“I do not understand all the mystery of grace – only that it meets us where we are but does not leave us where it found us.” – Anne Lamott

While pregnancy is a sacred and beautiful journey, part of that journey is the intensity of it. The stakes are raised, all of sudden you are not just caring for yourself; now you are also fostering a real responsibility for another living being, or beings.

While there are many lifestyle choices you can make to increase the chances of having a healthy and smooth pregnancy and birth, the sad fact is that some forces are simply beyond our control. While many mothers will never experience a miscarriage, stillbirth, or loss of a child, many will. While some may contribute recklessly or inadvertently to these tragedies, many will do everything right and will still become a face of loss.1

Technically every mother is at risk. Preterm labor afflicts every demographic, age and ethnicity but a few factors may place you at a higher risk. By understanding compiled statistics, we hope we can increase awareness and do everything in our power to give you the knowledge to learn from what others have experienced, like Jake.

“It was on Friday, January 14, 2011 when I found out my pregnancy was at risk. I can check off several of the boxes below; carrying twins, high blood pressure, and over 35. But It wasn’t until after my diagnosis and loss of my twins did I discover I was a candidate. I was also not aware of what signs to look for prior to my hospitalization and loss.  I was angry at myself for a long time. I placed a lot of blame on me because it was my body that failed (cervical insufficiency). Why me? What if I did this differently? What if I knew about that? The truth is I cannot go back in time. I wish I knew about preterm labor signs, higher risk factors and that I was not alone. Please know you are not alone.” -Jake McKenna Ibarra, Bereavement Director Doula Spot

When You Find Out

What do you do when you hear the words, in any variation, that your pregnancy is at risk and that your baby may not survive? The truth, is as in any situation, we all process things differently. Feeling anxious, overwhelmed, sadness and disbelief are just a few emotions mothers feel. What on earth were the doctors talking about? There must be a mistake.

What can you do?

  • Have a loved one or a friend attend your OBGYN or hospital appointment with you.
  • If you have older children have a plan in place for childcare, as your appointment may take several hours for testing and diagnosis.
  • Designate one person as your family spokesperson, to share info with friends and family, and possibly hospital staff.
  • Surround yourself with comforting items and people.
  • If you haven’t already, hire a doula for additional support.


Know What the Risks Are 

Every year roughly 25,000 babies die in their first year of life. One third of these deaths are from premature birthsIncreased risk of miscarriage, premature birth, and stillbirth are associated with women who:

  • Are younger than 17 or older than 352
  • Have previously delivered a premature baby
  • Became pregnant too soon after the birth of a previous baby3
  • Are carrying twins or multiples4
  • Have uterine, vaginal and/or membrane infections5
  • Have certain genetic disorders or birth defects6
  • Have high blood pressure7
  • Whose membranes rupture early -known as your water “breaking”8
  • Are pregnant from in vitro fertilization9
  • Become pregnant less than 6-9 months after previous pregnancy10
  • Have high levels of stress
  • Have had a prior miscarriage or pregnancy loss11

Premature Labor 

Preterm (premature) labor occurs when the uterus contracts and your cervix opens earlier than normal. The cervix is the opening of your uterus. In preterm labor, contractions are strong enough and often enough to allow the cervix to open for delivery of your baby. Preterm labor happens after the 20th week of pregnancy but before the 37th week of pregnancy12. An early labor could cause you to have your baby before he or she is ready to be born.”

Sometimes problems with the placenta, uterus or cervix can lead to premature labor:

  • When the cervix does not stay closed on its own (cervical insufficiency or cervical incompetence)
  • When the shape of the uterus is not normal
  • Poor function of the placenta, placental abruption, and placenta previa
  • Look for the following signs of Premature Labor13and act quickly:
  • Pelvic pressure: Sometimes this sensation of fullness and pressure is your only warning sign.
  • Menstrual-like cramps (even if occasional)
  • Watery or bloody vaginal discharge
  • Pain in the lower back (usually dull and may be only occasional)
  • Abdominal cramping (with or without diarrhea)
  • Loss of mucus plug

Stillbirth and Miscarriage 

What are the common causes?

