Pregnancy, Childbirth, and the Newborn: The Complete Guide, 4th Ed.

CHAPTER 9 When and How Labor Begins

In the last month or so of your pregnancy, your baby begins gearing up for life outside your womb. She’s grown strong and mature enough to handle physiological functions on her own, such as breathing, eating, and regulating her temperature. Sometime between the thirty-seventh and forty-second week of pregnancy, your baby signals to your body that she’s ready to be born. At that point, labor begins. This chapter describes the events and changes that occur in you and your baby during the shift from late pregnancy to labor.

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In this chapter, you’ll learn about:

• The events of late pregnancy and the shift to labor

• Things you can do to prepare for labor

• Key terms and concepts of maternity care

• Differences between prelabor and labor

• Signs of labor and how to time contractions

The Last Weeks of Your Pregnancy

As you near the end of pregnancy, you may wish for it to be over. You may feel awkward, tired, fat, hot, and uncomfortable. You and your partner are probably eager to meet your baby and ready to enter the next stage of your lives. If your pregnancy passes your due date, try to remember that labor likely hasn’t begun because your baby isn’t ready to be born.

Most normal, healthy births occur after the thirty-seventh week of pregnancy but before the forty-second week. However, some preexisting conditions can override the physiological interaction among the baby, mother, and placenta, leading to births that aren’t “on time.” Examples of such conditions include illness or infection in the mother, heavy smoking or other drug use, extremely stressful life circumstances, as well as unknown factors. About 12 percent of births occur before the thirty-seventh week of pregnancy, and between 5 and 10 percent of births would occur after the forty-second week if labor weren’t induced.1 (See Chapter 10 for more information on the effects of labor induction, which bypasses the intricate hormonal processes of normal birth.) See Chapter 13 for further discussion on premature and post-mature births.

During the last weeks of pregnancy, your entire body and your baby undergo many changes to prepare for the birth. Your breasts produce more colostrum (first breast milk). Your uterus contracts more often and more strongly. You may have contractions when you exercise, sneeze, bump your belly, or for no apparent reason. You may swear that you’re in labor only to have the contractions stop. Along with your changing hormones, these contractions are helping your body prepare for labor.

Your pelvic joints relax, allowing room for your baby to descend into your birth canal. You produce more cervical mucus, and your vaginal wall becomes more elastic. Even though you aren’t yet in labor, you’re making good progress.

Your baby is rapidly storing iron, enough to meet his needs for the next six months (along with the iron he’ll consume from your breast milk). He becomes chubby and able to regulate his own temperature. His lungs mature, preparing him to breathe without difficulty after the birth.

As your placenta ages, the membrane between your baby’s bloodstream and yours becomes more permeable, permitting large molecules such as antibodies to reach your baby. These protect him against diseases to which you’re resistant or immune, and the protection lasts for months. If you breastfeed your baby, such protection will continue for as long as you nurse him.

When your baby is ready to survive outside your body, his body and yours initiate labor.

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Events of Late Pregnancy

During the last 6 to 8 weeks of pregnancy, numerous complex interrelated events take place among your baby, your body and the placenta. A change in one of these three components triggers changes in the other two. This process typically leads to the birth of your mature, capable baby and prepares you to nourish and nurture her. Here’s a breakdown of the events of late pregnancy.

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Preparations for Your Baby’s Birth

In the final months of pregnancy, there are many things you can do to prepare for your baby’s birth. If you’re planning to give birth in a hospital or birth center, use the following lists to help you get organized. If planning a home birth, many of these tasks are still relevant, but ask your midwife what additional preparations you should make in your home, such as what food and beverages to have available for everyone and what birth supplies to have on hand.

1. Prepare a birth plan and review it with your caregiver. (See Chapter 8.) When preparing your birth plan, consider consulting with your childbirth educator or doula, who can answer questions you may have. Make sure your birth plan reflects your priorities and preferences.

