Women
Q: How will I be able to tell that I'm really in labor?
A: The one completely sure sign that you are in fact in labor is that you are experiencing regular contractions that are causing your cervix (the neck of uterus) to dilate or open, and this can only be determined by your midwife or doctor during an internal examination.

True labor contractions are usually painful, they occur very regularly, and they grow stronger and more frequent as time goes on. There are, though, other signs that labor could be on its way, such as a mucous vaginal show or discharge , but these are not true indicators that labor is actually underway.

If you are unsure about whether or not you actually are in labor, you could try timing your contractions from the beginning of one contraction to the beginning of the next contraction and make a note of how often your contractions are occurring. If you are actually in labor, then you will notice the contractions becoming closer together and increasing in duration and perhaps in pain. If you think you are in labor, always call your midwife, doctor, or your birthing center or hospital for guidance and advice.

Q: What is a “show”?
A: During pregnancy, a plug of jellylike mucus seals the lower end of your cervix and this plug prevents infection getting into your uterus. This mucusy “plug” comes away toward the end of a woman's pregnancy, and although this occurrence can sometimes mean that labor is going to start soon, it can also dislodge up to six weeks before your labor actually starts. When the plug comes away, this is commonly referred to as a “show.”
Q: There was some blood with my show—is that OK?
A: Yes, it's very normal for a show to contain a small amount of either fresh (red) blood or dark old blood (similar to the blood at the end of your period) as part of the clear or cloudy mucus of the plug called a “show.”
Q: At what point should I call the hospital?
A: If you are experiencing regular contractions that are getting closer together and increasing in the amount of time that they are lasting, then labor may well have started. When your contractions are around 5–10 minutes apart, you should phone the birthing unit for further advice.

Other situations when it is recommended that you phone are if you think your water has broken or is leaking, your baby's movements have slowed and become less frequent, you experience any bleeding, or you are in pain and not due for delivery.

Never worry about phoning for advice; it is better to be well informed than to sit at home worrying about things. Always carry essential contact numbers in your bag and keep them by the phone at home, since you never know when you may need to seek advice or when your labor may begin.

Q: What do people mean when they talk about your “water breaking”?
A: The “water” is actually the amniotic fluid contained in the membranous sack surrounding and protecting your baby in the uterus. These membranes usually leak or break toward the end of the first stage of a woman's labor. This means that the fluid continues to cushion the baby's head and prevents direct contact with the cervix at first, helping you to manage with the pain. Eventually, the pressure causes the membranes to burst, releasing the amniotic fluid, which can either leak out slowly or gush out through the vagina.
Q: What should I do once my water has broken?
A: If there is quite a large gush of fluid then you will be in no doubt about what has happened. Sometimes, however, the water breaks and produces a small trickle of fluid, which can leave you in some doubt as to whether or not your water has actually broken. If you think your water has indeed broken, try resting for an hour and then get up to see if there is an increase in vaginal discharge. If you are still unsure, then you can always phone your midwife, doctor, birthing center, or hospital for individual advice. Occasionally, the membranes can break early for other reasons, for example if the mother has an infection, or they may break for no apparent reason.
Q: Can I take a bath after my water has broken?
A: In general, once the water has ruptured or leaked, it is advisable to come directly to the hospital or birthing center. Ask your provider's advice about bathing or showering. Some feel it is fine for women to stay home for several hours after rupture has occurred while others want you to come right in. If the baby is breech or you've had any complications, or you're preterm, you should come right in to the birthing area.
Q: What is a false labor?
A: False labor can be a number of things. It can be a series of contraction-type pains that subside after some hours that do not have the length, strength, or regularity to actually dilate the cervix, or neck of the uterus. Braxton Hicks contractions very close to your due date can also be confused for real labor. With these, you do experience your uterus tightening and relaxing and there is a degree of discomfort as with labor contractions. These Braxton Hicks contractions are a sign that your uterus is preparing for labor. If this is your first pregnancy, you may be unsure how to tell the difference between these practice contractions and the real thing. Real labor contractions are more regular, powerful, and usually more painful. Some women barely notice these practice contractions. For other women they are quite uncomfortable. If this is the case, it can help to move around a bit or take a warm bath to ease the discomfort.
Q: Is it true that I will have to go to the hospital if my water breaks, even if contractions haven't started yet?
A: If your water breaks before contractions have started, most maternity units in hospitals and birthing centers have a policy to come in to determine if you and your baby are both well. The main concerns when the water breaks are the position of the umbilical cord—whether it is stuck in front of the baby's head—and to rule out any chance of infection, and the answers to these two questions will determine the plan of care you will be offered.

