Q&A: I had a premature baby with my last pregnancy and I am afraid it will happen again.

I am sorry to hear you delivered so early last time. Having a preemie is stressful for the whole family, and you have already experienced the challenges of giving birth early. While most moms who have had preemies go on to deliver at term, you will be considered at increased risk for preterm birth again. About 20 percent of moms who delivered a preemie in their first pregnancies go on to have another early birth. Having prior full term pregnancies decreases that risk, and having had other premature births increases it.

Unfortunately, medical science doesn't totally understand why some babies come early, and prevention options are limited. Cigarette smoking is clearly related to premature birth, so if you are a smoker, quitting before your next pregnancy will help. A medication called 17 alpha hydroxyprogesterone, given by weekly injection starting in the second trimester, seems to provide some protection from recurrent preterm birth. Research is being done to see if there are alternatives that don't require injection.

Talk to your obstetrician about why you gave birth early last time, and what can be done the next time around to try to prevent the same thing from happening. You can help improve your odds by spacing your children more than 18 months apart, and getting early and consistent prenatal care. Although bed rest hasn't been shown to improve outcomes, pregnancies go best when the mom can change her activities based on how she is feeling, and slow down when she needs to.