preterm labor | signs + symptoms

• Leaking fluid: This is often caused by uterine cramps that rupture the bag of waters causing fluid to leak, sometimes with a gush.

• Cramps: Light cramping similar to menstrual cramps.

• Nausea/Vomiting: Many women experience these symptoms at some point during labor. If you cannot keep fluids down for 6-8 hours contact your doctor immediately.

• Contractions: Of course, contractions are a major sign of labor. As labor progresses contractions will become stronger, closer together and longer. These are more tense and should not be mistaken as Braxton-Hicks. To know if these are actual contractions, feel your abdomen. If they are real, you will feel your belly harden as it contracts and soften as it subsides.

• Pressure: This is a big indicator that the baby is descending and pushing down. This feeling can also be related to the urge of a bowel movement.

• Vaginal Discharge: You may see a colored tent that is odorless or possibly foul smelling. A change in your vaginal discharge can be a sign of early labor and the details are important when notifying your caregiver. Bloody show can be a more definite sign of potential cervical change.

• Back pain: Many women experience pain in their back during labor, sometimes called back labor.

If you have any of these signs before 36 weeks gestation, contact your midwife or seek medical attention as they may be signs of premature labor. Midwives carry different thresholds surrounding their comfort with attending births as early as 36 weeks. Knowing these signs and acting quickly can help stop dangerously early births. By taking care of yourself, eating healthy, taking the appropriate vitamins, getting adequate care during pregnancy, and staying hydrated you can help prevent preterm labor.

Risk factors of premature labor/birth include (Varneys 7th ed 932):

Demographic

• Age < 17 years or > 35 years
• Chronic stress
• Exposure to systemic racism
• Genetic variants
• Low pre-pregnancy body weight
• Low socioeconomic status
• Congenital anomalies 
• Infection
• Fetal growth restriction

History

• Cervical insufficiency 
• Mother born preterm
• Previous preterm birth
• Substance use
• Short inter pregnancy interval
• Hypertensive issues in pregnancy
• Infections during pregnancy
• Placenta previa
• Polyhydramnios

While most pregnancies will continue safely to full term, it’s still important to recognize the early signs of labor and know when to reach out. Premature birth may be uncommon, but awareness can make all the difference. A midwife supports more than just the physical body—she checks in on stress levels, emotional wellbeing, and the overall rhythm of a woman’s life. She offers reassurance, education, and guidance about when to call, what to look out for, and how to care for yourself in the meantime. Rest, nourishment, hydration, and paying attention to your body are vital. Clinical factors—like infections or a history of early labor—may also be gently assessed to help rule out risks. With knowledge, care, and steady support, women are better equipped to respond with confidence if signs of early labor arise.