Signs of Labor

This was originally written on Wednesday, February 27, 2008

I've forgotten to mention in the past that many women notice faster growth with their hair and nails during pregnancy. For me, I can agree with the latter one--but as for the hair, I have the world's slowest growing hair so it doesn't surprise me that I haven't noticed an improvement with this one. I think I have some gene that makes my hair stop growing when it gets to the point it is now, because it's never been longer than this--which is the same length it's been for almost two years (with only trims, no cuts).

Moving on. . .no matter if you are in the first, second, or third trimester, it is good to learn the signs of labor.

*Lightening: Earlier in your pregnancy, your uterus/fetus was positioned high in your abdomen, just underneath your breasts. As delivery nears and your baby grows, it drops two to three inches away from your ribs. This process is called lightening. It can occur weeks before the onset of labor or anytime right up to when labor begins. Many women describe it as increased pressure in the pelvis. This pressure results from the baby's head settling into the bony pelvis.

*Contractions: Throughout pregnancy, the uterine muscles contract from time to time. They are often painless, irregular in frequency and mild in intensity. Many women describe these contractions as a "balling up" sensation. The closer you get to your due date, the more likely you are to experience Braxton-Hicks contractions. These contractions can mimic true labor contractions and may make you feel as if your labor has begun.

*Effacement: After prostaglandins soften and ripen your cervix, it further prepares for birth by thinning out the cervix or effacing it. The cervix is normally an inch and a half to two inches long and will become paper thin as it stretches and pulls over the baby's head. Your nurse or healthcare provider are able to tell you if there are any changes to your cervix by doing a pelvic exam.

*Dilation: The cervix opens gradually and is measured in centimeters from 0 to 10. Both effacement and dilation are estimated upon vaginal exam and are subjective measurements. One way to help you visualize these changes is for you to think about a ketchup bottle. If you hold it upside down, you can think of it as your cervix. It has a very long thick neck. Compare this image to a mayonnaise jar held upside down. The neck of the mayonnaise jar is thinned out and its opening measures about 10 centimeters. This is a strange analogy but a great way for you to visualize exactly how the process of labor changes the cervix.

*Station: The relationship of the top of the baby's head or presenting part to the spines of your pelvic bones is known as station. Upon vaginal exam your healthcare provider can feel two bony prominences through your vaginal wall. These are known as the ischial spines. If the baby's head is above the ischial spines it is a negative number--below the spines it is a positive number. For example, +2 station means the head is 2 centimeters below the spines.

*Mucous Plug: The plug blocks the long cervix and helps to prevent bacteria from getting into the uterus. As the cervix ripens and softens, the plug may be dislodged. It is a very thick, stringy piece of mucous that is not always noticed by women. It can also be called a bloody show. The cervix has a rich blood supply and as the mucous passes through the cervix it may appear blood-tinged. It could be moments or days until labor begins and is one of the signs of the prelude to labor.

*Bag of waters or ruptured membranes: You never know where you are going to be when your labor begins or when and if your membranes rupture. It is advisable to carry a towel in your car, sanitary pads in your purse, and most important, protect your mattress with a plastic shower curtain or something which will not allow the amniotic fluid to ruin it. It is important to come to the hospital if you think your water has broken. Most healthcare providers prefer to deliver your baby within 24 hours of the time of the rupture because of the possibility of infection.

*Nesting or burst of energy: One day you will wake up and clean one end of the house to the other. It is the best you have felt in nine months! This is commonly referred to as the nesting instinct; you will prepare and get things ready for the big event. Just do not over do it. You do need to conserve as much energy as possible. Fatigue and a lack of sleep are your worst enemies when labor begins.

*Gastrointestinal disturbances: It is very common for some women to experience nausea and/or diarrhea at the beginning of labor. Many believe it is due to the sudden increase of hormones once labor begins. Some women will have nausea and vomiting as the stages of labor progress, and others may have no symptoms at all.

