Understanding Preterm Labor & How to Respond

Pregnancy is full of surprises. Some are sweet, some a little strange, and some can feel a little unsettling. For many soon-to-be parents, one of the biggest worries during pregnancy is labor showing up earlier than planned.

Preterm labor isn’t something anyone expects. And while it’s not extremely common, it does happen. If labor starts sooner than 37 weeks, it’s important to understand what’s going on, why it may happen, and how to to handle preterm labor.

Knowledge won’t erase the uncertainty, but it does make you feel safer and more confident.

So, let’s walk through it together. In this article, we’ll explain what preterm labor really means, what causes it, how to recognize the signs, and how midwives support families through these unexpected moments. 

Listen to the Homebirth Midwife Podcast Episode on Preterm Labor!

What is preterm labor?

Preterm (or premature) labor happens when contractions and cervical changes begin before 37 completed weeks of pregnancy. Since full term is 37 to 42 weeks, anything earlier falls under the “preterm” category.

If preterm labor continues, it can lead to premature birth, when a baby arrives before their lungs and other organs are fully ready. That can carry risks, but it’s not always as straightforward as "early contractions = early birth”. Sometimes, labor can be slowed or even temporarily paused, giving your baby valuable extra time to grow stronger.

According to the CDC, in 2022, about 1 in 10 babies were born prematurely in the United States. The most recent provisional data from 2024, show this number holding steady at 10.41%. Preterm birth is also one of the leading causes of infant illness and death, accounting for 14% of infant deaths in 2022.

But behind those numbers are real parents and babies navigating unexpected turns in their journeys. That’s why understanding preterm is so important. 

What Causes Preterm Labor?

One of the hardest parts of preterm labor is that it doesn’t always have a clear explanation. Many parents do everything right and still find themselves facing contractions earlier than expected. Preterm labor can be influenced by many factors, and often there’s no obvious cause.

We do know that certain patterns make it more likely. A history of preterm birth is the strongest indicator, and carrying multiples (twins, triplets, or more) puts extra strain on the uterus. Sometimes the shape or length of the cervix plays a role, or previous surgeries may have left the uterus more sensitive. Conditions like preeclampsia, high blood pressure, diabetes, or infections can also contribute.

Age can be a factor too, with pregnancies in the teenage years or beyond age 35 showing higher risk. Lifestyle and environment also matter. Smoking, stress, or not having consistent access to prenatal care can add weight to the body’s load.

The numbers also show deep disparities. In 2022, nearly 15% of babies born to Black mothers in the U.S. arrived too soon, compared to around 9 to 10% for White or Hispanic mothers. That difference has nothing to do with biology and instead reflects systemic inequalities and daily stressors that too many families live with.

What matters most here is awareness, not blame. Knowing potential risk factors helps you and your midwife pay closer attention, but it’s not about fault. It’s about being supported and prepared.

Recognizing the Signs of Preterm Labor

How do you know if what you’re feeling is just normal pregnancy discomfort, or the beginning of something more serious? Isn’t always easy to know, but there are certain red flags to watch out for.  

Here are the most common preterm labor symptoms and signs:

• Regular contractions (more than 4 to 6 in an hour) that don’t ease up with rest.

• Menstrual-like cramps or steady abdominal cramping.

• A dull backache that won’t let up.

• Pelvic pressure, as if the baby is pressing downward.

• A change in vaginal discharge,  watery, mucus-like, pink, or brown.

• Vaginal bleeding or spotting.

• Leaking fluid, which could mean your water has broken.

• Noticeably less movement from your baby.

It’s easy to confuse these with Braxton-Hicks contractions. The difference is that Braxton-Hicks are usually irregular, mild, and often stop if you rest or hydrate. Preterm labor contractions keep coming, get stronger, and don’t go away.

Here’s a good rule of thumb: If you’re less than 37 weeks and you notice any of these symptoms for more than an hour, call your midwife or doctor right away. It’s always better to be checked and reassured than to wait it out at home.

Handling Preterm Labor

If preterm labor signs show up, the very first step, again,  is to call your midwife or medical provider. Don’t wait to see if things pass on their own as preterm contractions need immediate attention. Your provider will want to assess you and your baby quickly, either in the clinic or at the hospital.

Once you’re in care, there are several tools your team may use to give your baby more time and protection:

• Corticosteroid injections help your baby’s lungs mature faster if birth seems likely. Even an extra 24 to 48 hours can greatly improve breathing after birth.

• Tocolytic medications may be used to relax the uterus and slow contractions for up to 48 hours, buying time for steroids to work or for transfer to a neonatal intensive care unit if needed.

• Magnesium sulfate may be used to delay contractions for a few days if you’re before 32 weeks. It also reduces the risk of cerebral palsy if your baby is born prematurely.

• Antibiotics are given if there’s evidence of infection or if your water has broken early. Preventing infection protects both you and your baby.

The goal of these interventions is generally to slow things down. These steps aren’t a guarantee of premature birth prevention but can give your baby a little extra time to grow and for your medical team to prepare in case a preterm birth does happen.

Meanwhile, there are gentle, natural ways you can help yourself feel calmer and more comfortable while waiting for your care team to act. These won’t replace medical treatment, but they can make contractions less overwhelming and give you a greater sense of control in the moment.

Related: How Midwives Handle Complications during a Natural Birth

Tips for Handling Preterm Labor Contractions

While your provider manages the medical side, there are small things you can do to ease the experience of preterm labor contractions. 

First and foremost, try to rest and relax. Take a warm shower or place a heating pad on your back to help soothe cramping. Try to slow your breathing and hold your partner’s hand to help you stay grounded when contractions feel strong. Drink fluids and nibble on something light if you’re hungry. 

These little preterm labor tips don’t change the course of labor, but they can make a tough moment feel a little more manageable.

Common Questions About Preterm Labor

What causes preterm labor?

It can happen for many reasons, including a history of preterm birth, carrying multiples, health conditions, or infections. Stress and limited prenatal care may also add risk, though sometimes there’s no clear cause.

What are the symptoms of preterm labor?

Common preterm labor symptoms include regular contractions, cramping, backache, pelvic pressure, changes in discharge, spotting, or leaking fluid. If you’re under 37 weeks and notice these signs for more than an hour, call your provider.

Can preterm labor be stopped?

Not always, but it can often be slowed. Treatments like corticosteroids, magnesium sulfate, or tocolytic medications may buy valuable time for your baby to grow.

How can I handle preterm labor if it happens?

Call your midwife or provider right away. While waiting for care, rest, hydrate, use warmth for comfort, and lean on your support system. 

Questions About Home Birth? Hearth & Home Is Here to Help!

Preterm labor can be one of the most unsettling surprises in pregnancy. That’s why it’s important to understand what it is and the signs to watch out for. It’s also a good idea to have a plan in place in case you do go into labor preterm. 

If you notice contractions, pelvic pressure, back pain, changes in discharge, or decreased baby movement, it’s time to rest, hydrate, and call your midwife. If things don’t slow down after an hour, head in for care.

And remember: your birthing experience still belongs to you. Even when things don’t go according to plan, you remain in charge. With certified professional midwives and a strong support system by your side, you can feel safe and confident in the face of unexpected preterm labor. 

If you’re looking for a midwife for your own birth, make sure to check out our article on how to find a midwife.