Labor and birth : 1st Stage of Labor (part 1) - Approaching Labor

Approaching Labor

As your pregnancy comes to an end, your cervix starts to soften as your body prepares for the forthcoming labor and birth.

As labor approaches, your body starts to prepare itself for the task ahead and you may notice various physical symptoms and signs that labor is about to start. Not every woman experiences labor in the same way, and certain signs can occur either before labor starts or during labor.

Common physical symptoms

Toward the end of your pregnancy, you may experience a sensation of building pressure or cramping in your pelvic or rectal area. This pelvic cramping can feel very similar to monthly menstrual cramps. A dull pain in your lower back that comes and goes is common too. You may also notice an increase in heartburn (acid reflux) and gassiness. Unless you have a high-risk pregnancy, there is no need to go to the hospital or call your doctor if you experience any of these symptoms in the later stages of your pregnancy.

Your emotional state

This is a time of waiting and many women busy themselves with household tasks. These bursts of activity are often thought to be instinctual, as the mother prepares the home for the new arrival, referred to as “nesting.” The anticipation of what will happen during labor can give rise to a mixture of emotions, from fear and anxiety to excitement and impatience. Women may feel fearful about how much pain they will feel or how uncomfortable they will be with bodily functions. Nothing can prepare you fully for how you will feel in labor, but the more you understand about pain relief options  beforehand, the more confident you will feel about your ability to manage. It’s also thought that by being informed and prepared, you are likely to reduce your anxiety during labor, which in itself can enable you cope better with the pain of contractions.

To prepare your body for the task ahead, ensure that you get plenty of rest and relaxation. In addition to getting a good night’s sleep, take a light nap during the day if you feel fatigued.

Braxton Hicks’ contractions

One of the most common symptoms of approaching labor is an increase in the strength and frequency of Braxton Hicks’, or practice, contractions , which may be occurring up to four times an hour. The purpose of these practice contractions is to prepare your uterus to deal with real labor contractions so that labor progresses smoothly. Some women find Braxton Hicks’ relatively painless, while others find these practice contractions fairly uncomfortable, especially if the baby is quite low and contractions cause increased pelvic pressure.

Apart from the level of pain, one of the main ways to distinguish Braxton Hicks’ from real contractions is that Bracton Hicks’ are irregular and they fade away, whereas labor pains occur at regular intervals and gradually become stronger, more intense, and closer together. The other main difference between Braxton Hicks’ contractions and real ones is that, unlike Braxton Hicks’, real contractions cause your cervix to dilate, which indicates that labor is beginning.

Engagement of the head

With a first baby, dropping down of the baby’s head into your pelvis, known as engagement, usually means that labor is likely to start soon. In second and subsequent pregnancies, engagement may not occur until the start of labor.

You can usually tell that your baby’s position has changed in two ways. First, you may notice that you have less discomfort in your upper abdomen or around your ribs because the downward movement releases some pressure. Second, you may notice increased pressure or pain in your pelvic or vaginal area as the baby’s head moves into position. Your walking may become more of a waddle and you may have to use the bathroom more frequently than before. In some cases, your baby’s head may pinch some of the nerves that run through your pelvis and you may experience sciatica, a sharp electric pain that runs down the outside of your leg to your outside toes .

The “bloody show”

In pregnancy, a plug of mucus forms at the end of the cervix to prevent infection from entering the uterus. At the end of pregnancy, as the cervix softens and widens, this plug is dislodged and comes out through the vagina. When this occurs, you may see a discharge known as the “bloody show”; although some women don’t notice anything. The discharge may appear as a thick, clear or yellow clump that looks like mucus from your nose. It’s common for small amounts of blood to be present due to small tears in the cervix as the plug comes away.

Losing the plug of mucus usually means that labor will begin soon and you should make plans to leave for the hospital in the near future (within 12 hours). However, if loss of the plug is accompanied by other symptoms, such as painful, frequent contractions, heavy bleeding or leaking fluid (indicating your water has broken), you should call your doctor or hospital immediately.

Water breaking

Rupture of the amniotic membranes, called the water breaking, usually occurs once labor has started, but it can happen earlier. If this happens, it often means that labor is imminent. For some, a big gush of fluid is a clear sign that their water has broken, while for others there may be a trickle and it can be hard to determine if the amniotic fluid is leaking. Also, since many women have trouble controlling their bladder in pregnancy, telling the difference between urine and amniotic fluid can be hard. One way to tell is to wear a sanitary pad. If the pad quickly becomes soaked, your water has probably broken. Amniotic fluid also has an odor that is different than urine, even to nonprofessional noses.

