Signs of Labor

Learn the signs of labor so that you know when to call your doctor and go to the hospital for delivery. If you have any signs of labor before 36 weeks or 9 months of pregnancy, call your doctor right away.

The signs of labor are contractions and rupture of membranes.

Contractions

Contractions occur when the muscles of the uterus tighten and relax as the uterus prepares for delivery.

False Labor Contractions

These often occur during the last month of pregnancy. They:

Are irregular.
Do not get closer together and may stop after an hour or so.
Are not often felt in your back.
Stop walking.
Do not get more painful over time.
Do not cause the cervix to change.

True Labor Contractions

Occur at regular times and last 30 to 60 seconds.
Get closer together and more painful over time.
May be felt in the lower back and lower abdomen.
Continue or increase with walking.
Help the cervix to soften, thin, and open for delivery.

If you think you are in labor:

Rest, if possible, on your left side. Eat or drink only light foods.
Time your contractions with a watch. If one contraction starts at 9:10 and the next starts at 9:16, they are 6 minutes apart. Call your doctor, clinic, or hospital when contractions are:
- 5 minutes apart for 2 hours for the first pregnancy
- 5 minutes apart for 1 hour for other pregnancies
- As directed by your doctor or clinic.

Rupture of Membranes

The rupture of membranes, called water break, is the trickle or gush of fluid from the vagina after the bag of fluid around the baby breaks. The fluid is often clear, but it may be white or green. The bag of water can break at any time. It may break before you feel any contractions and may leak during a contraction.

If you think your water has broken, call your doctor and go to the hospital.
Do not take a bath or put anything into your vagina.
You may wear a pad.

Talk to your doctor or nurse if you have any questions or concerns.

Induction of Labor

Most pregnancies last about 40 weeks. Some end a few weeks earlier and some end a few weeks later. The birth of a baby anytime between 37 and 41 weeks is considered normal. When your baby is “done,” labor usually starts on its own. Sometimes, however, if the woman or her baby is ill, or if the woman and her healthcare provider think it is safe, the healthcare provider may try to get labor started using medicines or other treatments. When this is done, it is called induction of labor.

How Is Labor Induced?

There are many ways to induce labor. The method used depends on the condition of your body and your preferences, as well as the preferences of your healthcare provider. Some of the methods help your body get ready for labor and some make contractions start. The methods most often used to induce labor include:

Stripping membranes: Your healthcare provider puts her or his finger into the cervix at the mouth of the uterus and gently separates the bag of water from the side of the uterus. This releases hormones that soften the cervix, making it easier to open. Sometimes it causes contractions and gets your labor started. Stripping membranes does not break the bag of water and does not always make labor happen right away.
Prostaglandin gel: Your health care provider may place Ibis gel on your cervix. It causes chemical changes in your cervix that soften and prepare your cervix for labor. Sometimes Ibis is all it takes to start contractions and get your labor started, and sometimes it just helps make your labor shorter once real labor starts or is induced with other methods listed next. ·
Placing a Foley bulb: Your health care provider may insert a tube called a Foley bulb into your cervix, and then he or she inflates the small balloon on the end of the tube. The balloon puts pressure on the inside of your cervix and slowly opens the cervix. It may also start contractions and get your labor started.
Breaking your bag of water (also called “rupture of membranes”): Your health care provider may use a small hook, like a darning hook, to break the bag of water. When this happens, the baby’s head may come down and help open the cervix. Chemicals in the waters (amniotic fluid) soften the cervix, cause contractions, and get your labor started. If you are in early labor breaking the bag of water can make active labor come sooner.
Pitocin: Your health care provider may ask the nurse in the hospital to start an IV-this is a fluid that will go into a tube and then into your arm. Medicine can be given in the IV fluid. Pitocin (oxytocin) is the same chemical your body makes that causes the uterus to contract. If you are given Pitocin through an IV, it is given slowly, so it may take a few hours or several hours before you are in active labor.

Epidural Pain Relief for Labor and Delivery

An epidural is often used for pain relief during labor and delivery. A small flexible tube is put in the lower back. Medicine is injected into the tube to provide pain relief in the lower abdomen, legs, and birth canal. A special doctor called an anesthesiologist will place the tube in your back.

How is the procedure done?

Your nurse will help you stay in position while the tube is being put in.
- You may be asked to lie on your left side and bring your knees up to your stomach as far as you can. Arch your lower back. A roll will be put under your left hip. OR
- You may be asked to sit on the side of your bed and lean over a table to round your back.
The doctor cleans your lower back.
Numbing medicine is injected into the lower back. You may feel a sting or burning.
The staff will ask you to put your chin to your chest and push your back out.
The doctor puts a needle into the numbed area and positions the tube into the epidural space around your spinal cord.
Breathe slowly and deeply. Relax and do not move. (If you have a contraction, use breathing and relaxation techniques.)
The needle is removed, and the soft tube will stay in your back. The tape will hold it in place.

