Pregnancy is a time of much joy and anticipation for a woman. It is also a time of caution and for first time mums, fear of the unknown.
As a mum-to-be, you take utmost care – of yourself and your unborn baby. You eat healthy, you exercise in moderation, you go for antenatal classes and you remind yourself not to take on unnecessary stress. You meticulously plan for the birth of your child and hope that all will go well.
What you don’t plan for however, unless there are early complications pointing towards the possibility of an early labour, is that your baby could arrive earlier than planned. You believe that your baby will stay safely tucked in your womb till at least the 37 weeks of gestation are over and come into this world, healthy.
However, some women do go into early labour and their babies arrive into this world not quite ready to face the challenges of the first year of life. In fact, in Singapore, 1 in 10 babies are born premature. These babies born-too-soon miss out on the last few crucial weeks in the womb, which is when the brain and other vital organs become fully developed to equip them to survive successfully outside the womb. As a consequence of that, these babies almost always require longer hospital stays, and at times they may also have health complications.
When an unanticipated event like this happens, it’s natural to ask why did this happen…what could I have done to avoid this.
Not all causes of premature births can be explained. However, there are certain factors that place some women at a much higher risk of preterm labour – this could be because of their personal medical histories, complications developed during pregnancy or simply because of certain lifestyle choices.
Here are some tips to assess your risks of having a preterm baby and minimize the risk of premature labour.
Know Your Own Medical History
Be extra mindful of your own personal medical history. One is more likely to have a premature baby under these circumstances:
- Previous premature births - One of the main risk factors for premature delivery is a previous premature delivery.
- Multiple pregnancy – Being pregnant with twins, triplets or other multiples increases the risk of premature delivery.
- Under 17 years old or over 35 years old – The chances of going into preterm labour are heightened significantly if one falls within the age group.
- Have cervical insufficiency – This means that the cervix could open or shorten before one reaches full term, leading to preterm births. Cervical insufficiency could be attributed to the cervix being inherently weak, or the weakness may be caused by previous pregnancy, obstetric trauma or childbirth.
- Have had Premature Rupture of the Membranes (PPROM) previously.
Watch out for Complications During Pregnancy
Even though none of the abovementioned factors may be part of one’s personal medical history, pregnant women could develop complications that could lead to preterm labour and a premature baby. Some of the more common causes are:
- Intrauterine infection - Infection within the womb is one of the leading causes of preterm births. At times, bacterial infections such as E-Coli and Group B Streptococcus (GBS), chlamydia, trichomona, gonorrhea and syphilis travel up from the vagina and infect the womb, causing the fetal membranes to become inflamed and infected. This is called chorioamnionitis. An infection of the membranes may in itself trigger preterm contractions or lead to preterm premature rupture of the membranes (PPROM).
- Pre-eclampsia – This is a relatively common condition, affecting between two to eight in 100 women during pregnancy. Pre-eclampsia is a combination of hypertension (high blood pressure) and proteinuria (protein in urine) and usually sets in after the 20th week of pregnancy. In some cases, organs such as liver or kidneys can become affected and there can be problems with blood clotting. This can lead to intrauterine growth restriction/fetal growth restriction (IUGR).
- Gestational Diabetes – Some mothers develop this complication during pregnancy. It usually happens because your body cannot produce enough insulin to meet its extra needs in pregnancy, resulting in an increase in blood sugar levels. While most women who have gestational diabetes have healthy pregnancies and healthy babies, some women develop more serious complications which could lead to preterm labour and even still births.
Certain Lifestyle Choices Can Increase the Risk of Premature Birth
Lifestyle may be an important factor for increasing risk of preterm birth.
- Smoking during pregnancy can significantly increase the risk of premature birth up to two-fold. Research has found that it is associated with waters breaking early and IUGR.
- Drinking alcohol or consuming street drugs such as cocaine or heroin while pregnant, can harm a growing baby and mothers are more likely to give birth prematurely.
- Body weight is a big factor in determining the state and quality of a pregnancy. Mums are at higher risk of having their baby early if they have poor nutrition, are underweight or obese.
- Mental health is a key factor in determining a healthy full term pregnancy. Women who experience physical abuse are at increased risk of premature labour, as are women who are experiencing severe stress from a serious life event.
While medical history is a given and one cannot always avoid a complication during pregnancy, mums can alter their lifestyles to reduce the risk of premature birth.
Take Care, Be Cautious and Change Lifestyle to Prevent Preterm Labour
Here are some do’s and don’ts that can help reduce the risk of preterm labour.
- Don’t ignore any symptoms - Even at the risk of being labelled as a “paranoid” mum-to-be, it is better to err on the side of caution. Look out for any signs of fever, vomiting, unusual pains or aches, prolonged swelling or discomfort and speak to your doctor immediately. This could help detect an infection earlier.
- Do be regular with antenatal checkups – The importance of this cannot be emphasized enough. Mums may not be aware of many early signs of foetal distress or pregnancy complications, but a doctor or a mid-wife should be able to detect them during antenatal check-ups. Therefore, regular antenatal care is a must. It has been found that many women who have premature babies have less frequent contact with antenatal services.
- Do eat healthily and exercise regularly – This will help maintain a healthy body weight and possibly reduce risk for developing pre-eclampsia and gestational diabetes.
- Do seek help – If you are struggling with depression, abuse or very high levels of stress, don’t cope with it alone. Seek out a friend or professional help.
- Don’t drink alcohol - While no one will frown upon a mum-to-be having an occasional glass of wine, it is safest not to drink at all during pregnancy as the alcohol passes through the placenta and may affect the baby.
- Don’t smoke - Smoking has been linked with premature labour, and the more you smoke the more likely you are to have your baby prematurely.
- Do maintain high levels of hygiene – Wash your hands, keep contact surfaces clean, and avoid contaminated sites – to reduce the possibility of catching an infection.
- Don’t plan a caesarean section unless medically necessary – Several families plan for their baby to arrive on a certain date because of auspicious or other reasons. It is strongly advised not to do so. If the mum-to-be and the baby are healthy, then the pregnancy should be allowed to go through the full term.
While most preterm babies arrive early without any warning, in many cases the risk of a premature birth can be reduced. Mums-to-be need to take greater care, be watchful of their health and be diligent about their antenatal appointments.
Nearly 1 in 10 babies in Singapore is born premature. Support prematurity awareness by sharing this with other mums and mums-to-be. Continue to follow Abbott’s DreamBig series, especially for parents of premature babies and pregnant mums-to-be. The next article will share practical tips with parents about how they should care for their premature baby at home.