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Signs of Labor

Often some signs of your body preparing for labor appear even weeks before your labor begins.

Braxton Hicks Contractions

The contractions may appear about 4-6 weeks before a first baby arrives, or may go unnoticed. They are typically mild, short contractions perceived as a “tightening” of the abdomen. They are generally not painful. While they are normal and generally not dangerous, it is important to increase fluids and rest if you are experiencing regular Braxton Hicks contractions. Being overly tired or relatively dehydrated will increase the frequency of these “practice contractions”. If you are concerned with either the frequency or strength of contractions before 36 weeks gestation, please call the office or answering service.

Engagement

(Lightening or dropping) is the term used to describe the baby’s movement into the birth canal. This may cause more bladder pressure and a need to void more frequently. You also may be able to eat a bit more or take a deeper breath. This is a normal process, more prominent in women having their first baby. This event is less well defined in subsequent pregnancies. Moms with older children may feel generally increased pelvic pressure or “like the baby is falling out”, especially when walking.

Increased Vaginal Mucous/Loss of Mucous Plug

The increase in whitish vaginal discharge is normal; a response to the increased hormone levels preparing the body for labor. The increased secretions help to cleanse and protect the cervix and vagina in the final weeks of pregnancy. If you choose to wear a panty liner or mini pad, please change it frequently. You may lose the mucous plug (thick, gray, gelatinous material) up to weeks before your labor, or it may be a sign of onset of labor. Some women never experience this.

Irritability/Insomnia

These late pregnancy symptoms are caused by the physical discomforts you are experiencing, the changing hormone levels as your body prepares to labor, and the uncertainty of the birth story you are about to live out. Try more pillows in the bed, migrating to the sofa or spare room, and/or massage from your partner. A nap or rest every day becomes important to maintain your energy levels. Good nutrition is especially important now.

Early Labor

Signs of early labor are variable. Some women experience all of them while others have very little warning! If at any time you are uncertain about whether you are in labor, do not hesitate to call the office for further instructions. If the office is closed, call KCH and your call will be forwarded to the answering service.

Contractions

The contractions of “real labor” increase in regularity, frequency and intensity. You may feel the discomfort in your lower back, as menstrual cramps, or in your upper, inner thighs. First labors may last 16-24 hours or even longer. It is important to rest in early labor and maintain hydration and nutrition. Consider going to the hospital when contractions have been five minutes apart and strong for an hour. If you have had a baby before, you need consider going to the hospital when your contractions have been about ten minutes apart for an hour. Your physician or nurse may have more specific guidelines based on your last labor and birth. Of course, we defer to your judgment should you feel you need to go to the hospital sooner.

Rupture of Membranes (Water breaking)

Rupture of membranes or “water breaking” is the loss of amniotic fluid from the vagina. This may be a subtle leak, or a gush. If you are unsure if you are leaking amniotic fluid (sometimes it may feel as though your bladder is leaking) call the office to be seen, or if the office is closed, please call the answering service. If your water has broken, you will need to prepare to go the hospital. Please note the time that your membranes ruptured (when you noticed the leak), the color of the fluid, and if your baby is moving. These are the three things your obstetrician will want to know whether you contact him by phone or go directly to the hospital. You may shower after your breaks, but please no bath tubs. A disposable baby diaper inside you underclothes will help keep you and your car seat dry. Do not use a tampon to stop the leakage of amniotic fluid.

Bloody Show

This is a bloody or blood tinged mucous discharge, usually associated with the thinning and/or dilation of the cervix. You may also notice this symptom before labor if your doctor does a cervix check. This is a common sign of labor and as long as the volume is less than a period, it is not cause of concern. If you have frank, bright red bleeding (no mucous or amniotic fluid mixed in) and the amount is more than a period, you should go to the hospital immediately.

Coping with Labor at Home

It is fine to spend your time of early labor at home. It is important to remain well hydrated, nourished and rested. If your first contractions come late in the evening, get your things ready for the hospital, shower and go to bed. First labors may take 12 hours to become active and even a brief nap will improve your stamina and your tolerance for discomfort. When your contractions are strong and regular, you will not be able to rest. It is very uncommon to sleep through active labor. If your labor starts during your usual waking hours, it is fine to time a few contractions and then get on with your day. Light nutritious food and fluids, like juices and water are encouraged during early labor and will help maintain your energy levels. You may find it comforting to listen to music, visit with friends, watch a video or read. Aromatherapy and/or a massage may aid relaxation and rest.

Timing Contractions

  • Length: How long the contraction lasts is measured in seconds from the beginning of the contraction until you can no longer feel it.
  • Frequency: How far apart the contractions are is timed in seconds or minutes from the beginning of one contraction to the beginning of the next contraction.

