In the last few weeks of pregnancy, the body changes to signal that labor is approaching. Some of these changes can occur quite a while before labor begins.
Signs of Labor
The following are signs of labor:
Lightening refers to changes in bodily sensations resulting from the baby's head settling into the pelvis. IN the first pregnancy, lightening may occur up to two weeks before the onset of labor; in subsequent pregnancies, it may not occur until labor starts.
Sensations produced when the baby moves lower into the pelvis include:
- decreased shortness of breath
- decreased heartburn
- increased urinary frequency
- increased pelvic pressure
- increased constipation
- increased stretching of the pelvic ligaments, causing the mother to "waddle" and her hips to ache
- The uterus also changes in size and shape, causing clothes to fit differently (the top of the uterus is lower and more forward).
Increased frequency of Braxton-Hicks (false labor) contractions are sometimes experienced by women. The uterus feels like it "balls up" for several seconds. These contractions generally are painless or mildly uncomfortable and usually occur in the last two months of pregnancy. They are irregular, infrequent, shorter in duration than real labor contractions and do not cause the cervix, the lower portion of the uterus, to dilate or efface (thin). Although they usually subside in a few hours, these contractions become more pronounced during the last three weeks of pregnancy, especially if this is not the first baby. Remember, these are not regular.
Bloody show is a pink-to brownish-colored mucus vaginal discharge caused by the loss of the mucus plug, which seals the cervix during pregnancy. As the cervix softens in preparation for labor, the mucus plug is released. The may sometimes be confused with the small amount of bloody discharge caused by a recent vaginal exam or intercourse. Bloody show is not bleeding. Bleeding, which is red and resembles a period, must be reported to the doctor immediately.
Rupture of membranes refers to the breaking of the bag of water (amniotic fluid), which surrounds, cushions and protects the baby during pregnancy. Clear, odorless fluid may leak or flow from the vagina. This may occur before labor starts; if so, contractions, or tightening of the uterus, usually begin within 24 to 48 hours. Once your water breaks, call the doctor immediately, whether or not you are having contractions. The doctor will want the baby delivered within 24 to 48 hours after the membranes rupture to protect the baby from infection.
Other signs of labor:
Although somewhat vague and unreliable, other signs of oncoming labor include:
- diarrhea
- backache
- nesting instinct (the desire to clean everything)
How to know when labor begins
It is sometimes very difficult to distinguish between true and false labor. False labor is a common occurrence. Even women who already have had children can go to the hospital in false labor. If you go to the hospital in false labor, you should not feel embarrassed, upset or discouraged. Following are a few guidelines to help you distinguish between true and false labor.
True labor
Contractions have a regular pattern. They become longer, stronger and closer together. They are intensified by walking, cause more discomfort as time passes and are often accompanied by backache. Bloody show may be present. True labor causes dilitation (opening of the cervix), effacement (thinning of the cervix) and a change in station (the descent of the baby into the birth canal).
False labor
Contractions often have irregular patterns. They do not increase in intensity or frequency over a period of time and may stop when you change your position. Lasting 30-45 seconds, contractions usually do not increase in discomfort. There is no cervical change, and they may or may not be accompanied by backache. False labor generally does not cause bloody show, dilation, effacement of change in station.
Timing contractions
When labor begins, your physician will want you to time contractions. When timing contractions, it is important that you pay attention to frequency and duration. You will need a watch or clock with a second hand, a paper and pen or pencil.
Frequency and duration
How often contractions occur is determined by the number of minutes between the beginning of one contraction and the beginning of the next. The length of each contraction is described in seconds. Length is determined by counting the number of seconds that pass from the beginning of the contraction to the end of the contraction.
Draw a line down the middle of your paper to create two columns. On the left side, write down the exact time each contraction begins. Count the number of seconds from the beginning to the end of the contraction and record this directly opposite in the right hand column.
Example:
- 12:05 -- 40 seconds
- 12:12 -- 45 seconds
- 12:19 -- 50 seconds
- 12:24 -- 45 seconds
- 12:31 -- 40 seconds
- 12:36 -- 50 seconds
- 12:43 -- 45 seconds
In the above example, there are five to seven minutes from the beginning of one contraction to the beginning of the next. They are lasting 40 to 50 seconds. They are regular. During a period of time (30 to 60 minutes), you will notice if a regular pattern develops.
At one of your prenatal appointments, discuss with your health care provider when you should call once you think you are in labor. When you call, you will be told when to come to the hospital based on which pregnancy this is, your obstetrical history and how far you live from the hospital.
Regardless of how often contractions occur, always call your health care provider if your water breaks, if you have vaginal bleeding or if you notice the baby's movements have decreased. If you cannot reach your health care provider, go to the hospital's Emergency Department.
Preterm Labor
Preterm labor occurs three or more weeks before the due date. Because they have not finished growing and maturing, infants born before this time may have problems with breathing, staying warm, feeding and fighting off infection. The earlier your baby is born, the more serious these problems may be and the longer he may have to remain in the hospital.
If preterm labor is recognized in time, it may be stopped, allowing your baby to remain in your womb to grow and mature before birth. As an expectant mother, you should be aware of and watch for signs of preterm labor.
Signs of preterm labor
- Menstrual-like cramps that may be continual or sporadic; usually felt above the pubic bone
- Low, dull backache that may be constant or intermittent
- Increase or new onset of pressure that feels like the baby is pushing down; a heavy feeling in your lower abdomen, back or thighs
- Abdominal cramping, with or without diarrhea
- Increase or change in vaginal discharge (mucousy, watery, light bloody discharge)
- fluid seeping from the vagina
- Uterine contractions that occur four or more times in one hour; they may be virtually painless (feeling as though the baby is "balling up") and usually occur regularly, not sporadically
How to feel for contractions
While lying down, place fingers on top of your uterus (womb). A contracting uterus becomes hard or tight for a while and then it relaxes and becomes soft. If your uterus is becoming hard and then soft, write the time the contraction starts, how long it lasts and when the next contraction begins. (Refer to the section on timing contractions).
What to do when signs of preterm labor occur
If you have bleeding or fluid leaking from your vagina, call your health care provider or clinic immediately. If you cannot reach your health care provider, go to the hospital's Emergency Department.
If you have one of the other signs of preterm labor:
- Empty your bladder
- Drink two or three glasses of water or juice
- Lie down, tilted toward your left side, for one hour.
- Many times the signs of preterm labor will stop.
If the signs of preterm labor do not stop in one hour, call your health care provider. Tell the following information:
- your name
- when your baby is due
- other medical conditions
- what signs you are having
- if and how often you are having contractions
You may be asked to come to the office or hospital. If the signs of preterm labor disappear in one hour, you may slowly resume your permitted activities during the next 24 hours.
About Labor and Delivery Services at AGH
Virtual tour of Labor and Delivery at AGH
About Labor and Delivery Services at WPH
About Labor and Delivery Services at Forbes
Virtual tour of Labor and Delivery at Forbes
Last Updated: June 03, 2009