2. Tour your hospital, or backup hospital if you’re planning to give birth at a birth center or at home. (See page 13.)

3. Preregister at the hospital. (Preregistration may be unnecessary for an out-of-hospital birth.) Sign admission forms, including a general consent form. During labor, you may need to sign additional consent forms for specific procedures. Try to read these forms before you arrive at the hospital in labor, and ask for clarification of information that you don’t understand or that makes you uncomfortable.

4. If you have other children, arrange for their care while you’re in the hospital or birth center. If you have pets, also arrange for their care while you’re away (and for the first few days after you bring your baby home).

5. Pack three bags for the hospital or birth center: one bag for labor, one for the postpartum stay, and one for your baby. Visit our web site, http://www.PCNGuide.com, to download a checklist of the items listed below. Also make sure your partner packs items he or she will need during the labor and after the birth, such as a toothbrush, changes of clothes, pajamas, and a swimsuit (so he or she can accompany you in the shower or bath).

Items for labor

• Hairband, headband, or barrette (to keep your hair off your face)

• Toothbrush, toothpaste, and lip balm

• Warm socks

• Massage oil

• This book

• Two nightgowns or long T-shirts (if you don’t want to wear a hospital gown)

• Hot water bottle (or fill a sock with uncooked rice, tie off the open end, and heat it in a microwave for three to five minutes)

• Rolling pin or other item to relieve back pain (See page 231.)

• Birth ball (if the birthplace doesn’t have one)

• Favorite juice, tea, or frozen fruit juice bars

• Snacks for you and your partner

• Phone numbers of people to call after the birth (Check the birthplace’s policies on cell phone use.)

• Camera or video camera (Check the birthplace’s policies on recording births.)

• Personal comfort items (your own pillow, photos, blanket, and so on)

• iPod or MP3 player, CDs of relaxing music, and headphones or speakers (Check the birthplace’s available audio equipment and policies on listening to audio devices.)

• Laptop computer (Check the birthplace’s Internet access.)

Items for your postpartum stay

• Nightgowns or pajamas that you can nurse in

• Robe and slippers

• Cosmetic and grooming aids

• Nursing bra

• Clothes for the ride home (You won’t return to your prepregnant size immediately after giving birth, so make sure the clothes are a comfortable size.)

• Other personal items

Items for your baby

• Cloth diapers and waterproof diaper cover, or disposable diapers

• Undershirt or “onesie”

• Nightgown or stretch suit

• Receiving blanket

• Warm blanket and cap (for the ride home)

• Car seat (properly installed in your vehicle before labor)

Key Vocabulary for Late Pregnancy and Labor

During late pregnancy or early labor, your cervix changes so it can dilate, and your baby assumes his birth position (usually head down). To describe and assess these changes and developments, your caregiver may use a special vocabulary. The following sections define terms that you may hear during labor and birth.

PARITY

Parity describes the condition of having given birth. Primigravidas are women who are pregnant for the first time, nulliparas have never given birth, and primiparas have given birth once (this term is often wrongly used to refer to nulliparas). Multiparas are women who have given birth more than once.

PRESENTATION AND POSITION

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Babies can situate themselves in the uterus in several ways, some more suitable for an easy birth than others. Presentation or presenting part describes the part of your baby that’s lying over your cervix and will emerge from your body first. The most favorable and most common presentation (95 percent of births) is vertex, in which the top of your baby’s head is down over your cervix. Other presentations are the frank breech (buttocks down), breech (one or two feet down), complete breech (buttocks and feet down), and shoulder, face, or brow presentations. (See Chapter 13 for further discussion of these rare presentations that may cause labor difficulties.)

Position refers to the direction toward which the back of your baby’s head (the occiput) or other presenting part lies. The possible positions are anterior (toward your front), posterior (toward your back), and transverse (toward your side).

Here are the most common descriptions of presentation and position:

Occiput anterior (OA)

The back of your baby’s head is pointing toward your anterior (front).

Left (or right) occiput anterior (LOA or ROA)

The back of your baby’s head is toward your left (or right) front.

Occiput posterior (OP)

The back of your baby’s head is directly toward your back.

