Pre Labor vs.

True Labor If you have never experienced labor before, you may find it difficult to know if you are in labor. Before heading to the hospital, call your physician or midwife to discuss your labor symptoms. It is common for first time mothers to make more than one trip to the hospital. If you are in early labor and sent home, the following activities may be helpful: walking, showering, resting, drinking fluids, listening to music, etc.

Pre-labor vs. True Labor Onset of Labor When to go to the hospital

Pre-labor vs. True Labor "How Do I know if I'm Really in Labor?" Pre-labor can only be differentiated from true labor by an internal examination of the cervix. True labor contractions become stronger, difficult to talk through, last longer, and are closer together as labor progresses. These will effect changes in the cervix, causing it to thin out and open while encouraging the descent of the baby through the pelvis. True Labor Contractions

Cervix

May be irregular at first Usually become regular Get longer, stronger, and closer together as time progresses Walking usually makes them stronger Lying down does not make them go away Often begin in your back and move to the front

Changes by becoming thinner and starts to open (dilates)

False (or "Practice") Labor Contractions

Cervix

Usually are irregular and short Do not get longer, stronger, or closer together Can last several minutes in length Walking does not make them stronger, may even cause them to stop Lying down may make them go away May be felt more in the front area and in the groin area Beneficial in preparation for true labor

Very little change or no change; does not thin or open

Prodromal Labor Contractions

May begin irregular and become regular Usually stay five or greater minutes apart May feel strong, but usually do not get closer together Lying down does not usually make them go away May last 24-36 hours without significant cervical changes Resting and sleeping may be challenging It is common proactice to be sent home to rest or to await stronger labor

Cervix May thin out but not dilate more than Back to top Onset of Labor Several theories exist as to why labor begins:

The physical aging of the placenta may cause insufficient nutrients to reach the fetus. The uterus reaches a crucial point of distension, which may cause tension on muscle fibers and stimulate their activity. Nerve impulses from the uterus to the posterior pituitary gland may bring about release of oxytocin (a hormone which causes the uterus to contract). Decrease in the level of the hormone pregesterone, may cause uterine changes. Adrenal glands of the fetus, when mature, may release a substance to stimulate labor. The release of prostaglandin from the wall of the uterus may initiate labor.

The four stages of the childbirth process are based on changes in the uterus and cervix as labor progresses. The beginning and end of each stage are described below: First Stage of Labor

Begins at the onset of labor and ends when the cervix is 100 percent effaced and completely dilated to 10 centimeters. Average length ranges for a first-time mother is from ten-to-fourteen hours and shorter for subsequent births. Read more in our Health Libarary o The first stage of labor o Cerival Effacement and Dilation o Illustration of Cervical Effacement

Second Stage of Labor

Begins when the cervix is completely effaced and dilated and ends with the birth of the baby. Average length for a first time mother ranges from 1 to-2 hours and shorter for subsequent births. Read more in our Health Library o The second stage of labor

Third Stage of Labor

Begins with the birth of the baby and ends with the delivery of the placenta. Average length for all vaginal deliveries ranges from five-to-fifteen minutes.

Fourth Stage of Labor

Begins with delivery of the placenta and ends one-to-two hours after delivery.

How Will I know if I am Making Progress? The progress of labor and the baby's position is determined by an internal vaginal exam. These exams are not done frequently and may be done during a contraction. Internal vaginal exams assess:

Cervical effacement (thinning measured as 0 to 100 percent) Cervical dilation (opening measured as 0 to 10 centimeters) Baby's presentation (the part of the baby to move to the pelvis first, e.g. head, buttocks, feet) Position of the baby's presenting part (described as anterior, facing your back, or posterior, facing your front) Station (baby's progress down through the pelvis or birth canal. Measured in minus to plus numbers)

