Ask the expert: What are the early signs of preterm labor, and when should you call your doctor?

As you move through the later weeks of pregnancy, it can be hard to tell which symptoms are normal and which ones need attention. Many parents experience cramps, pressure, or back pain, but how do you know if these could be signs of something more serious, like preterm labor?

Preterm labor happens before 37 weeks of pregnancy and can sometimes begin with subtle symptoms that are easy to miss or dismiss. 

To help us break down the early signs of preterm labor and offer clarity on what’s normal and what’s not, and when to call your doctor, we spoke with Charles M. Carlsen, OB-GYN and Registered Diagnostic Medical Sonographer at Drsono. With over two decades of clinical and technical experience and a background from Johns Hopkins University School of Medicine, Dr. Carlsen brings deep insight into maternal care and innovation in prenatal diagnostics.

What is preterm labour and how is it different from Braxton Hicks contractions or from other typical symptoms of the third trimester?

Dr. Carlsen: Preterm labour is labour before the pregnancy is at 37 weeks. It’s different from Braxton Hicks contractions, which are unpredictable, discomfort free, and don’t lead to labour. Preterm labour contractions are predictable, painful, and usually have extra symptoms such as back pain or the change of vaginal discharge.

What are the first warning symptoms of preterm labour ?

Dr. Carlsen: The earliest signs of preterm labor include regular contractions, lower abdominal cramping, lower back pain, pelvic pressure, and changes in vaginal discharge, such as increased mucus or water breaking.

When should you call your physician if you are having potential symptoms of preterm labor?

Dr. Carlsen: If you experience any of the above symptoms before 37 weeks, especially if they’re frequent or worsen over time, it’s important to contact your doctor immediately.

Are there any subtle or surprising symptoms of preterm labor that are easy to miss?

Dr. Carlsen: Some of the subtle indications are an abrupt and incessant change in the movements of the baby, abnormal pressure on the pelvic region, or a sense of heaviness. These may go unnoticed, but should never be ignored.

Who is at highest risk of preterm labor, and how can those at highest risk screen themselves best?

Dr. Carlsen: Women who are at higher risk include those who have experienced prior preterm birth, multiple pregnancy, hypertension, infection, or severe stress. The routine ante-natal care and knowledge about symptoms would facilitate the early detection of warning signs.

What if it was a false alarm?

Dr. Carlsen: If preterm labor is ruled out, it’s a relief. Doctors will likely perform tests to confirm, and the patient can return home with reassurance. Better safe than sorry.

If preterm labor is caught early, what are the typical treatments or interventions used to manage it?

Dr. Carlsen: Early treatment may include medication to stop contractions, hydration, bed rest, or even steroids to help accelerate the baby’s lung development. In some cases, hospitalization is necessary for monitoring and more intensive treatment.

Conclusion

Preterm labor can feel confusing, especially when its early signs overlap with normal pregnancy symptoms. But paying attention to changes in your body and trusting your instincts can make a meaningful difference.

If you notice symptoms like regular contractions, unusual pressure on your pelvic region, or changes in discharge before 37 weeks, it’s always best to reach out to your doctor. Getting timely care can help ensure the best possible outcome for both you and your baby.