If you notice any changes, trust your instincts. You know your body and your baby best. Don't hesitate to call your caregiver or birth centre at any time.

Call your caregiver or birth centre immediately if you experience any of the following:

• Bright red vaginal bleeding with or without pain
• Signs of preterm labor (labor before 37 weeks of pregnancy)
• Signs of high blood pressure in pregnancy (sometimes called pre-eclampsia or toxemia), which include
• sudden or severe swelling of your face, hands and feet
• sudden weight gain of 1 kg (2.2 lb) over a period of a week or less
• dizziness, headaches, changes in your vision (such as blurring or seeing spots)
• sudden and severe vomiting
• Any change or absence of fetal movement. Once you begin to feel your baby's movements regularly (at about 28 weeks) you should feel movement throughout the day, every day. A decrease in movement may be the first warning that your baby is not well or having trouble.

Counting movements is best done when you are lying down. Feel for your baby's movements by placing your hands on your abdomen.  If you do not feel your baby move six times in two hours, call your caregiver or birth centre. A decrease in movement does not occur before labor starts. Even when you are in labor, you should still feel your baby move.

Call your doctor if you have:

• Less than 6 movements in two hours.
• Abdominal pain.
• A gush or trickle of fluid from your vagina. This could indicate that your membranes (bag of waters) have broken. The amniotic fluid is enclosed in a sac that surrounds and protects your baby. Once this sac has broken, your baby faces an increased risk for infection.
• Foul-smelling vaginal discharge. (Vaginal discharge causing itchiness and irritation should be reported within 24 hours.)
• Frequent passing of urine with a burning sensation should be reported within 24 hours.
• Any illness causing fever (over 38 degrees C or 100.4 degrees F).
• An injury or accident, such as a fall or a motor vehicle accident.
• Persistent negative feelings, lasting low mood and/or overwhelming feelings of anxiety.
• Suicidal thoughts.

Labor that starts too early (more than 3 weeks before your due date) may lead to preterm birth.

 Why be concerned?
Preterm babies are at greater risk the earlier they are born. Preterm babies are more likely to:

• Have trouble breathing, feeding and keeping warm
• Suffer long-term problems (seeing, learning, walking, breathing)
• Be too small and weak to live
• Suffer from infections
• Have longer hospital stays

 Who is at risk?
Preterm labor can happen in any pregnancy. Half of all preterm births are to women with no known risk factors. Some things that increase the risk include:

• Tobacco smoke
• Previous preterm birth
• Injury (including family violence)
• Alcohol and drug use
• Multiple pregnancy (twins or more)
• Periodontal disease (gum and bone disease)
• Age less than 17 or greater than 35 years
• Pregnancy complicated by other conditions like high blood pressure, diabetes, bleeding
• Not eating often enough (at least every 3 hours) during the day

 What are the signs of preterm labor?
Some women just know that something is not right, but specific signs include:

• Contractions (may be painful or painless)
• Bleeding from the vagina
• Cramps (may feel like menstrual cramps or gas pains)
• Changes in low back pain
• Fluid gush or leak of fluid from the vagina
• Full or heavy feeling in the vagina
• Change or increase in vaginal discharge

It is important to know the signs of preterm labor - often labor can be stopped or delayed. Trust your instincts. If you are concerned that something is wrong, do not hesitate to call your caregiver or go to the hospital. It can make a big difference to your baby's health.

How to reduce the risk of preterm labor

If a baby is born before 37 weeks
About 6 out of every 100 babies are born before 37 weeks. In general, the earlier a baby is born, the greater the chance that he or she may have problems. Premature babies are more likely to have breathing and feeding problems and are more prone to infections. However, with the medical treatments available today most premature babies survive and most do very well.

If your baby is born before 37 weeks, he or she will likely require care in a Special Care Nursery. If further medical treatments are required, your baby may need to be moved to another intensive care nursery, perhaps to another hospital.

Having a premature baby can be scary. Your baby may need to be in a special incubator to be kept warm and might need tubes and monitors. The doctors and nurses will provide you with information and support. Although the staff may seem very busy, they invite you to be involved in your baby's care. It is important for you to ask questions and share your concerns with the staff.

All babies, including premature babies, need to be touched and spoken to. You will be encouraged to be involved in your baby's care as much as possible. Breastfeeding is encouraged as breast milk is the perfect food for all newborns, especially premature babies. The staff will help you to breastfeed and teach you how to express your breast milk.

Parent groups can be a good source of support. Ask the nursery staff for further information.