ONE: Book for pregnancy care with a midwife early in pregnancy (ideally before 12 weeks) and let your GP know that you are pregnant.

You may find it helpful to call the community midwifery team at your local hospital or go to find your midwife.co.nz.

Your midwife will be able to ask the right questions to see if you need extra care to reduce your chance of spontaneous preterm birth.

TWO: Keep in touch with your midwife and attend all your appointments, scans and tests.

This will allow you to share any concerns with your midwife and they can continue to assess your chance of spontaneous preterm birth.

THREE: Complete a urine sample and vaginal swab when you first meet with your midwife.

Let your midwife know if you have symptoms of a urine infection (burning when you pass urine, or a change in the colour or smell of your urine) at any time during your pregnancy.

Treating urine and sexually transmitted infections with antibiotics reduces the chance of you becoming unwell and reduces the chance of spontaneous preterm birth.

FOUR: If you are smoking cigarettes in pregnancy, try to become smokefree by 16 weeks.

Talk to your midwife/doctor about nicotine replacement therapy and ask for a referral to your local smokefree programme to help you achieve this goal.

Becoming smokefree by 16 weeks, reduces your chance of spontaneous preterm birth to that of a non-smoker.

FIVE: Let your midwife know.

At the beginning of your pregnancy, if you have any of the following risk factors for spontaneous preterm birth, ask if referral to your local hospital is recommended.

• Previous spontaneous preterm birth or late miscarriage (after 16 weeks)
• Previous surgery to your cervix - LLETZ procedure or cone biopsy
• An unusual shape to your uterus or cervix – for example a bicornuate uterus
• Previous caesarean section performed when the cervix was fully dilated (10cm)
• Multiple operations through your cervix - surgical termination of pregnancy or surgical management of a miscarriage (ERPC or D&C).
• Connective tissue disorder like Ehlos Danlos syndrome

Your local hospital will arrange for review by the Preterm Birth Clinic or a doctor with a special interest in preterm birth. They may consider some additional treatments (cervical cerclage or progesterone treatment) and recommend some extra scans to check your cervix in the middle part of your pregnancy.

Once you have reached 20 weeks, if you have any of the following signs or symptoms of labour. Preterm birth can happen to anyone, so it is important to know what to look out for.

• Puku/tummy/abdominal or lower back pain that feels like period pain or comes and goes at regular intervals (contractions)
• Bleeding from the vagina
• Watery fluid from the vagina
• Increase in mucus discharge from the vagina

Although it is not always possible to stop all early labours, there is lots that can be done to prepare and help pēpi survive and be healthy and well when labour happens from 23 weeks.