Understanding Early Labor Signs: A Doctor's Response

Question
Dear Dr. Rappaport,
I am currently 29wks +3days pregnant, edd Dec 24th. This is my second pregnancy (1st one ended in a missed miscarriage at 12 weeks). This pregnancy has been fairly normal other than a subchorionic bleed early on and some unconfirmed small amniotic fluid leaks at 14 and 18 weeks.

For about the last week I have been having what I think are contractions off and on. They seem to be fairly irregular, not terribly painful, and the closest together has been 4 in one hour (15 minutes apart), but then they stopped. I have also been having some lower back pain and period like cramping off and on over the last few days, as well as a very severe spontaneous nosebleed a couple of days ago. The baby still seems quite active and feels like it is still up quite high as I can feel it hitting my ribs.

Would these likely be normal Braxton-Hicks contractions at this stage or could they be possible signs of preterm labour? Will they likely become more frequent as the pregnancy progresses into the final weeks? I have an obstetrician appointment in just over a week, but am wondering if I should ask to be seen earlier?

Thank you so much for your time!

Regards,

Autumn

Answer
You will normally have occasional contractions throughout the pregnancy. These contractions may be Braxton-Hicks contractions (no effect on cervical dilatatin), or merely prodromal labor. As long as you are not having regular contractions occurring more than 10 minutes (from the beginning of one contraction to the beginning of the next contraction) at the level of the belly button and as long as each contraction does not remain hard for more than 30 seconds, you can ignore them. Drink plenty of water so that you are well hydrated. Dehydration can cause preterm labor. If, however, you start to have contractions more frequently than 10 mintues, first drink lots of water. If the contractions do not stop, go the the hospital and be checked.