Episode Transcript
Dr. Rebekah Tompkins:
We have so many new moms that are out there, and it is such a scary and exciting time, but it is stepping into the unknown, and it’s probably the biggest or one of the biggest things that they’ll ever do in their life.
Courtney Collen (host):
Hello and welcome to “Her Kind of Healthy,” a podcast series brought to you by Sanford Health. I’m your host, Courtney Collen, with Sanford Health News. We are starting new conversations about age-old topics from pregnancy to postpartum, managing stress, healthy living, and more. “Her Kind of Healthy” is here to bring you the honest conversations about self-care, happiness, and your overall well-being with our Sanford Health experts. In this episode, we are talking about preterm labor.
I have Dr. Rebekah Tompkins joining me. She specializes in obstetrics and gynecology at Sanford’s Southpointe Clinic in Fargo, North Dakota. Dr. Tompkins, welcome. Thanks so much for being here.
Dr. Rebekah Tompkins (guest):
Thanks so much for having me.
Courtney Collen:
So happy to have you. OK, let’s jump right in. If a normal pregnancy lasts around 40 weeks, what is considered preterm?
Dr. Rebekah Tompkins:
Yeah, you’re exactly right. A normal pregnancy is considered about 40 weeks, and term is considered 37 to 41 weeks. And so preterm would be anything prior to 37 weeks.
Courtney Collen:
What are signs or symptoms that a woman might be experiencing preterm labor?
Dr. Rebekah Tompkins:
Sure, great question. And it can be so tricky because sometimes some of the things that we’re feeling are completely normal and those can bleed over into preterm labor:
- So some of the symptoms could be cramping, and that can happen at normal or with preterm labor, but it often is associated with vaginal discharge.
- There can be some bleeding that’s associated.
- And there can be a lot of pressure or even pain in the pelvis, a dull lower back ache that’s constantly there.
- And you can feel that sometimes women really feel their belly getting very, very, very tight and uncomfortable.
- And then of course what makes it obvious is if the water breaks along with that.
But so those are some of the things, some of the symptoms that occur with preterm labor.
Courtney Collen:
Thank you. Can preterm labor be stopped if any of those signs or symptoms have started?
Dr. Rebekah Tompkins:
It can, and sometimes it even just stops on its own. About 3 in 10 women with preterm labor, it will stop on its own. And for those other 7 out of 10 women, there often are things that we can do to help. A lot of it depends on how far along they are in the pregnancy and a lot of what is actually happening at that exact time.
So there are some medications that we can give. Some IV fluid hydrations can sometimes help, but there are some things that we can do to help out preterm labor to make it stop in a majority of the cases.
Courtney Collen:
Moving on to regular contractions versus Braxton Hicks. What is the difference, Dr. Tompkins, and how do we know?
Dr. Rebekah Tompkins:
Something I tell a lot of my patients when they’re asking about it is, I have women that worry that they aren’t having Braxton Hicks contractions, and then I have women that worry that they’re having too many Braxton Hicks contractions. And what if they turn into regular contractions and how do I know?
So with Braxton Hicks contractions, they’re usually irregular and they don’t really have a specific pattern. You might get, you know, one and then your belly gets really tight and then there’s another one five minutes later, but then it’s 15 minutes until the next one. And so, they don’t have a pattern. They don’t get closer over time. And then the big thing is they’re not changing the cervix, which is obviously hard to know unless you come in to get examined.
If you are having Braxton Hicks contractions, a lot of times if someone drinks water, lays down, empties their bladder, that can really help to make them stop. If someone’s having regular contractions, doing those things isn’t going to make them stop. If someone’s actually in labor, none of those things will make the contractions go away as opposed to other things with contractions.
If they’re real contractions, they’re usually increasing over time, getting closer together. And that’s why you may have heard during your pregnancy, or a lot of women that have been pregnant have heard the 5-1-1 rule where contractions are happening every five minutes, they’re lasting for a minute and that pattern is going on for an hour or more. That’s definitely a time that we want somebody to come in and get checked out. It doesn’t mean that they are for certain in labor, but it certainly is one of the things that we worry about.
Courtney Collen:
If a woman is experiencing any of these things, specifically symptoms of preterm labor like we talked about earlier, what should she do?