Right (or left) occiput posterior (ROP or LOP)

The back of your baby’s head is toward your right (or left) back.

Right (or left) occiput transverse (ROT or LOT)

The back of your baby’s head is toward your right (or left) side.

Your baby’s position may change during labor among OA, OT, and OP, although by birth most babies are OA.

Six Steps to Birth

The following six steps occur before a vaginal birth. The first three steps usually begin days or weeks before labor starts (prelabor), and the last three steps happen during labor.

1. Your cervix moves forward.

2. Your cervix ripens.

3. Your cervix effaces.

4. Your cervix dilates.

5. Your baby’s head rotates and tucks (chin to chest).

6. Your baby’s head molds, descends through your pelvis, and is born.

STATION AND DESCENT

Station refers to the location of the top of your baby’s head (or other presenting part) within your pelvis. It’s measured in centimeters, in relation to the middle of your pelvis (the ischial spines), which is referred to as 0 station (see illustration). For example, if the top of your baby’s head is at 0 station, it has descended to the middle of your pelvis. If her head is still “floating” above the level of your pubic bone, it may be as high as a -4 (minus four) station (4 centimeters above the middle of your pelvis). If her head is at a +1 (plus one) or +2 (plus two) station, it’s 1 or 2 centimeters below the middle of your pelvis. When her head is at your vaginal opening and on its way out, it’s at a +4 station.

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The downward movement of your baby into your pelvis is called descent. During late pregnancy and birth, your baby moves from the highest station (-4) to the lowest station (+4) and is then born. For primigravidas, some descent—either gradual or sudden—usually takes place several weeks before the onset of labor. These women may begin labor at a -1 or 0 station. For multiparas, it’s common for labor to begin with their babies still “floating.” Most descent, however, takes place during pushing in late labor.

Other terms associated with your baby’s descent before labor include lightening and “dropping.” These terms refer to the decreased pressure in your chest and upper abdomen, and the increased pressure on your bladder. Engagement describes the condition in which the top of your baby’s head (or other presenting part) is “engaged,” or at 0 station, and fixed in your pelvis. It can be determined by palpating your abdomen or by a vaginal exam.

CERVICAL CHANGES

Changing levels and interactions of hormones cause your cervix to change gradually, beginning before labor and ending just before your baby’s birth. Your caregiver can assess these changes during a vaginal exam and evaluate your body’s readiness for labor as well as the progress of your labor.

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Because these cervical assessments are subjective, they may vary if more than one person examines you. You may become confused or discouraged if examined within a short time by two people whose assessments differ. If the same caregiver checks your cervix each time, you can rely on his or her assessment of your progress.

The following describe the changes your cervix undergoes during the labor process.

Your cervix moves forward.

Usually weeks before labor begins, your cervix is high and posterior (pointing toward your back); as labor approaches, your cervix gradually moves down to an anterior position (pointing toward your front). See illustration on page 168.

Common Q & A

Q: Will a vaginal exam tell me when I can expect labor to begin?

A: While a vaginal exam can provide information about the present state of your cervix, it can’t predict when you’ll go into labor or how long your labor will last. If you have a very ripe, effaced cervix, you may go into labor right away or in several weeks. The same is true if you have a thick, firm cervix.

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Your cervix ripens (softens).

During pregnancy and prelabor, when your cervix is still firm, it doesn’t change during Braxton-Hicks (or practice) contractions. However, once your cervix begins to ripen, other cervical changes begin. Your cervix may begin to ripen weeks before labor begins or just a few days before. This variation in the timing of ripening helps explain why some women’s cervixes dilate in late pregnancy, while others don’t even with strong, frequent contractions.

Your cervix effaces (thins or shortens).

The cervix of a primigravida usually effaces a lot before it dilates. The cervix of a multigravida typically effaces and dilates at the same time.

Effacement is measured either as a percentage or as a length in centimeters. Zero percent effacement means that your cervix is 3 to 4 centimeters long and hasn’t begun to thin. Fifty percent effacement, or 2 centimeters, means that your cervix has thinned about halfway; 100 percent effacement, or “paper-thin,” means that your cervix has thinned completely. Make sure you don’t confuse the centimeters of effacement with centimeters of dilation!