Labor Contractions Labor contractions are the periodic tightening and relaxing of the uterine muscle, the largest muscle in a woman's body. Something triggers the pituitary gland to release a hormone called oxytocin that stimulates the uterine tightening. It is difficult to predict when true labor contractions will begin. Contractions are often described as a cramping or tightening sensation that starts in the back and moves around to the front in a wave-like manner. Others say the contraction feels like pressure in the back. During a contraction, the abdomen becomes hard to the touch. In the childbirth process, the work of labor is done through a series of contractions. These contractions cause the upper part of the uterus (fundus) to tighten and thicken while the cervix and lower portion of the uterus stretch and relax, helping the baby pass from inside the uterus and into the birth canal for delivery. How Contractions are Timed Contractions are intermittent, with a valuable rest period for you, your baby, and your uterus following each one. When timing contractions, start counting from the beginning of one contraction to the beginning of the next.

The easiest way to time contractions is to write down on paper the time each contraction starts and its duration, or count the seconds the actual contraction lasts, as shown in the example below. Writing down the time and length of the contraction is extremely helpful for describing your contraction pattern to your physician, midwife or hospital labor and delivery personnel. TIME CONTRACTION STARTS 10:00 10:10 10:15 10:20 What Contractions Feel Like Many mothers describe contractions that occur in early labor as similar to menstrual cramps, or as severe gas pains, which may be confused with flu symptoms or intestinal disorders. Imagine your contractions as looking like a wave. Each contraction will gradually gain in intensity until the contraction peaks, then slowly subside and go away. As your body does the work of labor, it is likely that the time in between contractions will become shorter. As the strength of each contraction increases, the peaks will come sooner and last longer. There should be some regularity or pattern when timed. Persistent contractions that have no rhythm but are five-to-seven minutes apart or less should be reported to your physician or midwife. Try to visualize contractions as positive Think of each contraction as something positiveit is bringing you that much closer to the birth of your baby. Visualize what the contractions are accomplishing, the thinning and opening of the cervix and the pushing of the baby downward. Try to work with your body rather than against it by staying as relaxed as possible during the contractions. Typical Length or Duration A typical labor for a first time mother is eight-to-fourteen hours, and is usually shorter for a second or subsequent birth. For many women, rocking in a chair or swaying during a contraction assists them with this relaxation. Pushing: The Second Stage of Labor The pushing stage occurs after the cervix is completely dilated and no longer in front of the baby's head. A smooth passageway now exists through which you can push your baby from the uterus and down through the birth canal to delivery. Your contractions may decrease just prior to getting the urge to push. You should take this time to rest prior to pushing. The length of this stage varies with the position and size of the baby and your ability to push with the contractions. For first-time mothers the average length of pushing is one-to-two hours. In some instances, pushing can last longer than two hours if mother and baby are tolerating it. Normally, the baby is born with his face looking toward mother's back (referred to as an anterior position). However, some babies are facing the mother's abdomen (referred to as a posterior position). Posterior babies may have a more difficult time passing through the pelvis, which may cause pushing to be more difficult or require more than two hours of pushing. Contractions during the Pushing Stage During the second stage of labor, the uterus continues to contract about every five minutes and each contraction lasts 45-to-90 seconds. The contractions are usually strong and forceful and may or may not be accompanied by an urge to push. This can make this phase somewhat more enjoyable since you are now working with each contraction. A renewed sense of energy may occur as you feel the closeness of your baby's birth! However, sometimes after a long or difficult labor, the pushing stage can be exhausting and uncomfortable. Most women will feel increased pressure in their perineum, rectum, and low back at this stage. For many women, the rectal pressure feels the same as having a bowel movement. As the baby's head begins to appear, you may feel a stretching or burning sensation. You may want a mirror positioned so that you can see your progress. Delayed Pushing Pushing is most effective when the mother feels the urge to push. Women who receive epidural anesthesia may have the sensation to bear down numbed by the anesthetic. The practice of "delayed pushing" (waiting for the baby to passively come through the birth canal) has been studied as an alternative to start pushing at 10 centimeters. If you and your baby are doing well, a one-to-two hour period of "passive descent" is safe and may make your pushing more effective. Positions for Pushing There are many different positions that may be used for pushing. In all positions, keep your chin down and use a rounded back to help your abdominal muscles assist your uterus in pushing your baby. DURATION OF CONTRATION 45 seconds 45 seconds 60 seconds 55 seconds

