Treatment to slow your preterm labor contractions may be used if:

• You are between 23 and 34 completed weeks of pregnancy.
• You are having regular contractions. 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.
• Your cervix has opened (dilated) to more than 2 centimeters and has begun to thin (efface).

Preterm labor is not always treated. When a pregnancy is nearing term (about 37 or more weeks), or when the mother or her fetus has a serious medical problem, preterm labor is usually allowed to continue until delivery.

When deciding on the amount and type of treatment, your doctor or nurse-midwife will consider:

• Your baby's weight and age. Ideally, preterm labor is delayed until a baby is mature enough that complications after birth are unlikely.
• Your health. Very high blood pressure, severe preeclampsia, HELLP syndrome, chronic disease, infection, or heavy bleeding can make it necessary to deliver immediately, rather than try to delay a birth.
• Your baby's health. Signs of fetal distress or illness can make it necessary to deliver immediately, rather than try to delay a birth.
• Whether your amniotic sac has ruptured (preterm premature rupture of membranes, or pPROM).
• The stage of your labor and its rate of progression. For example, when your cervix is well effaced (thinned) and dilated (opened) beyond 4cm, tocolytic medication to slow labor is less likely to be effective.
• The distance to a neonatal intensive care unit (NICU). Impending labor may be delayed for transport to a hospital with an NICU.
• The benefit of the tocolytic medications used to delay labor versus their risks to you and your baby.

If you are treated for preterm labor

Preterm labor is usually treated in the hospital, in the labor and delivery area. Whether your amniotic membranes have ruptured before contractions start (preterm premature rupture of membranes, or pPROM) or after contractions have begun (spontaneous rupture of membranes, or SROM), you will be admitted directly to the labor and delivery unit. If rupture of membranes has not occurred, you will be observed for at least an hour or two to see whether your contractions continue and your cervix changes (opens and thins).

• If your cervix does not change, or if your contractions stop or slow down, you may be sent home.
• If your cervix changes, you will be admitted to the labor and delivery unit.

If you are admitted to the labor and delivery unit, your doctor or nurse-midwife may choose to:

• Use medication to try to slow or stop the contractions, thus preventing the cervix from opening wider (dilating) or becoming thinner (effacing). Short-term treatment with tocolytic medication is the current treatment. If effective, tocolytics may delay birth for more than 48 hours.¹⁰
• Treat or prevent infection with antibiotics.
• Help the fetus's lungs mature quickly with antenatal corticosteroids (given to you). These medications take 24 to 48 hours to benefit the fetus.

What To Think About