The cervix dilates (opens).

Although your cervix usually dilates before labor begins (1 to 2 centimeters in primigravidas or up to 4 centimeters in multigravidas), most dilation occurs during labor. Dilation is measured in centimeters. When your cervix has opened the width of a fingertip, it’s 1 centimeter dilated; when fully dilated, it’s about 10 centimeters.

Hormonal Interactions That Start Labor

If you’ve had a normal pregnancy, labor typically begins when your baby has grown enough to thrive outside your body and has needs that the placenta can’t meet. At that time, a complex interplay of biochemical events signals to both your body and your baby that it’s time to start labor. Here’s a breakdown of the interactions that lead to your baby’s birth.2 (See also page 242.)

1. In your baby’s brain, the hypothalamus (the main control center of the autonomic nervous system) secretes corticotrophin-releasing hormone (CRH), which sets in motion a cascade of hormonal interactions.

2. The CRH goes to the pituitary gland (which influences hormone secretion) in your baby’s brain, stimulating the gland to secrete adrenocorticotropic hormone (ACTH), which makes his adrenal glands secrete large amounts of the steroid hormone androgen into his bloodstream and onto the placenta.

3. In the placenta, androgen is converted into estrogen, which overrides the calming effects of the hormone progesterone on your uterus. Estrogen also causes your uterus, membranes, and placenta to produce prostaglandins, which may lead to cervical ripening and uterine contractions. It further causes changes to your uterine muscles, increasing the number of oxytocin receptors by 100 to 200 percent. This greater number of receptors makes your uterus more sensitive to oxytocin, which increases the frequency of your contractions.

4. As your uterus contracts, it places pressure on your cervix and causes it to stretch. Nerve fibers carry impulses from your cervix up your spinal cord to your pituitary gland.

5. The stimulation of your pituitary gland causes it to release more oxytocin, further increasing the frequency of your contractions.

6. The process thus gains momentum, and your contractions intensify and speed up throughout labor.

How to Distinguish between Prelabor and Early Labor

As you near the end of pregnancy, one of your biggest challenges is figuring out whether you’re in labor or still in prelabor. For most women, the shift from prelabor contractions (Braxton-Hicks contractions that intermittently tighten your uterus) and labor contractions (ones that dilate your cervix) is subtle and gradual. For a few women, this shift is obvious if their membranes rupture (bag of waters breaks) with a gush before contractions begin, or if their contractions begin suddenly and intensely.

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PRELABOR

During prelabor, contractions can last thirty to forty seconds each and occur ten to twenty minutes apart, or they may last up to two minutes each and occur five minutes apart. Some women barely notice prelabor contractions, while others need to use distraction, slow breathing, tension release, and other comfort techniques to get through them (see Chapter 11).

The distinguishing feature of prelabor contractions is that they’re nonprogressing; that is, they change very little in length, frequency, and intensity over time. They may even subside for a while and resume later. See page 241 for more tips on distinguishing between prelabor and labor contractions. Prelabor may last for a few hours to a day; if it lasts longer than a day, it’s considered a prolonged prelabor, which can be tiring and discouraging. (See page 245.)

As puzzling and frustrating as prelabor contractions may be, try to recognize that they’re getting your cervix ready to dilate by moving it forward and helping it ripen and efface. While some women’s cervixes undergo these changes without noticeable contractions, others (especially those of first-time mothers) need the help of contractions to change. Both situations are normal.

You may wonder why it matters whether you’re in prelabor or labor. You have to deal with its contractions, whatever it’s called! From a clinical viewpoint, the status of your labor determines when you can be admitted to the hospital or birth center. For a normal pregnancy, maternity care providers consider prelabor and early dilation no different than the events of late pregnancy. If you arrive at your birthplace with prelabor contractions and a cervix that hasn’t yet dilated to 3 or 4 centimeters, you’ll likely be sent home with instructions on when to return. For a home birth, your midwife probably won’t stay with you if you’re in prelabor, although his or her birth assistant may.

