What should I do if I'm going into pre-labor?

What to Do If You're Going Into Pre-Labor

If you're experiencing signs of pre-labor (also called "false labor" or Braxton-Hicks contractions), you should rest and hydrate, but if contractions become regular, painful, and don't subside with rest, you need to contact your healthcare provider immediately to determine if you're in true labor.

Distinguishing Pre-Labor from True Labor

Key differences to assess:

• Pre-labor (Braxton-Hicks) contractions are irregular in timing, generally uncomfortable but not painful, and subside with rest 1
• True preterm labor contractions are regular, painful, and persist despite rest 1
• Women experiencing regular and painful uterine contractions should cease any physical activity and seek advice from a healthcare provider immediately 1

Immediate Management Steps

If you think you're in pre-labor:

• Rest in a lateral (side-lying) position to optimize blood flow 1
• Hydrate adequately, though evidence shows intravenous hydration alone doesn't prevent preterm birth 2
• Monitor contraction patterns - note timing, duration, and intensity
• Avoid strenuous activity until contractions resolve 1

When to Seek Medical Attention

Contact your healthcare provider or go to the hospital if:

• Contractions become regular (occurring at consistent intervals) and don't stop with rest 1
• You're less than 37 weeks pregnant and experiencing any signs of labor 1
• You experience rupture of membranes (water breaking) at any gestational age 1
• You develop fever ≥100.4°F (≥38.0°C) 1
• You notice vaginal bleeding 1

Hospital Evaluation for Preterm Labor (Before 37 Weeks)

If admitted with suspected preterm labor, expect:

• Vaginal-rectal swab for Group B Streptococcus (GBS) screening unless done within the preceding 5 weeks 1
• GBS antibiotic prophylaxis started immediately if your colonization status is unknown or positive 1
• Continuous assessment to determine if you're progressing to true labor 1
• Antibiotics discontinued if contractions stop and you're not in true labor 1

Historical Context on Hydration and Sedation

Older protocols used intravenous fluids and morphine sulfate to distinguish "real" premature labor from false labor, with 55% of patients responding to this treatment alone 3. However, modern evidence shows hydration doesn't prevent preterm birth and offers no advantage over bed rest alone 2. Women who initially respond to hydration still have a 2.6-fold increased risk of premature delivery compared to the general population 3.

Common Pitfalls to Avoid

• Don't assume all contractions mean labor - many third-trimester women experience increased uterine activity that intensifies with physical activity but isn't true labor 1
• Don't delay seeking care if preterm - if you're less than 37 weeks and contractions persist, immediate evaluation is critical 1
• Don't restrict oral fluids or food unnecessarily during early labor evaluation 4
• Don't continue strenuous exercise if experiencing regular contractions 1

Pain Relief Options During Evaluation

If you're in early labor (less than 5 cm dilation):

• You should be offered neuraxial analgesia (epidural) when available, as maternal request alone is sufficient justification 1
• Neuraxial analgesia should not be withheld based on achieving arbitrary cervical dilation 1
• Reassurance that epidural use does not increase cesarean delivery rates 1

Special Considerations

If you have specific medical conditions:

• Women with severe pre-eclampsia should not engage in strenuous physical activity and require immediate delivery 1
• Women with intrauterine growth restriction (IUGR) should avoid exercise but maintain activities of daily living 1
• Women with cardiovascular disease require specialized monitoring during labor 1