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

Tuesday, August 7, 2007

What Happens Before Labor

Here is the last of the childbirth ed posts from Life and Times. Don't worry, though, there are tons more to follow in this series.

What Happens Before Labor?

Everyone wants to know: "How will I know it's labor?"
And every time I answer: "Because you can't mistake it!" I get looks of frustration and confusion. Labor won't pass without you knowing it. Trust me.
Here's a known fact among labor units everywhere: if you can easily talk through a contraction, like you can tell us you're having one while smiling with excitement, means you are either not in labor or in very early labor. And if you come to the unit like this, you'll likely be going home.
Other things that women frequently ask is what signs can I look for to tell me when labor is going to happen? Well, hate to burst your bubble here but there is no specific sign or scientific formula that is going to tell you that either.
There are things that can occur that tell you that your body is preparing for labor. They don't occur in any specific order nor do they occur in every woman.

  • Braxton-Hicks Contractions: these are contractions that occur in the third trimester of pregnancy that are irregular and mild. These contractions do not change the cervix like true labor contractions do. Think of them as practice contractions on a very small scale. Some women can be bothered by them and others never seem to experience them. These contractions will typically subside with rest and fluids.
  • Lightening: You've heard the saying, "The baby has dropped", right? This is lightening. It's when the baby engages it's self into the pelvic cavity and you can suddenly catch a good breath. And you pee like every 22 minutes.
  • Nesting: Ya, this really happens. This is when you get an urge where everything must be ready. Clothes must be washed in Dreft, folded, and placed in the cute little baby bureau in the nursery. Diapers must be stacked in the changing table. The suit case must be packed. The house must be cleaned. You've mustered up some new found energy that just must be put to use.
  • GI Changes: Here's everyones favorite! That nausea and vomiting you finally got rid of? It's come back. And that diarrhea? Ya, its to empty out the system and triggered by prostaglandins (more on the hormones later).
  • Dilation and Effacement: I hate to even put this in here because everyone wants to hang on to their cervical exam at 39 weeks like it's their ticket to the labor room. But dilation and effacement can occur before labor. Typically the changes in the cervix prior to labor are minimal at best, particularly in a first time mom. There is no formula that says if you are 1 centimeter dilated at 38 weeks then you will go into labor in 16.23 hours. Sorry, there just isn't. I've told this to countless women, but everyone wants to hang on to that damn exam! Why are they done, anyhow, is what I'd like to know! But that's beside the point. So many get hung up in this and just make themselves frustrated and disappointed with each passing day that the stork passes them by. Here's what I've seen happen: cervical exam at prenatal appointment is 2 centimeters. You think labor will hit you at any moment. And then you find that your doctor is booking a postdates induction. OR cervical exam at prenatal appointment is zippo. Cervix closed tighter than Fort Nox (Knox?). You think you'll never go into labor but end up having a baby hours later. So either way, you just never know. I've seen women walking around at 4 centimeters for several weeks and not go into labor; and I've seen the disappointed mom with the closed cervix go into labor later that night. So I guess the take home message here is that dilation and effacement of the cervix can happen before labor, but it won't tell you when labor is going to occur.
  • Loss of the infamous Mucous Plug: Here is another event that can't really tell you diddly squat. Well, other than your body is doing all the right things and labor will occur at some point in the future. And the mucous plug doesn't come out looking like a cork. Typically its seen as an increase in mucousy vaginal discharge over a couple of days. Sometimes the cervix does spit it out in one big glob. I can tell you that the big event of the mucous plug has doctor's offices rolling their eyes when someone calls in a panic thinking that at any moment labor will strike them down like Kryptonite. I can attest that no one cares but you about the mucous plug. We'll care if there's bleeding associated with a mucousy discharge... but otherwise you can just make note of it in your scrapbook. Well... I mean write about it...don't scrapbook the actual plug.

Makes labor signs clear as mud, huh?


The Nurse said...

Don't you hate it when they bring their mucus plug (sealed nicely in an old Country Crock butter tub) into your triage so they can show it to you?

Labor Nurse said...

Eck! I hear ya! Although I have never had anyone bring it in a butter container. Although I have had the used toilet paper.

Anonymous said...

Ewwww.... why would people think that it's necessary to bring in their mucous plug? Our childbirth educator *begged* us not to bring it in! Makes me think of the line from Ghostbusters, "Somebody blows their nose and you wanna keep it?"

Zahra said...


Love your blog...but could you please add the label widget and label your posts? This way we can see any posts that are related in the archieves. I think you had that in your previous blog.

Nice that you came back. I was a longtime lurker. :)

Anonymous said...

Can you change your template to a more attractive one? Maybe the one with the white background?

Play with it! Maybe put pregnant women pictures/figures on the sidebar.

Rachel said...

This has been a fantastic series - thanks so much for posting it.
Why do you think women bring in the plug?

Amy said...

I can't believe people actually bring theirs in! I'm a pregnant FTM and I would never have thought that was a normal thing to do. Gross!

Jess B said...

Honestly? People bring in their plug. EEEEEWWWWWWWW!! I can't imagine the thought process there. Anyway, I love the series. I am set to deliver before the end of August (for the 4th time) and this is still educational...I like the honest nurse approach rather than just hearing what they want me to hear. Thanks!

Labor Nurse said...

Amy, it's not normal!

I am not sure of the thinking behind it. Maybe they think we need it or that we want proof? Who knows.

Anonymous said...