If you’re not admitted to the hospital or birth center because you’re still in prelabor, you may feel embarrassed, disappointed, or upset. To overcome these negative feelings, try to focus on helpful ways to get through prelabor. See page 243 for practical suggestions on restful, distracting, and pleasant activities to make both prelabor and early labor positive experiences.

A NOTE TO FATHERS AND PARTNERS

The events of prelabor can be difficult to understand, making this time challenging for everyone. But prelabor can be a pleasant experience with support, guidance, and the right attitude. Join your pregnant partner in distracting activities and try to remain patient, cheerful, and attentive. If you become confused or frustrated, contact your doula or a friend who has been through labor. He or she can offer support, reassurance, and companionship.

SIGNS OF LABOR

Recognizing the signs of labor is the best way to ensure that you don’t mistake prelabor contractions for labor contractions. The signs of labor are divided into three categories: possible signs, prelabor signs,and positive signs. You might or might not experience all categories of signs.

Possible signs of labor occur in late pregnancy and may indicate that the hormonal changes described on page 170 are underway (but cervical changes aren’t yet occurring). These signs occur intermittently for days or weeks, but they don’t indicate labor.

Prelabor signs of labor indicate that your cervix is probably moving forward, ripening, or effacing. These signs may progress into positive labor signs the same day they begin, or they may simply alert you that labor will begin in a few days or weeks.

Positive signs of labor include contractions that become longer, stronger, and more frequent (progressing contractions), and the rupture of membranes in a gush of amniotic fluid (that is, your bag of waters bursts, not leaks). These are the only reliable signs that labor has begun and (with few exceptions) your cervix is dilating. Although most labors start with progressing contractions but without the rupture of membranes in a gush of fluid, about 6 percent of labors start with the latter sign. If this happens to you, you’ll almost certainly begin having contractions within minutes or hours of the rupture.

Caution: If you’re at least thirty-seven weeks pregnant, these are all normal healthy signs of labor. However, if you’re less than thirty-seven weeks pregnant and have two or more possible signs along with six contractions in an hour (or eight contractions in two hours), whether or not the contractions are progressing, call your caregiver. You may be in preterm labor. Your caregiver may ask you to try resting, taking a bath, or drinking water to stop your contractions. If they don’t stop, you’ll probably be asked to go to the hospital for further assessment. (See page 249.)

Possible Signs

Restless back pain that comes and goes

This vague, nagging back pain is often accompanied by a feeling of uneasiness or restlessness. You’re unable to be comfortable in any position for long. This pain differs from the postural back pain that you may feel after standing or sitting for a while. It may resemble the back pain you feel before a menstrual period and may occur off and on for days. If restless back pain is the only symptom you have, don’t get too excited. By itself it doesn’t indicate labor or even prelabor.

Mild to moderate abdominal cramping

These cramps may be similar to menstrual cramps and may be accompanied by discomfort in your thighs. With time, they may progress into distinct contractions, or they may stop.

Frequent, soft bowel movements

This sign may be accompanied by intestinal cramps or an upset stomach. It’s probably due to increased levels of prostaglandins, which cause your lower digestive tract to clear itself in order to make room for your baby as she descends.

Nesting urge

In this sudden burst of energy, you focus on getting your “nest” ready. Whether you scrub every floor in your home, shop extensively, tie up all loose ends at work, or spruce up your baby’s room, you do it with a sense of urgency. Your behavior may seem reasonable to you at the time, but it may surprise others. In fact, you might not recognize it as a nesting urge until after the birth.

Think of the extra energy as a sign that you’ll have strength to handle labor, but try to avoid doing exhausting activities.

