Preterm labor often starts without obvious symptoms. However, you may notice one or more symptoms, including:

• Menstrual-like cramps, with or without diarrhea.
• A feeling of pressure in your pelvis or lower abdomen.
• A persistent, dull ache in your lower back, pelvic area, lower abdomen, or thighs.
• Changes in your vaginal discharge, which may increase in amount or become pink or reddish.
• Regular contractions of your uterus for an hour. This means about 4 or more in 20 minutes, or about 8 or more within 1 hour, even after you have had a glass of water and are resting.
• Not feeling well, including:
  • Unexplained fever.
  • Fatigue.
  • Uterine tenderness.

It is sometimes hard to tell the difference between Braxton Hicks contractions and preterm labor contractions.

You may have one or more of these symptoms and not be in preterm labor. However, if you are concerned, notify your doctor or nurse-midwife.