Dr. Rebekah Tompkins:
Well, if they have concerns, I always tell someone that they should come in and get checked out.
And so that’s the really truly the only way we can really know what’s going on is to have someone come up and get the baby on the monitor, make sure the baby’s doing well, look for a contraction pattern and see what that’s doing, and also check the cervix often and we can sometimes check the cervix and then an hour or two later check the cervix again and see if there’s been any change that’s happened.
And then obviously we also have the medications that are there that can sometimes help stop the labor as well, if that is deemed to be necessary.
Courtney Collen:
Do you find that there are any lifestyle factors or health factors that might lead to a preterm labor more so in some women than others?
Dr. Rebekah Tompkins:
There are. If someone has had a procedure done to their cervix so that it is shortened or weakened, that can increase the risk for preterm labor. Certain chronic conditions also can increase the risk for labor diabetes, high blood pressure, some autoimmune diseases can also increase that risk. And then there can be infections that are present that can increase the risk for preterm labor. So there certainly are things that can lead to preterm labor that when we do the new OB visit that we’re discussing and throughout the pregnancy we’re checking for to see if anything develops.
Courtney Collen:
And are there any risks associated with preterm labor?
Dr. Rebekah Tompkins:
If someone has had a previous preterm birth, that would certainly increase their risk for having that happen again. It’s certainly not guaranteed, but it can increase that risk if they have a very shortened cervix for whatever reason.
It’s one of the things that we’re looking for when we do the ultrasound at around 20 weeks. When we do – we call it the anatomy scan – we’re also looking at that cervical length and if there’s any concern that can certainly be followed up or looked into more. If the cervix is starting to dilate or looks abnormal even on that first visit, that’s why we usually are looking and checking the cervix at that point.
And then if they’ve had injury during a previous delivery to the cervix, that could increase that risk as well. And bleeding during pregnancy can increase the risk, having more than one baby in there, the more room that they’re taking up, the more chance and pressure that there is that that could cause issues in the future with preterm labor. Smoking, as well. There’s many, many reasons not to smoke. But that’s one of them. And then also being younger than 17 or older than 35.
Courtney Collen:
Are there any risks to baby as a result of preterm labor?
Dr. Rebekah Tompkins:
If they are just in preterm labor, but don’t deliver the actual just contracting of the uterus doesn’t necessarily that doesn’t increase the risk to the baby at all.
But preterm delivery, if the baby were to, if the woman were to go into actual labor and deliver the baby early? Yes, absolutely. I actually had a preterm baby myself. And so, knowing the medical side of things with that, but also knowing the other side of things with that there are definite risks that come along and it depends a lot on how early the baby is born and how developed the baby is and what medications they were able to get beforehand.
We do have some things that can help baby with lung development and some things to help with helping the brain a little bit. So there definitely are things that can be done to help those preterm babies thrive a little bit more right after delivery. And that’s why we encourage women to come in if they have concerns of preterm labor.
Courtney Collen:
Are there things a woman can do during pregnancy whether she is more at risk for preterm labor to prevent those symptoms and maybe reduce the risk of preterm labor?
Dr. Rebekah Tompkins:
Oh, that’s such a great question. There are, especially if someone has had preterm labor before, sometimes there are medications that we would give with progesterone that can help to decrease that risk a bit.
There used to be, if someone had had preterm delivery in the past, there used to be a shot that we would give people, but that actually had, the research has shown that that is not helpful any longer. And so that is not something that we do any longer, but there are things that we can do to help support the cervix and if we find it to be decreased in length, we can do things to try to help keep it at that length and not get shorter.
In general, at home, stop smoking. There are no positive effects to smoking at all, but especially during pregnancy that can increase to preterm labor risk. Drinking lots of water, keeping well hydrated, eating a healthy diet is really, really important, and getting rest. So those are all things that can help to decrease that risk a bit.
Courtney Collen:
Placenta previa is a medical risk factor for preterm labor. Can you explain what that is and why it would be a concern?
Dr. Rebekah Tompkins:
So placenta previa is when the placenta grows over the cervix. And so that can be a very dangerous situation. Thankfully it doesn’t happen very often. It can happen more often at the beginning of pregnancy, but the uterus often as it’s growing, just kind of takes that right out of the way and it becomes a non-issue.
