Signs of Preterm Labour Every Pregnant Woman Should Know

TL;DR: Preterm labour is labour that starts before 37 weeks of pregnancy. Warning signs include regular tightenings or contractions, period-type pains, pressure low in your pelvis, a gush or trickle of fluid, vaginal bleeding, and backache that is not usual for you. If you notice any of these before 37 weeks, call your maternity unit or go to hospital straight away. Steroid injections and other treatments work best when given early.

It is late evening, you are 31 weeks along, and your lower back has been aching since lunch. Every so often your bump goes hard, then softens again. You tell yourself it is the long day, the standing, the heat. Maybe it is. But sometimes those tightenings are the start of labour, weeks before your baby is ready. Today is World Prematurity Day, so we want to talk plainly about how preterm labour can feel, why it matters so much for African families, and why calling early is never an overreaction.

What counts as preterm labour?

Preterm labour is labour that begins before 37 completed weeks of pregnancy. A baby born before 37 weeks is called preterm or premature. Most pregnancies last around 40 weeks, and those final weeks are when your baby's lungs, brain and ability to keep warm and feed mature quickly. The earlier a baby arrives, the more help they are likely to need.

The NHS notes that about 8 in 100 babies are born prematurely. Not every early tightening means labour, and many women with symptoms go on to carry their babies for longer. That is exactly why getting checked matters: only an assessment can tell the difference.

How common is preterm birth in Africa?

Preterm birth affects families everywhere, but the weight of it falls hardest on sub-Saharan Africa and southern Asia. The World Health Organization estimates that 13.4 million babies were born preterm in 2020, more than 1 in 10 births worldwide, and that most of them were born in those two regions. Complications of preterm birth are the leading cause of death in children under 5, responsible for around 900,000 deaths in 2019.

Where a baby is born changes the odds sharply. WHO reports that in low-income settings, around half of babies born at or before 32 weeks die because they do not get feasible, cost-effective care such as warmth, breastfeeding support and basic help with infections and breathing. In high-income countries, almost all of these babies survive. So the gap is less about the babies themselves and more about access: to antenatal care, to a facility that can manage an early birth, and to someone who takes your symptoms seriously when you first call.

What are the signs of preterm labour?

The main signs of preterm labour are regular tightenings or contractions, period-type pains, pressure in your pelvis or vagina, a gush or trickle of fluid, vaginal bleeding, and backache that is not normal for you. If any of these happen before 37 weeks, contact your maternity unit straight away.

Here is what each one can look like in everyday life:

• Tightenings or contractions. Your bump goes hard and then relaxes, and it keeps happening in a pattern, or it gets stronger, closer together or more painful.
• Period-type cramps. A dull ache low in your tummy, like the start of a period, that comes and goes or does not settle.
• Pelvic pressure. A heavy, pushing feeling down in your pelvis or vagina, as if the baby is pressing low.
• Fluid. A gush, or a slow trickle that keeps you damp, can mean your waters have broken. It is easy to mistake for urine or discharge, so do not wait to be sure.
• Bleeding or a show. Any vaginal bleeding in pregnancy needs prompt advice. A "show" is the mucus plug that seals the cervix coming away, which can look like thick, jelly-like discharge, sometimes streaked with blood.
• Backache that is new for you. A low, persistent backache, especially one that comes in waves, can be labour in disguise.

NHS maternity services such as Kingston and Richmond NHS Foundation Trust also advise telling your midwife or hospital immediately if you are bleeding, your baby is moving less than usual, or your waters have broken and the fluid is smelly or coloured. The same leaflet offers some reassurance: in 7 out of 10 cases, the symptoms settle and women go on to give birth at full term. If you are not sure what normal discharge looks like at this stage, our guide to vaginal discharge can help, but in pregnancy the rule is simple: when in doubt, call.

What should I do if I think I am in preterm labour?

Call your maternity unit, labour ward or midwife straight away, or go to the nearest hospital with a maternity service if you cannot get through. Do not wait for symptoms to get worse, and do not wait until morning.