Monitoring after the water breaks

If you think your water has broken but contractions haven’t started, contact your doctor or the hospital for advice. If you’re due, there are no complications, and your baby’s head is engaged, you may be advised either to stay at home for a while to see if labor starts, or will be asked to be seen at the hospital. This is because, once your water has broken, your baby has lost the protective membrane surrounding him or her, which means there is an increased risk of an infection reaching your baby. The doctor should check your file to see if you’re Group B Strep (GBS)-positive, and if you are, you’ll be admitted and started on IV antibiotics. She may also monitor your baby’s heartbeat to check that your baby isn’t distressed. If you’re GBS-negative and all is well, you may be able to return home, or stay at home, for a set amount of time and an appointment will be made to see how you’re progressing. If labor doesn’t start within 24 hours (the timeframe may be shorter in some hospitals), the hospital may suggest an induction .

As you approach labor, you will experience irregular contractions; these will increase in strength and regularity as labor progresses.

Early contractions

As your body prepares to go into labor, you will start to experience mild and irregular contractions. These differ from Braxton Hicks’ since they build gradually and will soften and dilate the cervix.

Preparing for labor

The period before labor starts can last for hours or even days, particularly with a first labor. So that you can manage when you go into labor, you need to take care of yourself during this pre-labor stage.

• Stay well rested so that you aren’t completely exhausted when you go into labor.

• If you’re having trouble resting, possibly because of anxiety or discomfort, try practicing relaxation techniques, such as breathing or visualization techniques, whereby you focus on a tranquil setting to induce a state of calm.

• Continue eating to keep your energy levels up and provide fuel for the days ahead. You may not feel like eating a large meal; instead eat little and often. Opt for wholesome snacks such as dried fruit, nuts, or a whole-wheat sandwich, and drink lots of fluids.

• If you’re suffering with back pain, try showering in warm water or taking a warm bath. However, be careful when showering, since pregnancy increases your chances of feeling dizzy, and avoid a prolonged bath in very hot water since this may not be good for your baby.

• A lower back massage is comforting and a good way to relax and ease discomfort—ask your partner to give you a soothing massage.

No one is sure exactly what triggers labor, but it seems the process varies with each species.

In sheep, a drop in progesterone signals the start of labor. In mice, babies release proteins to signal their maturity, which in turn triggers labor. In humans, little is known about the signals that start labor although there are many theories. Studies suggest that the production of hormones such as corticotrophin-releasing hormone (CRH) by the uterus and placenta may play a role. It’s also thought that an increase in pro-inflammatory substances known as cytokines may be involved. Whatever the trigger, it’s likely that the onset of labor involves a biological communication between your baby and your body to indicate that your baby is ready to be born.

Signs of approaching labor

Although each woman’s experience of labor differs and there are no hard and fast rules as to what will happen when, there are signs that indicate that labor is likely to start either imminently or within a matter of days. One of the classic signs that labor isn’t far away is a “bloody show” (see The “bloody show”), when you lose the plug of mucus that has protected your baby during pregnancy. The other indisputable sign that labor will be shortly underway is that your cervix begins to dilate, although of course this will only be visible during an internal examination.

One other sign that labor may be about to start is if your water breaks. However, for the majority of women this happens later on during established labor.

As the cervix starts to soften and shorten, the thick plug of mucus that protected your baby from infection during pregnancy comes away and falls out of the vagina, an event referred to as a “bloody show.” When this happens, you may notice a yellowish discharge.

The amniotic membrane bulges through the cervix as the baby’s head presses down. When the membranes break (water breaking), labor is imminent, or may have already started. The amniotic fluid may pass out as a gush of fluid or a trickle.

When to seek help

Make your way to the hospital or seek advice if any of the following occur:

• You have vaginal bleeding that is like a period or heavier.

• You’re leaking amniotic fluid or leaking greenish fluid that could indicate the baby is distressed.

• The baby isn’t moving as expected (ask your doctor for advice).

When am I in labor?

A common concern of many women is how they will know when they are in labor. The following are indications that labor is truly underway.

• You are having contractions that are becoming stronger and more intense, lasting longer, and the interval between the contractions is getting shorter.

• Changing your position or walking around doesn’t ease the intensity of the contraction.

• The contractions start high in your abdomen and move down through the uterus and lower back, rather than occurring only in the lower abdomen.

• Your water breaks (see Monitoring after the water breaks) while you’re having contractions.