Contractions
False Labor, Preterm Labor, and Labor
Normal pregnancy discomforts, apprehension about labor and delivery, and the joy of holding your little one in your arms all are a part of this anxiety. Knowing the early signs of labor can help you to be observant of your body and know that your baby’s birthday is drawing near.
The uterus is composed of smooth muscle cell, which over the course of your pregnancy will begin to connect to other smooth muscle cells in the uterus. When one cell contracts, any muscle cells connected to that cell will contract as well.
As your pregnancy progresses, the number of connected cells will increase, forming bands of connected cells. Islands of connected cell will contract. This is what is know as a Braxton Kicks contraction.
Braxton Hicks Contractions
- Are typically painless, but can be uncomfortable and can include irregular cramping.
- Can sometimes be triggered by an increase in either mother’s or baby’s activity, or a full bladder.
- Don’t cause the cervix to dilate.
- May help promote blood flow, help maintain uterine health during the pregnancy, or prepare the uterus for childbirth.
Premature Labor
Labor contractions before 37 weeks of pregnancy are a sign of preterm labor.
Women who notice regular, frequent contractions at any point in pregnancy should notify their provider. We can check for changes in the cervix to see whether labor has begun.
Among women who experience preterm labor, only about 10% go on to give birth within a week.
Premature Labor Signs
- Contractions occurring more than 4-5 times per hour that are painful may be signs of premature labor.
- There may be an increase in discharge
- There may be mucous, blood stained discharge, fluid leaking, and/or an increase in pelvic pressure.
Your doctor will review with you the signs of labor, but it is important to contact us if there are any questions or concerns.
Labor
Throughout late pregnancy, your uterus has been painlessly contracting in preparation for delivery. Eventually, after 36-37 weeks, the islands of cell that were contracting (Braxton Hicks) connect to other islands of cells, and the uterus will begin to function as a single unit.
Some women experience contractions and backache on and off for weeks before entering active labor. These pre-labor contractions are important work for your body to soften and shorten your cervix in preparation for dilation and delivery.
The primary sign of labor is a series of contractions (tightening and relaxing of the uterus) that arrive regularly.
Over time, they become stronger, last longer, and are more frequent.
The intensification of contractions going from a tightening or cramping sensation to becoming stronger and rhythmic is usually the surest sign of impending labor.
In true labor, changing activity or position does not slow them down, and walking may intensify them.
Signs of Labor:
- Contractions that last a minute.
- The top of the uterus will become as hard as your forehead.
- Regular intervals of 5-8 minutes for 1-2 hours.
- Contractions may give you the sense of menstrual cramps, “the baby balling up” or lower back pain that comes and goes, lasting about a minute.
- Change in vaginal discharge – Called “show” or “the bloody show,” the discharge can be clear, pink, or slightly bloody. This discharge occurs as the cervix begins to open (dilate), and can happen several days before labor or just as labor begins.
- Mucous Plug – Losing the mucous plug is another early labor sign. This plug has formed a protective barrier to protect your baby from infection and outside debris. The mucous may be tinged with blood, which causes some people to refer to this as the “bloody show.” You can lose your mucous plug a few hours to a week before labor begins, either in small bits over time or in one large piece.
- Change in Bowel Movement – Several soft bowel movements occur days to hours before active labor.
Stages of Labor
Early labor
This is normally the longest and least intense phase of labor. Early labor is also called the latent phase of labor. This period includes the thinning of the cervix and dilation of the cervix to 3-4 cm. It can occur over several days, weeks, or just a few short hours.
Active labor
The next phase of the first stage of labor occurs as the cervix dilates from 3-4 cm to 7 cm. Contractions become stronger and other symptoms may include backache and blood.
Transitional labor
This is the most intense phase of labor with a sharp increase in contractions. They become strong and occur about two to three minutes apart, and average 60 to 90 seconds. The last 3 cm of dilation usually occur in a very short period of time.
Induction of Labor
Inducing labor means using medication or specialized instruments to artificially prompt contractions to deliver a baby vaginally. Most doctors do not recommend inducing labor for non-medical reasons before 39 weeks.
Indications for Induction
- Your baby is long overdue (about 41 ½ weeks).
- You develop a serious illness, such as preeclampsia or gestational diabetes.
- Your baby’s health is at risk inside the womb.
- It would be difficult for you to get medical help once the contractions begin naturally (i.e., you live far away from the hospital).
Elective Induction
You can choose to induce labor, called elective induction. Women may choose to induce to fit birth into their families’ or their doctors’ busy schedules.
Elective induction of labor is a controversial issue, but ultimately the choice to induce labor is yours. New studies have found that, in fact, inducing healthy women at 39 weeks is not associated with an increased risk of C-sections, and could be associated with some advantages, too.
How do I know if I am ready to be induced?
Your provider will use a measurement called the Bishop score to determine whether your body is preparing for labor. The Bishop score can help your provider decide how successful induction of labor will be.
The Bishop scoring system is based on a digital cervical exam of a patient with a zero point minimum and 13 point maximum. The scoring system utilizes cervical dilation, position, effacement, consistency of the cervix, and fetal station. Cervical dilation, effacement, and station are scored 0 to 3 points, while cervical position and consistency are scored 0 to 2 points.
A low score (0-5) is usually interpreted to mean that your body is not ready to deliver. Your doctor may have to “ripen” the cervix before attempting to induce labor.
A higher score (8-10) typically means that your body is ready to deliver very soon, and labor may begin on its own in the near future. Inducing labor will likely be successful.