The following suggestions of various positions for pushing and advantages of each one. You may be able to speed the progress of the labor if you try positions where gravity assists you (i.e. sitting, or squatting). However, if the baby is delivering quickly, you may be able to slow the stretching of the perineum by trying positions where gravity is neutral (i.e. lying on your side, or getting on your hands and knees). It is important for your comfort to experiment with pushing in different positions. Many women find pulling a towel or sheet held by a partner or tied on the squat bar to be very effective during a pushing contraction. Positions for pushing and their respective advantages Stopping your Pushing There may come a time when you may be asked not to push with a contraction. This is for reasons such as the cervix is not fully dilated or the baby is crowning and the perineum needs to stretch gradually. Usually these situations require you to stop pushing for a short time. During this time, relax your neck, shoulders and legs and pant or blow out during the contraction. Visualize blowing out candles. Your partner may need to hold your face, look directly in your eyes, and pant or blow with you to keep you from pushing. Pushing, for many mothers, is a powerful reflex that requires considerable effort to breathe through rather than to push through. Breathing Techniques for Pushing The breathing techniques used for pushing are varied and depend upon which works best for you. Your health care provider and labor nurse(s) will offer suggestions and are your most valuable resources in evaluating your progress as you push your baby through the birth canal. Work with your contractions to enable yourself to maximize your efforts at the peak of the contraction. Grunting or groaning may be helpful while pushing. Allow yourself the freedom to make the sounds that come naturally. It is unnatural and possibly damaging to you and your baby to hold your breath for a long time. Holding your breath while pushing is fine to do if you feel it assists with bearing down. Breathing techniques Positions for Labor There are many different positions that may be used for pushing. In all positions, keep your chin down and use a rounded back to help your abdominal muscles assist your uterus in pushing your baby. The following are suggestions of various positions for pushing and some advantages of each. You may be able to speed the progress of the labor if you try positions where gravity assists you (i.e. sitting, or squatting). However, if the baby is delivering quickly, you may be able to slow the stretching of the perineum by trying positions where gravity is neutral (i.e. lying on your side, or getting on your hands and knees). It is important for your comfort to experiment with pushing in different positions.

Squatting

Squatting Semi-Sitting/Upright Sitting Hands and Knees Lying on Your Side

Advantages

Opens pelvic outlet to its maximum width (up to an extra one-to-two centimeters) Takes advantage of gravity May require less bearing down May enhance the baby's rotation and descent in a difficult birth Helpful if you do not feel the urge to push If you have difficulty with squatting, try a semi-squatting position on a stool or a stack of pillows. Birthing beds have a squatting bar which may be attached to the bed so that squatting is more comfortable.

Back to top Semi-Sitting/Upright Advantages

Some gravity advantage Partner should place his/her hands on your lower back and instruct you to push toward his or her hand, encouraging you to tilt your pelvis. Pelvic tilt allows for greater opening of pelvic outlet Good resting position Can be used with fetal monitoring Vaginal exams are possible in this position

Back to top Sitting Advantages

Some gravity advantage Good resting position Can be used with fetal monitoring May lean forward to help relieve backache; a good position for a back rub

You may consider pushing on the toilet as it is a familiar place to push and offers a firm surface against which to push

Back to top Hands and Knees Advantages

Gravity neutral - slows a rapid delivery May help relieve backache by bringing the baby forward Assists rotation of the baby in a posterior position Takes pressure off hemorrhoids

Back to top Lying on Your Side Advantages

Gravity neutral - slows a very rapid delivery Very good resting position Can be used with fetal monitoring Vaginal exams are possible in this position May be helpful in avoiding episiotomy

Premature Labor Occasionally, labor may begin prematurely. Although you may not be at risk for premature labor, it is important to know the signs and symptoms that may indicate an early onset of labor. Many pregnancy symptoms, such as backache, are common discomforts throughout pregnancy and may or may not indicate premature labor. The following information will help you understand what is normal and when you need to call your health care provider.

