Are You in Labor? A Midwife's Guide
Particularly if this is your first baby, it may be difficult to decide when to go to the hospital or call your midwife. So often women will go to the hospital only to be sent home and told they are not in active labor. It is not unusual to have contractions and discomfort on and off for many hours or even days before active labor begins. This maybe referred to as latent labor. This is the time when your body is getting ready for active labor. Your cervix is softening and shortening. The uterus is getting organized. It is not false labor, it is real. But it is not active labor. Before you decide to go the hospital, birth center or call your midwife you should be able to answer yes to the following questions.
Are the contractions regular?
Contractions often begin far apart and slowly get closer together. In the beginning they are often irrregular. You may have contractions every 2 minutes for a half hour then one or two in the next half hour. They may be every 10 minutes then slowly go to every 5 minutes. But even if they are every 2 minutes, if they are short and mild it may not be labor. The uterus can get irritable if you do not drink enough water or if you are tired. Try resting and drinking extra water. If it is true labor then contractions will not go away, Contractions are timed from the beginning of one to beginning of the next? Active labor is characterized by regular contractions every 5 minutes or closer.
Are they lasting 40-60 seconds from the beginning of contraction to the end?
Early in the process contractions may only last 20 or 30 seconds. At first you may just feel tightening or mild cramping. Some women may experience intermittent back pain. Have your partner rub your back, take a warm bath or shower and relax as much as possible during this early stage. If you have an uncomplicated pregnancy you will be more comfortable at home in this early stage of the process. You can safely stay at home and walk, eat and rest in a familiar environment. As contractions get stronger they also get longer. Active labor contractions usually last about a minute.
Have contractions been regular for an hour or more?
As mentioned above, it takes time for the body to ready itself for active labor. Contractions can stop and start for hours or even days before active labor begins. This can be challenging emotionally and physically. The key is to understand that this is a normal process. Continue to eat and rest as much as possible. Stay calm and positive. This process has and end and at that end you will have your baby in your arms.
Do contractions take your breathe away?
As contractions get more intense you will need to really focus to stay in control. By the time your body is working hard enough to change your cervix and start dilation you will likely not be able to easily talk through a contraction. You will need to focus on breathing with each contraction. It is nearly impossible to describe what a contraction will feel like to you. They have been described as a wave washing over you or some may say tsunami! In any case, it is an intensely physical experience. When you cannot talk through the contractions, they are lasting close to a minute and they have been regular for an hour, every 5 minutes or closer then likely you are in labor.
If you think your water broke it is usually not an emergency. This may happen even before you notice contractions. If the water is clear and baby is moving you have time to get a bite to eat, take a shower, or go back to sleep if you choose. Call or go to the hospital when your care provider recommends. Slight vaginal spotting pink, dark red or brown is normal in early labor as your cervix starts to change. This is called bloody show and is a normal part of the process. Danger signs are green or brown fluid, heavy bright red bleeding and decreased or absent fetal movement. GO to the hospital if you can't keep anything down for over 24 hours, if you have any spots before your eyes or a headache that does not go away with plain acetaminophen (Tylenol). If you have any risk factors or medical conditions which may affect your labor be sure you ask your care provider and are clear on their recommendations for labor.
Labor is a normal process
The vast majority of women have normal pregnancies and labors. Staying home until you are in active labor will reduce the risk for unnecessary interventions and keep you more calm and comfortable in early labor. My best wishes for a healthy progressive labor and congratulations on the impending birth of your child.