At The Hospital

You will be admitted to a private birthing room at the KCH Birthplace. It has a birthing bed that is adjustable for your comfort and helps facilitate delivery. A nurse will check your temperature, blood pressure, pulse and cervix. She will apply a monitor to the outside of your abdomen to assess contraction during and frequency and the baby’s heart rate. This monitor may be in place for most of your labor, or may be used intermittently. Your obstetrician will make this decision, based on the status. Intravenous fluids may be given to maintain your hydration and facilitate the administration of medication. If you elect to have epidural pain relief, you will have an IV and fetal monitor will need to remain in place.

Usually you may have two support people with you in labor and during the birth. If your baby is born by Cesarean section, one support person may be present for the birth. Any additional persons who come to the hospital will need to wait in the waiting room. It will be the responsibility of your support persons to update others who may be waiting. Following the birth of your baby, your family may visit during visiting hours.

According to state law, insurance companies are required to pay for two days following a vaginal delivery and four days following a Cesarean delivery. If there is a medical need to extend your stay, the physician and/or case manager will arrange this. It is unusual to require more time after the birth.

Pain Management During Labor and Delivery

There are many options available to help you manage the discomfort of labor. Your obstetrician, labor nurse and anesthesiologist will help you decide what type of pain relief will be most helpful during your birth experience.

  • Unmedicated birth: Many women find the breathing and relaxation techniques taught in childbirth classes to be sufficient to manage their discomfort when combined with the support of their partner and labor nurse. Labor and delivery nurses are skilled in techniques and suggestions to help manage labor. Many of these techniques may be used in early labor, as they are unlikely to slow a poorly established labor.
  • Injection or intravenous medication: The most common pain medications currently used in labor and delivery are Nubain and Stadol, with or without another medicine called Phenergan. These medications “take the edge off” labor and may allow you to rest.
  • Epidural anesthetic: This is a regional anesthetic that is administered by an anesthesiologist. A catheter is placed in the epidural space that is outside the spinal canal. A local anesthetic is then infused to block the nerves conducting pain messages from the lower body. An epidural may be used in labor or at higher doses of medication, maybe used for Cesarean birth.
  • Spinal anesthetic: Spinal is similar to an epidural, but because the mediation is infused directly into the space with the spinal fluid and nerves, the anesthesia is much denser. This results in less sensation of any kind and the inability to move your lower extremities. This anesthesia is used for Cesarean birth.
  • Local block: This is used when an episiotomy is indication, or when a laceration requiring suturing has occurred. This is similar to the anesthetic a dentist uses for cavity repair. The medication is administered by injection directly into the tissues to be incised or repaired. The effect of the medication is only near the area of repair, or “local”.
  • General anesthesia: Anesthesia can be used to “put you to sleep” during a Cesarean birth. This type of anesthetic is now used primarily during acutely urgent Cesarean delivers when there is not time to use one of the regional blocks. This type of anesthesia involves medication in the IV tubing and an endotracheal tube in the back of the throat to maintain adequate breathing. The anesthesiologist monitors all vital signs carefully during the surgery. The anesthesiologist and a nurse will accompany you to the recovery room and assure that you are doing well.

Birth

As the time nears for your baby to be born, your labor nurse will call your obstetrician. There may be more activity in your room during this time, as equipment and personnel are readied for your baby’s arrival. If your baby has experienced difficulties during labor, you may find that there are people in the room especially to help get your baby off to a good start. These professionals may include an OB nurse, a respiratory therapist and possibly a pediatrician. If all has gone well, your birth team will include one or two labor and delivery nurses and your obstetrician. Your support people are welcome at this time as well.

When our baby is born, he or she will be closely observed. Attention is given to the baby’s breathing, heart rate, muscle tone, color and response to stimulus. If the baby requires assistance in any of these areas, it will be provided immediately. This may necessitate the baby being moved to a warmer unit to allow the staff to adequately meet your baby’s needs. A formal assessment of these conditions is called an Apgar score. This score is recorded at one and five minutes. If your baby is doing well, you may continue to hold him/her, or if you or your physician prefer, the nurse can weigh the baby, provide medications, take footprints and place identification bracelets. The baby will then be returned to your arms when your doctor has finished and you are comfortable.

After your birth, you may usually eat and drink as you please. If you have an epidural anesthetic, the nurse will discontinue it for you. If you have pain or discomfort, medications are available. It is best to eat before you take pain medication. If you are breast feeding take the opportunity to offer the breast in the recovery time. Your labor nurse will be checking your blood pressure, assessing the position and tone of your uterus and checking for vaginal bleeding. You may have an ice pack on the perineum to help reduce swelling. It is usual to remain in your labor room for one to two hours before moving to your postpartum room.

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