Prelabor Signs

Nonprogressing contractions

These contractions occur regularly and may continue for hours without changing in intensity, frequency, or duration. They don’t dilate your cervix, but probably prepare it for dilation. (See page 170 for more information on prelabor contractions.) Although nonprogressing contractions can be strong, long, and frequent, they’re most likely to be mild and occur eight to twenty minutes apart. They may last for a short time or continue for hours before they disappear or begin to progress. Try to be patient and maintain normal activity—eat, drink, and alternate between resting and doing distracting activities.

Bloody show

Throughout pregnancy, your cervix contains thick mucus, which may be loosened and released when your cervix begins effacing and dilating. Sometimes this loosened mucus appears as a sticky plug. More often, the mucus becomes thin and liquid (leukorrhea). It may be tinged with blood from small blood vessels in your cervix that broke as your cervix thinned and opened. Bloody show can appear before any other labor sign or it might not appear until hours after contractions have begun. You continue to pass bloody show throughout labor.

You may wonder how much blood to expect. In general, if the bloody show is more mucus than blood, you’re fine. However, if it’s more blood than mucus or your vagina is dripping blood, you may have a larger broken blood vessel or a more serious problem. In that case, call your caregiver immediately.

In late pregnancy, you may pass brownish, bloody discharge within twenty-four hours after a vaginal exam or sexual intercourse, both of which can cause harmless cervical bleeding. It’s easy to mistake this discharge for bloody show. If you’re unsure, note the appearance of the blood. If it’s pink or bright red and mixed with mucus, it’s bloody show. After an exam or intercourse, it’s usually brownish, like dried blood.

Leaking of amniotic fluid

Your membranes (bag of waters or amniotic sac) may begin to leak before labor. Leaking amniotic fluid before labor occurs in about 10 percent of pregnancies. (In more than half of those cases, it’s a gush of fluid rather than a trickle—see page 172). Leaking may mean that you’ve developed a small hole in the bag high in your uterus and amniotic fluid is seeping out. Your underwear feels damp and you notice leaking when walking or changing position. Let your caregiver know about the leaking. He or she may want to confirm that it’s amniotic fluid. (It may be urine or liquid mucus.) If your caregiver knows or suspects that you have Group B streptococcus (GBS—see page 131), he or she may want to give you antibiotics after your membranes have ruptured or begin to leak.

Positive Signs

Progressing contractions

The purpose of progressing contractions is to dilate your cervix and push your baby down and out of your uterus. Unlike nonprogressing contractions, over time these become longer, stronger, and more frequent (or at least two of these three changes)—regardless of whether your prelabor contractions were twenty minutes apart and lasted thirty seconds each, or they were five minutes apart and lasted a minute each. The point is, these contractions become stronger and harder to manage than your earlier contractions.

In early labor, your contractions probably feel like abdominal tightening with some back pain. As labor advances, your contractions likely become painful. (See page 241 for further description of contractions.) If you’ve given birth before, you may have contractions that come and go for several hours until their pattern becomes continual and progressive. These intermittent contractions can make it difficult to determine whether your contractions are progressing. To help you decide, time your contractions and keep a written record. (See page 175.)

Rupture of membranes with a gush of amniotic fluid

Also known as “when your bag of waters breaks,” the rupture of membranes (ROM) doesn’t occur in most pregnancies until the active phase of labor or later. However, some labors begin when ROM occurs with a gush of ½ to 1 cup of amniotic fluid. If ROM occurs this way, you may think you’ve wet yourself. You may even hear a popping sound before feeling the wetness. Contractions usually start within hours of ROM. If your membranes rupture before you have contractions, follow these guidelines:

1. Note the time and the color and odor of the fluid. Describe the amount of fluid (a trickle or a gush). Amniotic fluid is normally clear and practically odorless. A strong foul odor may mean infection. Brownish or greenish fluid is a sign that your baby has experienced stress. (See page 253.)

2. Notify your caregiver or call the hospital immediately. Your caregiver may recommend inducing your labor soon after ROM, if it occurs at term and especially if you tested positive for GBS (see page 131). See page 10 for the key questions to ask about induction. Also see page 277 for information on side effects of induction.

Or your caregiver may wait to see if you go into labor spontaneously or if you can get labor to start. (For suggestions, see page 278). If ROM occurs before term, your caregiver may take steps to try to prevent labor.

