Preterm birth (when a baby is born before 37 weeks of pregnancy) is much more common than most people think. In many cases, there is no single clear cause. Sometimes there are known risk factors, and sometimes everything seems “normal” until labor starts early.
If you’ve experienced a preterm birth, had a baby in the NICU in New York City, or are currently worried about it, there’s something important to say right away:
A preterm birth is not your fault.
Most parents instinctively search for what they “did wrong.” In reality, preterm birth is almost always the result of complex medical and social factors that are beyond any one person’s control.
This article is meant as gentle information and support. It is not a substitute for medical care—if you’re worried, please contact your healthcare provider or go to the nearest maternity unit or labor & delivery triage.
Why can preterm birth happen?
Preterm birth can happen for many different reasons. Some are related to the pregnant person, some to the baby or placenta, and some remain completely unexplained.
1. Conditions that increase the risk of early birth
Examples include:
Infections
Untreated urinary tract infections or certain vaginal infections can sometimes contribute to contractions or the waters breaking early. In pregnancy, even “small” infections can matter and usually need checking and treatment.Changes in the cervix
Sometimes the cervix shortens or opens earlier than expected, without strong contractions. This is not something you can reliably feel at home – it’s usually picked up on ultrasound or vaginal examination.Complications in the baby or placenta
Certain structural conditions in the baby or problems with the placenta or amniotic fluid can increase the risk of preterm birth.Multiple pregnancy (twins, triplets…)
Carrying more than one baby naturally puts more strain on the uterus and can increase the likelihood of a preterm birth.
2. Medically indicated preterm birth
Not all preterm births start “on their own.” In some situations, doctors may recommend starting the birth early (by induction or caesarean) to protect the health of the baby, the mother, or both.
This can happen, for example, when there is:
Severe high blood pressure in pregnancy or preeclampsia
Signs that the baby is not growing well in the womb
Serious complications in the placenta or umbilical cord
Certain severe fetal conditions
In these cases, the question is not “Can we avoid a preterm birth?” but rather:
Where is the baby safer: inside the uterus, or outside in a neonatal unit?
These are extremely hard decisions, and they are never taken lightly.
3. When there is no clear cause
Sometimes contractions start early or the waters break and, despite all tests, no clear reason is found. This can feel particularly upsetting and unfair, because there is nothing obvious to “blame.”
Even in these cases, specialist care can sometimes slow things down and gain precious days or weeks for the baby to grow.
The human side: very hard decisions
When a preterm birth threatens, parents and professionals often face painful choices:
Try to delay the birth with medication and close monitoring?
Or deliver early to prevent serious complications?
Good care means:
Explaining the situation clearly and honestly
Discussing possible outcomes at different gestational ages
Respecting parents’ values and questions
Involving neonatal specialists early, if available
Emotional support is crucial here. Parents are often in shock, frightened, and overwhelmed. Having someone to sit with you, repeat information, and be present during conversations can make a huge difference.
Warning signs you should never ignore
Pregnancy comes with many aches and sensations, and not every discomfort means something is wrong. That’s exactly what makes it confusing: the same symptom can be completely harmless in one person, and important in another.
In general, it’s important to seek medical advice promptly if you notice any of the following before 37 weeks:
1. Contractions or pain that feel “different”
Regular tightenings or contractions that don’t go away with rest
Menstrual-like cramps that are rhythmic or getting stronger
Strong, pulling back pain that comes in waves
These can be signs that the uterus is working harder than it should at this stage.
2. Vaginal bleeding
Any fresh red bleeding in pregnancy should be taken seriously.
Even if it is “just a little,” it is safer to be checked urgently.
3. Changes in discharge or possible infections
A sudden increase in watery, unusual or foul-smelling discharge
Symptoms of a urinary tract infection (burning when urinating, needing to pee very frequently, pain in the lower abdomen or back)
In pregnancy, these can be more than a nuisance—they can sometimes contribute to preterm labor if left untreated.
4. Possible leaking of amniotic fluid
Sometimes the waters don’t break in a big “splash.” It can be a slow leak that just feels like you’re a bit wetter than usual. If you are unsure whether you are leaking urine or amniotic fluid, it is always worth getting checked the same day.
5. A strong feeling that “something is not right”
You know your body and your baby. If you feel that something is off—even if you cannot clearly explain why—reach out:
Call your midwife, OB, or triage line
Go to the maternity unit or emergency department if you cannot reach anyone
You are not “overreacting” by asking for help.
What helps with prevention?
No one can guarantee that a preterm birth will not happen. But there are several layers of protection that can reduce risks or help catch problems early:
1. Good, continuous antenatal care
Regular check-ups
Monitoring blood pressure and urine
Screening for infections and treating them promptly
Ultrasound checks when indicated (e.g., cervical length, baby’s growth)
2. Taking symptoms seriously
Reporting pain, bleeding, unusual discharge, or decreased fetal movements early
Seeking a second opinion if you feel your concerns haven’t been understood
3. Extra care for higher-risk pregnancies
Some pregnancies deserve closer attention, for example:
Previous preterm birth or late miscarriage
Known cervical shortening or prior cervical surgery
Multiple pregnancy
Certain medical conditions (e.g. high blood pressure, some autoimmune conditions)
In many health systems, there are specialised clinics or outpatient services for pregnancies with higher risk of preterm birth. These can offer more frequent monitoring and rapid access if symptoms change.
4. Better information and support
On a broader level, public education around pregnancy warning signs, respectful maternity care, and easy access to reliable information can significantly affect how quickly parents seek help and how early problems are caught.
Articles like this one, antenatal classes, conversations with midwives and doulas, and clear hospital information all play a role.
If you’ve had a preterm birth
If your baby arrived early:
It is normal to feel shock, grief, guilt, anger, or confusion.
You are allowed to mourn the pregnancy and birth you hoped for.
You may need time and support to process what happened—this can include counselling, peer groups, or talking with a trusted midwife, doula, or therapist.
Your experience matters. You are not “too sensitive” or “overreacting” if you are still thinking about the birth months or years later.
A final word (and how I support NYC families)
Preterm birth sits at a difficult intersection between medicine, emotion, and society. It involves complex biology, hard decisions, and sometimes, despite everyone’s best efforts, outcomes that are deeply painful.
What parents deserve in the middle of all of this is:
Clear, honest information
Respectful, compassionate care
Space to ask questions and be part of the decisions
Emotional support during the hospital stay and long after
If you are pregnant in New York City and worried about preterm birth, or if your baby is in a NICU or was born early, you deserve calm, evidence-based support.
I’m a Swiss-trained midwife and doula in NYC with extensive NICU experience. If you’d like support during pregnancy, birth, or the postpartum period after a preterm birth, you can learn more about my birth doula services and postpartum & NICU-informed support here.