labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Monday, August 20, 2007

Falsies Vs. The Real Thing

I can’t begin to tell you how many first time mothers make trips to the labor and delivery unit thinking they are in labor when in fact they are just having a spell of Braxton-Hicks. The look of excitement and anticipation is universal to each mom, while their husband has their 6 suitcases and bags piled up beside their triage bed. We can spot these women a mile a way. They smile nervously and hold their bellies while they have a contraction. They’ll say to the nurse, “Oh, this is a strong one!” while carrying on a conversation on their cell phone to their friends and family to inform them that they are at the hospital.

And we (the nurses) think, “Ya, right sista!” Many times our report to the resident will be something like “Here’s another wannabe primip (first time mother)”. After their evaluation, you can see their hearts sink. Some will fight to stay. Some will leave with their bags with embarrassment.

Here are some ways to help distinguish real labor versus false labor:

  • False labor will have no distinguishable pattern. Contractions may come and go at different intervals. Contractions may go from 6 minutes apart, to 12 minutes, to 20 minutes, then back to 6 minutes apart. They may even stay at a specific interval for a while, but eventually will peter out after a while, or at least space themselves.
  • False labor contractions will not typically increase in intensity over time. Your contractions could last 2 hours, but none of them will get stronger than the previous. Sometimes they will lessen over time.
  • If you eat, drink, or go for a walk and the contractions space out or go away, it’s false labor.
  • If you lay down to rest, contractions will lessen in intensity or go away if it’s false labor.
  • True labor contractions will become longer, stronger and closer together over a period of time (for some over an hour while others over many hours).
  • No matter what you do, contractions just keep on coming. The walking, eating, drinking, and resting don’t do diddly squat for what you are feeling.
  • Real labor will not pass you by. Trust me. Even if the beginning of your labor starts off like false labor it will change and you won’t miss it.

Every provider has their own preferences as to when you should call them if you think you are in labor. In my classes, we use the guideline of contractions that are every 5 minutes apart for the last hour OR if the contractions are so intense or painful that you are having a hard time talking or breathing during them. But again, make sure you know what your provider wants you to do. There can be other variables that would determine when you go to the hospital, like any pregnancy complications or potential problems, distance to the hospital, or if you’ve had a very quick labor previously.


Midsummer Night said...

I always feel like I won't know what the real thing is. Silly really, this is my third baby and while the first two labors were far from ideal I still know what real labor is. I was able to distinguish at 28 weeks with baby #2 when the contractions started becoming real labor. And yet I knew up until that point that they were nothing.

Still I worry that I will go in early, so thank you for the reminders!

Amy said...

Thanks for posting this!

AtYourCervix said...

I get a kick out of the primips who come in, stating they can't walk/talk/breathe through their contractions, rating them 5/5 on the pain scale, and yet they are closed or only a fingertip --- and NOT in labor yet.

They have NO clue what real pain is like if they think the false labor contractions are the worst pain of their life.

mommymichael said...

I knew it was real I took a hot bath and saw my entire belly shrink with a contraction.

then after that I couldn't get my rear end off the toilet. I didn't think i'd have anything left to rid of, but somehow I found a way.

it also just felt different. a lot of pressure, not just tightening. and waaaay down low, with lots of pressure in my back. it was so crazy.

Jess B said...

After 3 babies, I thought I knew the difference....never once went to the hospital for preterm labor with any of them. And now, 10 days after having delivered another baby 4 weeks early, I still believe I can tell the difference....even though I REALLY didn't want to be in labor this last time. (At least not so early). I think it's interesting to hear the stories you and other nurses post. Thanks!

Anonymous said...

First time commenter. My first labor was awful. And lasted 54 hours. Yes, 54 hours. I was sent home from the hospital 3 times, stuck at 3 cms, told my contraction pattern was "not regular" and that I was in prodromal labor. My contraction pattern never really got all that regular without the help of pitocin. The culprit-sunnyside up was a long and painful 3 days. As excited as I was to meet my baby when labor first started, by the 3rd time I was sent home, I was defeated. I was exhausted, I was brow beaten and I felt humilated by nurses and doctors who were judging my pain entirely on my contraction pattern and the thinning of my cervix.

I was 6 cms by the time I got to the hospital with my second. I had no idea I was actually in labor because the pain paled in comparison to my first. 1 hour and 58 minutes later, my daughter was born, sans drugs.

It's funny, I was taken so seriously when I arrived at the hospital with my daughter because I had a qualifying cervix and contraction pattern, yet I laughed and walked and never even cried during her labor... but when I needed that empathy while in labor with my son, I got nothing.

Just my thoughts...

may said...

i was the opposite with my first baby. my water broke at 4 AM, no contractions. i called my doc at 10 telling her i'm not sure if it was indeed my water, because it felt like i was just incontinent of urine.

talk about stupid :)

CrankyProf said...

The thing is, primips have nothing to base what "real labor" feels like. (And in reality, every labor is different. What it feels like the first time won't be what it feels like the second, or fourth, or sixth). No matter how many times a mom asks, "How will I know it's real labor?" and "What does labor feel like?" a nurse or another mommy can't give them an accurate description -- it's too subjective and there are too many variables.