To decide if your contractions represent true or false labor, record the time between the start of one contraction and the start to the next. Do this for several contractions in a row. True labor contractions occur at regular intervals. Intensity of contractions increases. Intervals between contractions shortens. There will be discomfort in back and/or lower abdomen. Discomfort does not stop with walking. Cervix dilates. False contractions occur at irregular intervals. Intensity is relatively unchanged. Interval between contractions is not shorter. Discomfort is primarily in lower abdomen. Discomfort frequently relieved with walking. Cervix does not dilate.

If you suspect you could be in labor, the first thing to do is relax. Prepare to time your contractions. Stay calm. (My doctor said that if I'm after 36 weeks then I am to wait until I can hardly stand it and am having a hard time talking between contractions before going to the hospital. They will then call her. Prior to 36 weeks, however, I am to call her immediately and not hesitate for a second to go to the hospital.) If your water breaks, whether you have contractions or not, call your healthcare provider promptly or go to the hospital.

Warning signs which need immediate attention:

*Preterm labor (before 36 weeks): More than 4 contractions occurring in an hour, menstrual-like cramps--may come and go or be constant, abdominal cramps--may occur with or without diarrhea, low backache--comes and goes or is constant, pelvic pressure--feels like the baby is pushing down, and change in vaginal discharge---a sudden increase in the amount or may become more mucous-like, watery or slightly blood-tinged.

*Vaginal bleeding: Bright red bleeding is not normal. Note the following--amount of bleeding and presence of clots.

*Decreased fetal movement: You may choose to use a fetal activity chart the last few weeks of pregnancy to track movement. Absence of movement or significant lessening of movement may be of concern; notify your healthcare provider.

*Fever: Notify your healthcare provider if you have a fever.

*Headache: Unusually severe. Seeing spots or flashing lights. Other neurological symptoms--numbness, loss of vision, weakness, loss of balance or speech difficulty.

*Urinary discomfort: Frequency with small amounts. Painful urination. Blood-tinged urine. Pus in urine.

There are three stages of labor:

*First stage: Occurring from the time true labor begins until the cervix is completely dilated and the baby can pass out of the uterus through the cervix. This is the longest stage; the average duration for women having their first child is 12-16 hours. During the early stage (the start of labor until the cervix dilates to 3 centimeters), women are very social and feeling eager, excited, and full of anticipation. Do not overdo. Conserving your energy now is imperative since this is the longest phase. The active stage (dilates your cervix to 7 centimeters) averages around 4-5 hours. Women are now extremely involved in the work of labor and occupied with their focus on the job at hand. They are no longer social. The contractions grow stronger and are progressively longer. The transition phase is the hardest phase within the first stage of labor, but is the shortest. It can be as short as 30 minutes and as long as 2 hours. This phase will dilate the cervix up to full dilation or 10 centimeters. These contractions are very intense and they may almost seem as if they are one right after another. You may sense pressure on your perineum from the baby's head as it descends further into your birth canal.

*Second stage: Occurring from complete cervical dilation until the delivery of your baby. This stage is shorter than the first stage, lasting anywhere from one contraction up to two hours or so. At this stage, the cervix is dilated enough to allow the baby's head to pass through it. As the sensation of pressure on the perineum increases, so may the urge to push or "bear down." Your nurse will tell you when it is time to push although you may have the urge before you are fully dilated. It is important that you not push until you are instructed to do so. Pushing too early may cause the cervix to become swollen. With each contraction, the baby moves closer to the opening of the birth canal. As you bear down, the baby's head eventually will appear, and finally the baby is born.

*Third stage: Following delivery of the baby until the placenta detaches from the uterine wall and is expelled through the vagina. It is the shortest stage and lasts anywhere from 5 to 15 minutes. After a few labor-like contractions and massage of your uterus, the placenta or afterbirth is expelled. You will be observed closely for the next few hours to make certain that the uterus stays contracted and bleeding is not excessive.

There are many factors that will determine how long your labor will be or how long it takes to go from one stage to the next: position of the baby's head, size of baby, presentation of baby, size and shape of mother's pelvis, mother's physical and emotional state, the effectiveness of the contractions in dilating the cervix, the birth partner and the support they provide, and medications or anesthesia administered.

Thanks to my childbirth class for this information, found in their book: The Gift of Motherhood by Alegent Health.