How will I know when labor begins?

It can be very difficult to tell the difference between true labor and “false” labor. When a woman experiences Braxton Hicks contractions they are often irregular and do not get closer together. They may stop when you walk, rest, or change position and they do not usually get stronger. During true labor the contractions usually start in the back and move to the front. True contractions will continue despite movement, come at regular intervals, get closer together, and increase steadily in strength as time goes on. Sometimes the only way to tell the difference is to have a vaginal exam to find out if your cervix has changed. 

Prepare to time your contractions if you believe they may be coming at regular intervals, becoming more intense, lasting longer, or be coming closer together. Contractions are timed for both duration (the amount of time the contraction lasts) and frequency (the time from the start of one contraction to the start of the next contraction). If you have a gush or trickle of fluid from your vagina note the color, odor, and amount along with the time it occurred. This may be what is called rupture of membranes or your “water breaking”. If you believe this has occurred you should contact your healthcare provider or go to the labor and delivery unit of your hospital regardless of rather or not you are having contractions. 

If you have bright red vaginal bleeding (other than bloody mucus or light spotting following a vaginal exam or intercourse), if you have severe pain with no relief between contractions or any time you notice the baby is moving less often you should contact your physician immediately or go to the labor and delivery unit of your hospital. 

Dilation, Effacement, and Station

As your body prepares for the birth of your child many changes begin to take place. Hormones, called prostaglandins, soften and “ripen” your cervix to allow it to thin and open to allow your baby to pass through the birth canal. The opening of your cervix is measured in centimeters from zero to ten. 10 cm dilation indicates that your cervix is completely open. During a vaginal exam these factors are evaluated by the healthcare provider. The thinning out of your cervix is referred to as effacement and is measured from zero to one hundred percent. 0% effaced means there has been no change to your cervix while 100% effaced indicates that your cervix is completely thinned out. Station refers to the level of your baby’s head in relation to two bony prominences in your pelvis that can be felt by the healthcare provider during a vaginal exam. As labor progresses the contraction of your uterus help to move the baby’s head downward toward the birth canal. Determining rather you are in true labor is in part determined by the degree of change seen in these factors within a time frame of observation. 

Stages of labor

The time from which true labor begins until your cervix is completely dilated is referred to as the first stage of labor. This is usually the longest stage and can be broken down into 3 phases. The early phase is the time between the start of labor and your cervix dilating to 3 cm. It is important to do your best to conserve your energy as much as possible during this stage. The excitement and anticipation may make this difficult to do. Many women feel very social during this stage but may also experience anxiety or fear knowing the time they’ve anticipated for so long is finally here. 

First Stage - Active Phase

During the active phase of the first stage of labor your cervix dilates to 7 cm. Contractions become progressively stronger and last longer. Most women will find themselves becoming more focused on the work of labor and become less social during this time but still desire companionship from their support person. You may experience dry mouth or nausea and perspire. The use focal points, learned breathing and relaxation techniques can be very helpful during this time. You may find it difficult to follow and understand conversations during this phase. Short and to the point commands along with encouragement from your support person will be the most helpful along with them helping to attend to your physical needs.

First Stage - Transition Phase

The transition phase of the first stage of labor occurs from the time your cervix dilates from 8 to 10 cm (or complete). Your baby begins to tuck its chin to its chest and rotate toward your backbone. This position will allow your baby’s head to align with the widest part of the pelvis for birth. You may experience severe low back ache along with contractions that are intense. Many women experience intense emotion during this phase and may feel out of control or cry yet fall asleep between contractions. You may feel hot or cold and experience “the shakes”. Know that this is not an indication of a problem but is actually very common.

Second Stage - Pushing & Birth

The second stage of labor is pushing and the birth of your baby. You may have been experiencing times when you thought you couldn’t go on but now a renewed energy can be found by knowing the birth of your baby is near. Contractions may become further apart and a strong natural urge to bear down with contractions may be felt. It may be difficult to push in the beginning since this is a new experience with no opportunity to practice but pushing may also be a relief that distracts from the discomfort of contractions. Pushing for some first time mothers may take 2 to 3 hours. This time is often shorter if you’ve given birth before. Your healthcare provider may instruct you to pant or blow and stop pushing as the head begins to crown.

Third Stage - Deliver Placenta

The third and final stage of labor is the delivery of the placenta. This may take up to 30 minutes routinely. Contractions slow after the birth of your baby and your uterus will begin to shrink down to about the level of your umbilicus (or belly button). Your uterus may be massaged to help it become firm and decrease the risk of increased bleeding. Medications may also be used to decrease bleeding. If during the delivery of your baby you received an episiotomy (an incision to allow the baby to exit the birth canal more easily) or if a tear to the perineum occurred your physician will then repair this if needed.

Monitoring and Procedures during labor

It will be important to monitor the well-being of the baby during labor to make sure the baby is tolerating the labor process well. This may be done by placing external monitors on your abdomen- one to monitor the baby’s heartbeat and one to record the frequency and duration of your contractions. If more detailed information is needed a small wire may be attached to the baby’s scalp after your water has been broken. This wire directly records the baby’s heart rate and is considered the most accurate. To directly measure the strength and frequency of uterine contractions a small pliable plastic catheter can be placed between baby and the wall of the uterus.

Pelvic exams will be done to determine the status of the cervix (effacement and dilation) and the position of the baby’s head (station). Every labor is different and so the needed number of pelvic exams varies.

Additional Information

Breastfeeding

Choosing how you plan to feed your baby is a very personal decision. Breastfeeding offers many advantages to both mother and baby. We encourage you to learn as much as possible about your choices so that you can be comfortable with your decision. As your healthcare team, we are here to support you and provide the information you need to make an informed decision for such an important aspect of your baby’s care.

Additional Information