I am the exception to the "talking through the contractions" rule. I have delivered 2 babies without doctors at the hospital...meaning nurses delivered because I was pretty doggone fast from 4 cm to 10. This is partly because they were my 4th and 5th babies. I had my 3rd within 45 minutes of getting to the hosptial. Oh, that 4th baby, I kept telling the nurse to call my OB but she said, "honey, she said to call her when you were at 8 cm." Well, then a few minutes later I said, "check me." I was then at 9 cm. She turned around to do something, and I said I felt my body pushing. She said, "don't push right now." She kept going about her business (preparing things I guess) and another nurse was helping get it together. I said, I think I feel the baby there." She replied, "no, that's your bag of waters." I then said, "break it." Of course, she was wise to say no to that. A few minutes after that I said, "hey, ring of fire, ring of fire." The baby just sort of plopped out. Mec all over the place, baby on the unbroken bed (thank God) and the warmer was cold. So, sending me home with a 4 cm dilated body after a few hours is bad...I can talk during contractions...and have a fast last stage with one to three pushes.

Labor Nurse said...

Anonymous, I'm jealous, and I've never given birth. May every women's labor be filled with conversation with contractions and 1 push second stage!

Anonymous said...

Yes, I wish it was that easy for everyone. My births were much easier I believe than most. Those last three were especially fast in the last stages.

Well, I did have to be in labor for real with my first born. I was at the hospital 5 hours before he was born, but my pushing stage was only 15 minutes. Unfair to the women who push for 3 hours and then get a c-section for sure. I did labor all night at home until I couldn't talk through the contractions. Then I went to the hospital, taking my time. I think I avoided extra intervention that way. Baby was having decels but the OB just had me on O2. He was born in a quick enough time frame that it worked out...mec with a cord wrapped around his sunny side up little head.

I would assume more multiparas have a shorter pushing stage?


Anonymous said...

I'd rather have the concerned mother come in with any questions and/or concerns-it's better to be safe than sorry. Cut some slack, just becuase you know about labor and delivery doesn't mean that everyone else does. Pregnancy is an exciting time for most first time mothers, speaking from experience, and it's hard not to question every little ache and pain, especially since we've never been through any of this before. At least we care about our baby. And yes, we are very anxious about labor so that's what makes us ask so many questions. Maybe if patients annoy you this much then you should find a different occupation! I would hate for you to work in my doctor's office.

Labor Nurse said...

Anon, I'm not so sure how this particular post seems like I am annoyed with pregnant women questioning what is going on in regards to labor. So, let me clarify for you: This post lists common things that can occur prior to a woman going in to labor. However, there is no specific formula or way of telling when labor is going to occur based on these common physiological changes. But these physiological changes do help reassure a woman that her body is preparing for labor at some point in the future. If my sarcasm is what bothers you, I suggest you not read my Childbirth Education Series, or my blog for that matter, because it's my style of humor. Hell, I could care less if every woman came in when she felt a few braxton-hicks contractions to make her feel reassured (or disappointed, depending on what she wanted). I'm just saying that many first time mothers end up being sent home in that case.

I also realize that pregnant women have lots of questions about what it going on, which is why I started the Childbirth Education Series. But because its my blog, I can present it with my sarcastic style while giving it straight (no hospital agenda here).

Anonymous said...

This website was very helpful. I am 36 weeks pregnant and this is my first pregnancy. It seems to be straight to the point. It gets to be an anxious time towards the end. It is so true from hearing stories of deliveries that some people walk around dilated for weeks and others never dilate and go into labor. Just from talking to my friends i have realized just because you may have one symptom of labor or your body preparing for labor doesn't mean you are going into labor because i know people that have no symptoms and never dilate and their water breaks. Well, anyway this was a great website.

Anonymous said...

Hay all. Im on my 2nd child although not actual experianced labour due to 1st being a breech and ending up with c-sec, intresting to hear all nurse's comments on the subject, proffesional and personal, Its nice to know what goes through their heads, whilst mothers whether 1st time or not have queries and worries on the procedures of forthcoming birth.

It would be nice though to know ALL maternity nurses are UNDERSTANDING and respect thier duties of expecting what patients will ask and say, like all jobs same ol same ol can drive you bonkers, i do agree if your at that stage in your job maybe think bout refreshing your career.

As the perspective of childbirth from pushing the equivalent of a melon out, to the natural concerns of your childs saftey shouldnt be a issue in you taking your duties other than showing proffesionism and support.

But thanks for opening my eyes to the view on some materinty nurses perspectives, Not sure "now" if I should apologise to my nurses on the day if I have a long stressful labour for all the incovienance I may have caused...!!

Lexy Lu said...

ewww i would never bring my mucus plug in, that is disgusting. mine has been coming out in bits so it would be hard for me to keep it anyway lol. i'm glad i came across this blog because i've been so confused on what to expect. my nesting happened about 2 weeks ago, so i thought i was going to go into labor then but here i am, still waiting V_V tho she's not due until the 17th

HisKitten92 said...

Firts off, eww.. why in the world would anyone find the need to bring it in with them. And on another note, I find the tone of this whole post very rude in a way. I understand that nurses and doctors see and hear alot of what they consider common sense questions and pointless panicking. But you have to realize for some women and first time moms like myself, every little pain and odd symptom is going to make us panic. It doesn't matter how many times we're told it's okay. If I lose my mucous plug before I go into labor, I will call my hospital immediatly and I'll probably be panicky until they tell me to come in. I'm worried that every contraction signifies labor even though I know better. I'm not being this way because I'm not intelligent about what's going on with my body. I know what symptoms I should and shouldn't be having. I've done my research. I'm just being cautious and ready. That way there aren't so many unexpected suprises. I'm 35 weeks and already started dilating and because of that, at every appointment, even though labor hasn't started, I will still ask to have my cervix checked and I will still ask the same "do you think it will be soon?" questions. It's the doctor and nurses job to answer my questions and reassure me, no matter how often I ask those questions. If nurses are so annoyed by it, change professions.