But for those few women that it does stay over the cervix, then we can’t have them go into labor because we don’t want the cervix to dilate be because of the bleeding concern for baby and for mom. And so it, we actually deliver those women early because we don’t want them to go into labor.
And so we usually deliver them around that 36- to 37-week mark. Having that over the cervix can irritate that a bit, and so it does increase that risk some for preterm labor, but it isn’t something that we can really, we can’t move the placenta unfortunately and it doesn’t happen very often. So it isn’t one of those things that come to mind as much for a risk factor for preterm labor, but it certainly is.
Courtney Collen:
Thank you. What do you say to women to ease their anxieties and ease any fears that they have, especially when this is all new to them?
Dr. Rebekah Tompkins:
Yeah, absolutely. It’s something that we see and talk about almost daily because we have so many new moms that are out there and it is such a scary and exciting time. It is stepping into the unknown and it’s probably the biggest or one of the biggest things that they’ll ever do in their life and a big change.
So what I typically tell women is that if you’re taking care of yourself, it means you’re taking care of baby. Doing all those things that we’d already talked about, there is a low likelihood that anything bad is going to happen and that Sanford Health does have just such wonderful obstetrical care. We’re very, very fortunate. If there is something that is happening, we can often pick up on it quickly because we have such an advanced unit up at the hospital.
We have our maternal-fetal medicine, our high-risk pregnancy experts, and they are able to come in and consult and help out with the pregnancy if needed. And if that little one just decides that they want their birthday to be early and they’re going to come no matter what, which does sometimes happen, our NICU is just amazing.
I’m from North Dakota originally. I did residency in Phoenix. Both of my kids needed to be in the NICU. And so when I was coming back to the Midwest, I wanted to pick some place with an excellent NICU as well, just because sometimes no matter what we do, those little ones need some extra help. And so the NICU at Sanford are also spectacular.
And so I really feel like a woman can feel comfortable that most likely what they’re doing is great, and if they’re taking care of themselves, they’re going to do just fine for the pregnancy. If they don’t, we’re always there to help them out and we’ve got just a wonderful amount of resources to help with the pregnancy and with the baby if the little one decides to come a little bit early.
Courtney Collen:
Well, we are so grateful for your insights and your expertise, Dr. Tompkins. Is there anything else on this topic of preterm labor that you wanted to add to this conversation today?
Dr. Rebekah Tompkins:
Boy, I don’t think so. Your questions were wonderful. I just hope that women feel comfortable going into the pregnancy and if they have any questions at all about preterm labor or concerns with it because, boy, even as an OB/GYN myself, my first pregnancy, when I started feeling those Braxton Hicks contractions, I was like, “oh, what is this?” and really had to think about it and kind of sit down and time them out a bit and figure out what was going on. And then once you get used to it, it was more like, “oh, OK, this is a Braxton Hicks contraction.”
I always tell women to never feel embarrassed or that, oh, this is going to be a silly question. There are none. And when you’re going into such a new – even if it’s your sixth pregnancy, you know – never hesitate to reach out and ask. That’s why we’re there.
Courtney Collen:
Yeah, certainly. I know a lot of people take a, “well, let’s just see what happens” approach, but there’s certain things you just don’t want to mess with. Exactly. Preterm labor is one of them.
Dr. Rebekah Tompkins:
Exactly that. And Dr. Google isn’t always the best source. But certainly, if you are really concerned and worried and considering whether you should go into the hospital and be checked out, you probably should be calling. We have 24-hour access throughout Sanford land. And so probably go to an expert, not Dr. Google.
Courtney Collen:
That’s why we’re so grateful for all your information and all that you do to care for patients in and around the Sanford community. Dr. Tompkins, thank you.
Dr. Rebekah Tompkins:
Thanks for this platform to be able to get that information out to people.
Courtney Collen:
Thank you so much for your time.
Dr. Rebekah Tompkins:
Absolutely.
Courtney Collen:
I sure hope you learned as much as I did from our conversation today. This was another episode of the “Her Kind of Healthy” podcast series, brought to you by Sanford Health. For Sanford Health News, I’m Courtney Collen. Thanks for being here.
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Posted In Fargo, Pregnancy, Women's
