DOES EV­ERY BABY COME EARLY?

Your Pregnancy - - Q & A Month 8 -

Q:

I’m 33 years old and preg­nant with my fourth baby. My first son was born at 40 weeks, my sec­ond son at 37 weeks and my third son at 34 weeks. I also mis­car­ried in 2013. I have been on semi-bedrest since 24 weeks (I’m now 30 weeks). Is it true that ev­ery baby you have de­liv­ers ear­lier? I’m so anx­ious.

A:

Preterm labour (PTL) has many causes and trig­gers, and we still don’t fully un­der­stand all the fac­tors in­volved. As a gen­eral rule it is not true that each sub­se­quent baby will be de­liv­ered ear­lier than the last, but hav­ing had a pre­vi­ous preterm de­liv­ery does sig­nif­i­cantly in­crease your risk of an­other preterm de­liv­ery. A pos­si­ble cause in this case is a mild cer­vi­cal weak­ness or in­com­pe­tence. In se­vere cases, cer­vi­cal in­com­pe­tence causes a mid-trimester mis­car­riage, typ­i­cally with a very rapid and fairly pain­less labour. Early into preg­nancy, a cer­vi­cal cer­clage (or stitch) re­duces the chance of a preterm de­liv­ery. At 30 weeks a cer­vi­cal cer­clage is not rec­om­mended. I would sug­gest bed rest. This helps to re­lieve the pres­sure on the cervix and re­lax the uterus. Get up only to go to the bath­room and for meals. Ex­clude a blad­der in­fec­tion if uter­ine con­trac­tions in­crease at any point. An early blad­der in­fec­tion can make the uterus nig­gle. Dis­cuss pro­ges­terone use with your health­care provider. This may help to re­lax the uterus and de­lay de­liv­ery. Re­quest a vagi­nal swab. Stud­ies are sug­gest­ing that cer­tain bac­te­ria found in the vagina may be linked to PTL and treat­ing th­ese may re­duce the chance of early de­liv­ery. Avoid hav­ing sex. Most ba­bies born af­ter 34 weeks do ex­tremely well – so that’s your aim. Af­ter that ev­ery day is a bonus.

DR BRON­WYN MOORE

Gy­nae­col­o­gist

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