someone failed to take care of themselves.
A previous preterm birth, a short cervix or previous cervical surgery, a multiple pregnancy, infection and some pregnancy complications can increase the likelihood. Tell your team about past pregnancies and procedures early so they can plan appropriate care.
For some people at increased risk, specialist care may include cervical-length monitoring, progesterone or a cervical stitch. These are options for specific circumstances, rather than something every pregnant person needs. Ask what applies to you at your antenatal appointments.
What care might a premature baby need?
Many premature babies do well. Some need help with breathing, keeping warm, feeding or other health problems. Earlier birth generally means more specialised support, but gestational age alone cannot tell you an individual baby’s outlook.
Your baby may spend time in a special care nursery or neonatal intensive care unit, often called NICU. Monitors and tubes can look overwhelming. Ask the staff what each one does and what they are watching for today.
You are still your baby’s parent while the team provides medical care. Ask how you can be involved, including touch or skin-to-skin when appropriate, nappy changes and feeding. If you want to provide breastmilk, ask for early expressing support. The team can explain the feeding plan and any extra nutrition your baby needs.
Before discharge, ask about feeding, follow-up appointments, developmental checks and who to call with concerns. Readiness to go home depends on your baby’s needs, rather than a promised date or weight alone.
Support for you matters too
You may need to recover from birth while travelling to a nursery or being separated from your baby. Ask about accommodation, transport, social work, counselling and support for siblings. A written daily update or a short list of questions can make conversations easier when you are tired.
Our recovery after birth guide covers your physical and emotional care. You deserve support alongside your baby’s care, however their arrival unfolds.
Sources and further reading
- Queensland Health: Preterm labour and birth, patient information
- Queensland Clinical Guidelines: Preterm labour and birth
- Pregnancy, Birth and Baby: Contractions and when to seek help
- Sydney Children’s Hospitals Network: Premature babies
This is general information for Australian readers. Suspected preterm labour needs assessment by your maternity team.