3. After ROM, don’t put anything into your vagina (such as tampons or fingers); doing so increases the risk of infection. Vaginal exams also increase the risk of infection, so try to limit the number of exams you have after ROM. It’s fine to take a bath for comfort or pain relief after ROM. Research hasn’t found that vaginal exposure to bath water causes infection.3

If you’ve tested positive for GBS or you’re at risk of the disease, you’ll probably receive antibiotics to prevent an infection in your baby. (See page 131.)

Caution: On rare occasions (fewer than 5 in 1,000 pregnancies), the baby’s umbilical cord prolapses (slips through the mother’s cervix into the vagina) when the membranes rupture with a gush. This event requires immediate medical intervention because the baby may press against the cord and cut off his oxygen supply. (See page 302 for further information on prolapsed cord.)

Changes in your cervix confirmed by vaginal exam

Your caregiver or nurse will check you for changes in cervical position, ripening, effacement, or dilation (more than 4 centimeters typically indicates labor). After ROM, your caregiver should postpone this exam until there are clear, positive signs of active labor (see page 173), in order to reduce the chance of infection.

Signs of Labor

Possible Signs

• Restless back pain (See page 172.)

• Cramps

• Diarrhea

• Nesting urge (See page 172.)

Prelabor Signs

• Nonprogressing contractions

• Bloody show (See page 173.)

• Leaking or trickle of amniotic fluid

Positive Signs

• Progressing contractions*

• Cervix dilated more than 4 centimeters

• Rupture of membranes in a gush of amniotic fluid

* See the Early Labor Record on page 175 for instructions on determining whether your contractions are progressing.

Note: Visit our web site, http://www.PCNGuide.com, to print out complete descriptions of these symptoms.

Sample of an Early Labor Record

Contractions on__________(date)

Starting Time

Duration (in seconds)

Interval or Frequency (minutes since beginning of last contraction)

Comments

1:54:10 AM

40 seconds

Bloody show noted at 6 PM.

2:03:00 AM

45 seconds

9 minutes

Can’t sleep

2:10:15 AM

45 seconds

7 minutes

Loose BM, back pain

2:17:30 AM

50 seconds

7 minutes

Stronger!

Early Labor Record

To help you decide whether you’re in labor, keep an Early Labor Record. See above for a sample, and visit our web site http://www.PCNGuide.com to download a template. You can also search the Internet to find online programs for recording your contractions, such as http://contractionmaster.com/.

Keeping track of your contractions also helps you decide when to call your caregiver or when to go to the hospital or birth center. (See page 244 to learn about the 4-1-1 or 5-1-1 rule.) Many women begin timing contractions when they can’t walk or talk through one or when they need to use slow or light breathing (see pages 224 and 225).

Either you or your partner can time your contractions. If you’re timing them manually, you need a watch or clock with a second hand. When a contraction begins, write down the time (hour, minutes, seconds) in the appropriate space. When the contraction ends, write down how long it lasted in seconds (duration). Note the length of time from the beginning of one contraction to the beginning of the next (interval or frequency). This information tells you how often your contractions are occurring. You can also include comments about the intensity of contractions, your appetite and the foods you’ve eaten, breathing rhythms used, bloody show, status of your membranes (have they ruptured?), and so on.

Time five to six contractions in a row. Then stop timing them until their pattern seems to have changed (this may take many hours or just a few), at which time you can resume timing. If your contractions are progressing, you’re probably in labor. If they’re not progressing, you’re probably still in prelabor.

Key Points to Remember

• Your baby and your body play key roles in the complex interplay of factors that trigger labor.

• It can be difficult to determine whether you’re in labor. Recognizing the signs helps you figure out if you’re in labor or still in prelabor.

• The most reliable signs of labor to look for are progressing contractions (ones that become longer, stronger, and more frequent over time) and the rupture of your membranes in a gush of amniotic fluid. To confirm that you’re in labor, your caregiver may also check for cervical dilation.