You may be offered an internal examination to look at the cervix to see if there is fluid leaking and, if so, its color, and to take a swab of the area to determine if there are any bacteria that could pose a problem for the baby. A fetal monitor may be applied to assess the baby's heartbeat over a short period to identify if there are any signs that the baby is distressed . If all is well with you and the baby, and baby's head is closed to engaged in the pelvis, you can rest or walk around with the hope of getting your labor to start.

Around 85 percent of babies are born within 48 hours of the water breaking, even if there are no contractions initially.

Q: How will I be able to tell the difference between real contractions and Braxton Hicks?
A: Labor contractions have several specific characteristics. They are very regular and over time increase in regularity and length, and they are also painful. Most start as a period-type pain or a backache that again increases in intensity over time. The other difference that you may or may not be aware of is that the cervix dilates (opens up) in response to true labor contractions, but does not with Braxton Hicks contractions. One thing that may indicate this is happening is if you experience a show.
Q: What do labor contractions feel like?
A: Generally speaking, women feel contractions as a painful tightening of the muscles of the uterus. Although they actually start at the top of your belly and progress downward to the bottom of the belly, you may experience more pain and a feeling of pressure in the lower part of your abdomen and pelvis as the baby is pushed down by the contraction.

Some women experience contractions as pain in their belly, while other women experience labor pain as a backache. Generally, contractions tend to start as something that can be compared to a severe period pain, gradually increasing in intensity; however, the degree of pain felt will be different for all women.

Q: We're having a home birth—what if the midwife doesn't show up?
A: This would be very unlikely if you've made prior arrangements about how to contact the midwife but you should always feel free to call emergency services in your community if the birth is imminent. Two attendants are usually present at any planned home birth. If traffic or weather, or a communication problem is an issue, one midwife, physician, or nurse could provide care for you until additional help arrives. If the doctor or midwife feels the situation is not safe for either mother or baby, you may be asked to accept a transportation to the hospital.

If you experience labor before 37 weeks, you will be asked to come to the hospital because this is considered “preterm labor.” If you are not considered appropriate for delivery at home, it is important to rely on the midwives wisdom and not attempt a birth at home unattended. However, if the baby starts to come before help arrives, most babies do just fine. The emergency (“911”) operator can help and guide you.

Q: They sent my friend home from the hospital—I don't want that to happen to me.
A: Labors differ and are dependent on so many different factors, and your friend's circumstances and your own are likely to vary enormously. Unless you have been specifically advised by your doctor or midwife to go to the hospital early once you think labor has started, then the best place to be in the early stages of your labor is at home. In first pregnancies, the first stage of labor, when your cervix dilates to around 10 cm , averages at about 12–14 hours. So if you go to hospital very early on they may well suggest you go home until your labor is a little more advanced. Although you may feel that you want to stay at the hospital “just in case,” unless you have to travel a great distance to and from your local birthing center or hospital, you are likely to be much more comfortable and relaxed in your own surroundings.
Q: Are there certain situations when you can't eat or drink in labor?
A: If you have a higher risk pregnancy when the chance of cesarean birth is high, it is likely that you will be asked not to eat or drink while in labor. Anesthetics may increase risk of vomiting and aspirating stomach acid into the lungs that can cause respiratory distress or pneumonia which is less likely to happen if you haven't eaten. Prior to a cesarean birth, you will be given an antacid drink to neutralize those acids but it is best to have nothing in the stomach if surgery is imminent.

Most women prefer to drink only fluids or consume only nourishing light foods during their labor which supplies enough fuel for the work ahead without actually filling the stomach. Hunger is rarely a problem in labor but you should keep up a fluid intake of at least 200 cc every hour (which is a little more than one cup).

Q: Will I be able to drive myself to the hospital when labor starts?
A: Driving while in labor isn't advisable and could be very dangerous to yourself, your passengers, other drivers, and pedestrians. If you are in labor, you will be having regular painful contractions and this will interfere with your ability to focus and drive a car and will also diminish your awareness of your immediate surroundings. In other words, you will be very distracted!

Because the general advice about labor is to stay at home in the early stages for as long as you feel comfortable, this means that by the time you are traveling to the hospital you will be in very established labor and so your ability to drive would be very much diminished.