  • Placenta Abruption (the placental lining separates from the mother)
  • Umbilical cord accidents
  • Infections in mother, baby or placenta
  • Carrying twins or more
  • Genetic disorders or birth defects

A routine ultrasound, blood work, fetal echocardiography  or urine test may detect a birth defect in the first trimester. Genetic tests typically requested of mother’s over 35 to detect:

  • Downs Syndrome (also referred to as Trisomy 21)
  • Tay-sachs
  • Chromosomal abnormalities
  • Heart defects
  • Sickle cell

Reduce Your Risks Any Way You Can

Make it a priority to cut the following out of your life during pregnancy:

  • Alcohol use
  • Cigarette smoking
  • Illegal drug use
  • Certain prescription drugs

For Family and Friends:

How to support a loved one who has just found out her pregnancy is at risk. 

This is a very difficult time and likely an unexpected one. Know you are loved and appreciated and that the family did not forget your treasured memories. Sometimes allowing a little space is the best way to help.

  • Be available to just listen.
  • Be present. If not physically, provide help with routine tasks and meals.
  • Keep questions to a minimum.
  • Offer or arrange for childcare (if needed).
  • Treat the family as you always would.
  • You may need support as well. Find someone you can talk to outside of the family, to process your feelings.
  • Remember, if they are distant it is because they are processing this new information. Do not take it personal.


The Delivery: Preparing for Preterm or Stillbirth

The Aftermath: Post Loss and Postpartum

One Year, Beyond, and Trying Again

  1. March of Dimes, “Reduce Your Risk of Preterm Labor and Birth”, http://www.marchofdimes.com/pregnancy/reduce-your-risk-of-preterm-labor-and-birth.aspx#, (September 2012)  

  2. March of Dimes, “A Mommy After 35”, http://www.marchofdimes.com/pregnancy/a-mommy-after-35.aspx (June 2008)  

  3. March of Dimes, “When Your Baby Arrives too early”, http://www.marchofdimes.com/pregnancy/preterm-labor.aspx?gclid=CLD4itfBx70CFaLm7AodT08AoA# (2014)  

  4. Department of Human and Health Services Office on Women’s Health, “Twins, Triplets, Multiple Births”, http://www.nlm.nih.gov/medlineplus/twinstripletsmultiplebirths.html 

  5. What to Expect “Premature Labor: What Might Cause it”, http://www.whattoexpect.com/pregnancy/labor-and-delivery/premature-labor/what-might-cause-it.aspx 

  6. Birth Defects Testing, http://www.webmd.com/baby/tc/birth-defects-testing-what-are-birth-defects-tests (May 10, 2013)  

  7. Mayo Clinic Staff, “High Blood Pressure and Pregnancy: Know the Facts”, http://www.mayoclinic.org/healthy-living/pregnancy-week-by-week/in-depth/pregnancy/art-20046098?footprints=mine, (July 30, 2011)  

  8. Preterm Labor, http://www.sanfordhealth.org/MedicalServices/FetalCareCenter/Learn/PretermLabor 

  9. American Society of Reproductive Medicine, “Risks of IVF Factsheet”, http://www.asrm.org/Risks_of_In_Vitro_Fertilization_factsheet/ (2012)  

  10. “Premature Labor” , http://americanpregnancy.org/labornbirth/prematurelabor.html (March 2007)  

  11. The Royal College of OBGYNs “The Effects of a Previous Miscarriage on Future Pregnancies”, http://www.rcog.org.uk/news/effects-first-miscarriage-future-pregnancies  (August 2008)  

  12. http://www.allinahealth.org/Health-Conditions-and-Treatments/Health-library/Patient-education/Beginnings/Second-trimester/Medical-care/Preterm-labor/ 

  13. http://www.marchofdimes.org/pregnancy/preterm-labor.aspx#