What is premature labor? What is a contraction? How do I check for contractions? Timing contractions Warning signs of premature labor Risk factors associated with premature labor

What is premature labor? Premature labor is labor that occurs before the 37th week of pregnancy due to uterine contractions that cause the cervix (mouth of the uterus) to open earlier than normal. This can result in the birth of a premature baby. Back to top What is a contraction? When any muscle in your body contracts, it becomes tight and hard to the touch. As the muscles of your uterus contract, you will feel your abdomen harden. As the contraction goes away, your uterus and abdomen soften. It is normal for your uterus to contract during your pregnancy. The muscle layers of the uterus tighten sporadically from the early weeks and throughout pregnancy. You may feel them as early as four months, but many women do not notice them until seven or eight months. Usually, these contractions are not painful. You may notice more contractions when you first lie down, after orgasm, if you have a full bladder, or after you walk up and down stairs. Also known as Braxton-Hicks, these normal contractions are usually irregular and do not change or open the cervix. If these contractions become regular (e.g., every 10 to 12 minutes for at least one hour), they may be preterm labor contractions, which can cause the cervix to change or actually open. Back to top How do I check for contractions? Lie down and place your hand on your uterus to feel the tightening and softening. Usually during contractions, your entire abdomen will feel hard, not just one area. Sometimes you may confuse the babys movement with contractions, especially as the baby grows. It is common for your abdomen to be firm over the babys head and buttocks, but in the absence of uterine contractions, your abdomen should be soft in all other areas. Back to top Timing contractions If your uterus is tightening and softening at regular intervals, you may want to time these contractions. Start timing from the beginning of one tightening to the start of the next tightening for about one hour. Some tightening feels harder or stronger than others. It is not normal to have frequent contractions (more than five in an hour) before your baby is due. Call your health care provider immediately if you think you may be in premature labor. Back to top Warning signs of premature labor Below are signs and symptoms of premature labor. Call your health care provider if you suspect you are in premature labor. Waiting too long to call for help could result in your baby being born too early.

Premature Labor Signs and Symptoms

A contraction every 10 minutes or more often within one hour (five or more uterine contractions in an hour) Watery fluid leaking from your vagina (could indicate that your water bag is broken) Menstrual-like cramps Low, dull backache Pelvic pressure that feels like the baby is pushing down Abdominal cramps that may occur with or without diarrhea Unusual or sudden increase of vaginal discharge Blood from your vagina

If you think that you may be in premature labor, call your health care provider immediately and:

Empty your bladder Lie down on your left side and drink fluids

Back to top Risk factors associated with premature labor Some risk factors have been associated with a higher chance of premature labor. However, just because you have some risk factors does not mean that you will experience premature labor. Review the following risks factors and let your health care provider know if any apply to you. Possible risk factor for premature labor:

Premature labor or delivery during a previous pregnancy Misshapen uterus DES (Diethylstilbestrol) daughter (If your mother was prescribed this medication during her pregnancy to prevent miscarriage, you are considered a DES daughter. DES has been linked to shortening of the cervix.) Abdominal surgery during pregnancy and/or cervical cerclage (a stitch in your cervix) More than two second trimester miscarriages or elective abortions Previous Cone Biopsy or LEEP (procedures used to diagnose and/or treat the cervix of women with abnormal Pap tests) Carrying more than one baby Dehydration History of cervical change and/or excessive uterine contractions at less than 33 weeks in a previous pregnancy Serious infections with fever (greater than 101 degrees Fahrenheit) during this pregnancy Recurring bladder and/or kidney infections Excessive amount of amniotic fluid Unexplained vaginal bleeding after 20 weeks of pregnancy Using recreational drugs, such as cocaine or amphetamines Domestic violence Smoking more than 10 cigarettes per day Extreme emotional or physical stress

Pre-Labor vs. True Labor When to Go to the Hospital Labor Stages Labor Contractions Pushing; The Second Phase Positions for Labor