Another consideration is accident insurance coverage; if your driving is impaired because of pain you may well invalidate your insurance coverage. The safe option is to get someone else to drive or to take a taxi.

Q: How likely is it for a first labor to progress so quickly that you don't make it to the hospital?
A: In first pregnancies, labor usually lasts for 12–14 hours, with contractions building in intensity and length. Most women are more than happy to stay at home for the early part of the first stage of labor, and get a better idea of when they want to be in the hospital as their contractions become more regular. It is unusual with first babies, but not unheard of, for labor to be so quick or for you to have no sign of contractions, that you wait too long to get yourself to the hospital. Although this also depends on your distance from the hospital, traffic delays, or other factors that may increase the time it takes to make it to the hospital.
Q: What are the signs that it is too late to go to the hospital?
A: Generally speaking, if you are having an uncontrollable urge to push, then that's the point in labor when it may be too late to reach your hospital or birthing center before the actual delivery of your baby. If you do happen to find yourself in this unfortunate circumstance, you should call 911 or your local rescue squad for assistance with the delivery. Paramedics are experienced and well-trained in assisting in childbirth.
Q: Can I check how dilated I am myself or get my husband to do this?
A: There is one school of thought that believes that vaginal examination of the cervix shouldn't be done routinely in a normally progressing labor by anyone, and that would include you and your partner. There are several reasons for this. One is that some women find it a very uncomfortable procedure and the birthing staff gain very little information other than that the woman's labor is progressing. Another reason is that it introduces the risk of infection. If you are having strong, regular contractions, your cervix will be starting to dilate, and any examination should be carried out by a trained midwife or obstetrician under “sterile” conditions to limit the risk of infection. There is also the potential that whoever is doing the examination may break the bag of water surrounding the baby before they would have broken naturally.

So although it might actually be possible to feel your own cervix depending on what stage of labor you are in, this isn't something that is generally recommended.

Relaxing in early labor

You will probably spend early labor at home with your partner, timing contractions and deciding when to travel to the hospital if that is where you are giving birth. Since this part of labor can continue for a considerable amount of time, possibly with periods when contractions stop altogether, try to spend time relaxing in between contractions to conserve energy for later. There are simple things you can do at home to help you relax. You can take a warm bath, get your partner to massage your back, stay mobile but rest if you need to, eat nutritious snacks, and drink fluids to give your body fuel to work well later. Contact the maternity unit or your midwife if you have any questions.

The early stages:

Staying at home until labor is established can be the most relaxing way to spend early labor. Let your doctor know that labor has started and that you will come in later.

Calling the midwife Is it too early to contact the doctor or midwife?

Although each woman has a different experience, here is a rough guide for when to call the midwife and when not to call the midwife.

  • Don't worry about calling if your contractions aren't regular, occurring just once or twice an hour, since these may be Braxton Hicks.

  • Don't call if you have only had a show.

  • Do call if contractions are strong and regular, every 5–10 minutes.

  • Do call for advice if your water has broken.

NOTE

Even though you are facing one of life's hardest tasks, keep firmly fixed on the fact that you will soon meet your baby

NOTE

Playing some favorite music at home or in the delivery room can lift your spirits and encourage you to move around

NOTE

Keep contact details close by, the car ready, and your cell phone charged, so that when labor starts you will be prepared

Myths and misconceptions Is it true that…

Q: You're small-boned with small hands and feet so you'll have a cesarean?
A: Research shows there's no relation between the size of a woman's feet and her pelvis. So those with dainty feet can relax. If, however, you are on the small side and your belly is growing at an alarming rate, your midwife will keep a close eye on you in the last month of pregnancy. If necessary, a pelvic assessment may be done by a specialist so your pelvis and the baby's head can be measured. Then—and only then—will it be determined whether or not you need a cesarean.
Q: You'll have the same delivery as your mom had with you?
A: Fed up with hearing all the details of your own birth from your mom? Some say you'll have the same sort of delivery your mom had with you—early or late, speedy or forceps. However, there have been big developments in science since your mom's days so health professionals are more knowledgeable now. Also, many women are healthier and stronger these days (try telling your mom that!) so don't assume you're in for a difficult labor just because your mom had one.
Q: Your pubic hair will be shaved before you give birth?
A: Shaving women used to be standard procedure in labor, when it was thought it might lower the risk of infection. Nowadays pubic hair will only be shaved for medical reasons (such as for a cesarean section, or for stitching an episiotomy cut) and even then only partially.
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