Possible Side Effects

Pain relief may vary. Most women get good pain relief from an epidural.
You will be able to move your legs. Your legs may feel slightly numb or weak, especially if you receive a stronger dose of medicine. You will be asked to stay in bed for your safety.
An epidural may slow or speed up labor. The amount of medicine can be changed as needed to make sure you stay comfortable or if you or your doctor wants you to be able to push more.
On rare occasions, there is a possible side effect of a headache after delivery.

When Not to Have an Epidural

If you have or think you may have any of these conditions, tell your doctor or nurse.

Bleeding problems
Infection in the lower back area
Previous lower back surgery
Blood pressure problems
Nerve problems
Drug abuse

Talk to your doctor or nurse if you have any questions or concerns.

Pain During Childbirth FAQ

How Painful Is Giving Birth?

You’ve probably heard a lot of stories about giving birth. The experience is very different for each woman. The amount of pain is different for everyone. The kind and amount of pain you have changed throughout your labor.

Why Is Labor Painful?

During labor, your uterus pushes the baby down and stretches the opening of your uterus (cervix). Each time the uterus muscles flex, you may feel pain like a strong cramp. As your cervix and vagina stretch and open, you may feel a stretching, burning pain. Most contractions last 30 to 60 seconds, and you will be able to rest in between.

I Would Like to Help With the Pain, But I Don't Want to Use Medicine. What Can I Do?

Please see below for tips on coping with the pain of labor. The less tense and afraid you are, the less painful your labor will be. Three things can help you labor successfully without using medications: knowledge about what to expect, belief in yourself, and emotional support and coaching during your labor.

Is There Medicine I Can Take for Pain if I Need It?

There are many types of pain relief available in a hospital. The most common pain medications are narcotics and epidural anesthesia.

What Are the Pros and Cons of Narcotics?

Pros:

They give fast pain relief (usually between 2 and 10 minutes).
Most can be given directly into your bloodstream through an IV.
They may help you relax and be more comfortable.
They don’t usually slow your labor.

Cons:

Narcotics do not last long (usually between 20 and 60 minutes).
They may cause nausea.
They may cause you to feel really “out of it” or sleepy.
They may make the baby sleepy and make it harder for him or her to breathe right after birth or start breastfeeding.
Narcotics don’t take away all of the pain. They may make each contraction less painful.

What Is an Epidural?

An epidural numbs your body from the waist down. It involves putting a needle and then a small flexible tube into a space near the spine in your lower back. The pain medication flows through the tube and you lose feeling in your abdomen and legs. The medication will not make you or your baby feel sleepy or “out of it.” However, you will not be able to walk or get up to go to the bathroom. You may have a harder time pushing your baby out because you won’t be able to feel the contractions.

How Can I tell Before Labor Starts What Is Right for Me?

If you plan to give birth in a hospital, you can choose to use pain medicines. First, learn all you can about how much help and what possible problems can occur if you use the pain medicines that are offered where you are going to have your baby. Then ask yourself the questions listed here. The answers will help you decide on the best way for you to keep yourself comfortable during your labor.
How strong is my desire to give birth without using pain medicines?
Will I be happier with my birth after it is over if I go through labor without using medicine or will I be happier afterward if I use pain medicines?
If my labor is normal and I am in more pain than I expected, do I want my helpers to talk me through it or do I want them to offer me pain medicine?

Remember that nobody knows ahead of time how painful or difficult your labor will be. Knowing your desires is the best place to start. Then when you are in labor, you need to be flexible and trust your support persons and caregivers to help you make decisions that are right for your experience then. The flip side of this sheet has some tips for coping with pain in labor.

Coping with Pain in Labor

What Can I Do Before Labor?

Stay active all during your pregnancy. You will have more strength to get through labor.
Take childbirth classes. The more you know, the less you fear. Fear makes pain hurt more.
Arrange for a birth coach or doula. Having a person whose only job is to support you will help you cope during labor and feel more satisfied with the experience.

What Can I Do During Early Labor?

In early labor go for a walk or dance. The more you move, the less you hurt!
Drink lots of fluids so you don’t get dehydrated and eat lightly if you are hungry.
Take a warm shower or bath.

What Can I Do During Active Labor? Find Your Rhythm.

All women who cope well during labor go back and forth between resting in between the contractions and movements that help cope with pain during the contraction. Each person has their own rhythm that works. You may

Rest between contractions by being still or by rocking gently.
Focus on your natural breathing. Awareness of breath relaxes you.
Change positions often.
Don’t be afraid to make noise. You might moan, hum, or repeat comforting words over and over as you go through each contraction.
Believe you can do it. You can!
Remember why you are doing this. Your baby will be here soon!

What Can My Birth Coach Do During Labor?

Help you find your rhythm and then help you during each part of it.
Give you a back rub or hold your hand quietly.
Offer you ice chips, water, or juice.
Help you change positions and support your body.
Keep the lights low and play soft music.
Put a cold washcloth on your forehead.
Put a warm washcloth on your lower back.
Talk to you through each contraction, supporting your movements and your noises.
Cheer you on!