A few practical steps help:

1. Note the time your symptoms started, and roughly how often tightenings are coming.
2. Wear a pad, not a tampon, so staff can see any fluid or blood. Keep it to show them if you can.
3. Bring your antenatal notes or maternity card, especially if you are attending a different hospital from your booking one.
4. Arrange transport early. In cities like Lagos or Nairobi, traffic can turn a 20-minute drive into an hour, so leave sooner rather than later.
5. Tell someone. A partner, sister, neighbour or friend who can come with you or mind your other children.

At the hospital, the NHS explains you may be offered a vaginal examination, blood and urine tests, and monitoring of your contractions and your baby's heartbeat. If your bag is not packed yet, our list of what to pack in your hospital bag is worth reading well before 37 weeks.

Who is more at risk of going into labour early?

Preterm labour can happen to anyone, often with no obvious reason. The CDC lists several factors that raise the chance:

• having had a preterm birth before
• carrying twins, triplets or more
• infections during pregnancy
• high blood pressure conditions in pregnancy, including pre-eclampsia
• being a teenager or older than 35
• smoking or using drugs
• stress and lower income

The CDC also lists Black women among the groups with higher rates of preterm birth. We explore this further in why Black women face higher risks in pregnancy and childbirth. If any of these apply to you, ask at your next appointment whether you need extra checks. Our list of questions to ask at antenatal appointments can help you start that conversation.

Which treatments can help if labour starts early?

There is no single fix that stops preterm labour every time, but several treatments improve outcomes for babies, and they work best when started early. That is one more reason to call as soon as something feels off.

Steroid injections. Corticosteroids given to the mother help the baby's lungs mature and lower the risk of death and breathing problems. The World Health Organization recommends them from 24 to 34 weeks when preterm birth is likely within seven days, the pregnancy dates are reliable, there is no sign of infection in the mother, and both mother and newborn can get adequate care. In the UK, NICE recommends offering them between 24 and 34 weeks.

Magnesium sulphate. Given through a drip, it helps protect the baby's brain. NICE recommends offering it when birth is expected within 24 hours between 24 and 30 weeks, and considering it up to 34 weeks.

Prevention for women at higher risk. If you have had a previous preterm birth or a short cervix, your team may offer a scan to measure the length of your cervix, usually between 16 and 24 weeks. Depending on the result and your history, they may recommend vaginal progesterone or a stitch in the cervix, called a cervical cerclage, to help support it. These are tailored to you, so ask whether they apply.

After birth. WHO highlights kangaroo mother care, holding your baby skin to skin on your chest, as one of the simple measures that saves the lives of small babies. On the podcast, we also spoke with Innitius CEO Rubén Molina about how technology could help spot preterm birth risk earlier, in Blush and Bloom episode 48.

Trust what your body is telling you

Many women describe feeling silly for going in with "just a backache", or being sent home and feeling embarrassed. Please do not let that stop you. Being checked and told everything is fine is a good outcome, not a wasted trip. Midwives would always rather see you early.

Keeping a simple record helps. Asele lets you log symptoms such as cramping, back pain or discharge, so you can tell your midwife when something started and how it has changed. You can also bring your Asele Health Brief, a pre-visit summary of what you have logged, to antenatal appointments. And if you want to talk through what a symptom might mean before you call, Amara can chat with you in Yoruba, Hausa, Igbo, Swahili, French or English, while always pointing you to your midwife or hospital when something needs checking. Find us at Asele.

This post is education, not medical advice. If you are pregnant and worried about any symptom, contact your midwife, maternity unit or hospital straight away.

References

1. World Health Organization. Preterm birth fact sheet. who.int
2. NHS. Premature labour and birth. nhs.uk
3. Centers for Disease Control and Prevention. Preterm birth. cdc.gov
4. Updated WHO recommendations on antenatal corticosteroids and tocolytic therapy for improving preterm birth outcomes. Lancet Global Health, 2022. ncbi.nlm.nih.gov
5. NICE. Preterm labour and birth (NG25): recommendations. nice.org.uk
6. Kingston and Richmond NHS Foundation Trust. Premature labour (patient leaflet). kingstonandrichmond.nhs.uk