Without a basis for comparison -- and with all the labor horror stories that first-time moms are subjected to -- their pain is exacerbated by fear of the unknown.

It may be "the worst pain of their life," because of anticipation. Throw in there someone being dismissive of their pain...

I think a lot of first time mommies end up feeling awfully belittled when they go to L&D anticipating labor, and get sent home for false labor -- and that makes the experience worse for them.

Jack and Lexi's Mom said...

With my second child I started prodroming at 32 weeks. I contracted every 15", sometimes as often as every 5", until I delivered at 37.3 weeks. I knew I wasn't in labor, even when I contracted as often as my labor patients. My cervix never changed. I was in pain sometimes and other times okay. It sucked! I hated it! I never discharge a labor triage home without telling her this story. I KNOW how bad it sucks!

sara said...

I was one of the ones that was sent home. :) My contractions were regular, lasting a minute (or more), through walking around/laying down (ooohh the laying down did NOT work. The pain!) for more than 5 hours. I didn't think it was time to go to the hospital but I was following my OB's instructions and then waited another 2 hours on top of that because my husband didn't want to wake up yet. :p I was sent home 1cm dilated and told to come back when I couldn't talk through the pain. I took it literally and came back in at 7cm dilated.

I remember the L&D nurse laughing at me because I was smiling and I was like "I didn't want to come in but my doctor TOLD ME TO!". :p

So your story reminds me of the L&D nurse that night. :) I'm sure she thought I was a crazy first time mom.

Judy said...

Everybody's different. I had Braxton Hicks contractions every 5 minutes for HOURS - starting at about 28 weeks with all 3 kids.

It used to scare the beejeebers out of my NICU co-workers.

By kiddo #3, I was pretty damn sure I'd know when I was in labor. That would be a couple of hours after they started the pitocin -- every single time.

With the first 2, I knew when to go to the hospital, because my membranes had ruptured. No contractions AFTER rupture. Just before. But then nurses NEVER follow the rules.

#3 I new to go to the hospital because my BP was 180/110 in the OB's office.

Lynn said...

Please, triage nurses, never ever make a woman feel foolish for coming in with false labor. With her first baby, a friend was belittled by the L&D nurses for thinking she had started labor, and was sent home. She was so afraid of making a mistake about labor that she waited too long and had the baby in the car en route to the hospital. This may not have been so bad, except that the couple lived on a farm an hour away, and were in the middle of nowhere on the side of the highway when baby arrived. She started hemmoraging after the placenta came, and it took the ambulance a while to get to them and get her to the ER for medical care. Sensitivity and understanding, knowing your patient's situation (such as living so far away), and giving good guidelines like 5-1-1 for a first-time mother are called for!

Lynn said...

I will also add this: I am about to have my fourth. My first labor was exactly as Suzanne described--54 hours of irregular but horrifically painful labor that got stuck at 3-4 cm, posterior baby, pitocin in hospital finally got him to rotate the right way so I could push him out. My second labor was pretty painless in comparison. Luckily, I have babies at a birth center with a midwife who understood how much pain the posterior baby caused even though I was only dilated 2-3 cm. My contractions would end, but the intense pain in my back was continuous. Some contractions were 3+ minutes long and worse than anything I had with my second and third babies, and still I was only 3 cm. She knew how bad it was, and when we had to transfer to the hospital, she went with me and supported me. I had an epidural because by then I was too exhausted from pain and not sleeping for days, and needed to rest so I could push, and I am grateful for it--I escaped a C-section by the skin of my teeth, barely mustering up enough strength to get the baby out. It also doesn't help when you can't feel when you are pushing! My 2nd and 3rd births were a breeze in comparison. I don't remember pain from transition with them, probably because I was in a waterbath. Pushing hurt but lasted 8 minutes, no big deal in the grand scheme, plus I could feel it and had something to direct my pushing energy toward. I don't think I could have handled that terrible first labor with L&D nurses and doctors refusing to acknowledge my pain because my cervix didn't look the way they thought it should to experience that level of pain. Baby's position makes all the difference! When a woman says 10/10, she means it! Now pre-labor is another thing I hate but experience nonetheless, starting at 35 weeks. I'll have an hour or so with contractions getting longer, stronger, closer together, all that--and then it will stop--then come back again after a few hours. I have to ignore it until my water breaks or it has been many hours and they are intense. I am glad I am not a fast birther! A friend just had a baby (also in the car in the hospital parking lot) forty minutes after telling me she thought she might be in labor but wasn't sure. She didn't realize birth was immenent until they pulled in and she pushed one time--there was baby. She was talking on the drive to the hospital! This was birth #5 for her. You just can't go by the book in all cases, and sensitivity to the individual woman and what her labor is doing is vital in this profession, I think.

Bernadette Birkenfeld said...


Tabitha Olson said...

You think that is funny? Labor is different for everyone and you think a woman is serious pain is funny? I really hope you aren't a nurse