Are you in labour?

iMoo's resident childbirth adviser Tracy Donegan on the sure signs you're in labour...

As your pregnancy moves into the final weeks every twinge stops you in your tracks……..”is this it?” you wonder….a part of you excitedly hoping yes and a part of you seeing your life flash before you.  Minutes pass and nothing more happens…you realize you’ve been holding your breath and you breathe a sigh of relief but you can’t help feeling just a little bit disappointed that it’s just another false alarm…

Just like pregnancy, every woman's  labour starts differently.

In the weeks leading up to the birth, your baby engages (move deeper into the pelvis) and you may have prelabour warm-ups which can sometimes be mistaken for the real thing, and even though it can be frustrating your body is preparing for the big day slowly and gently.

Some women have loose bowel movements just prior to labour beginning or feel like they’ve had a dodgy curry. Some Mums have a burst of energy and feel the need to prepare their ‘nest’; or a dull backache, often accompanied by a crampy premenstrual feeling. It can be tricky to pinpoint the actual start of labour, as the buildup is often slow and gradual and sometimes over a few days.  Most mums believe that labour starts with dilation but in fact there’s a lot going behind the scenes that you don’t usually hear about in antenatal classes that needs to happen before dilation can take place.

What’s Going on Before You Dilate

1. The cervix moves from a posterior (pointing slightly backwards) to an anterior  (forward) position.

2. Your cervix ripens or softens – the consistency of an unripe cervix is like the feeling of the tip of your nose – hard, but when the cervix is ripe it feels more like your lips – soft.

3. Your cervix effaces (shortens and thins)

4. Finally your cervix begins to dilate

Three Important Signs

The usual ways to tell if labour has started are: there is a show; the waters release; and/or mum has surges (or contractions) which are regular and continue building in strength and become more frequent.

a. You have a show:

Having a ‘show’ refers to the release of blood-stained mucous as the cervix starts to thin and dilate.  The show usually continues throughout labour and is a good sign that your cervix is starting to dilate.

Usually the show is pink or red, if any amniotic fluid passes at the same time it may also be a little blood-stained, but should then become clear. However, if there is heavy bleeding, contact your midwife immediately.

b. Your waters release

It’s every Mum to Be’s nightmare…..you’re in Tesco with a full trolley of shopping and your waters release and it floods the fruit & veg aisle….

The good news is that only about 12% of women will experience their waters going before labour starts it’s more likely that the waters will release when labour is well established – around 7cm. The waters may also release as a slow leak or trickle making it more difficult to determine if it’s amniotic fluid or a leaky bladder!

The waters are normally clear, sometimes there is a little pink or red which should become clear. If the waters are particularly red there may be bleeding into the fluid, or if they are brown or green then the baby may have passed meconium.   Contact your hospital immediately.

For the majority of women labour will start soon but for some labour won’t start for several hours or maybe days. Avoiding repeated internal exams and being home in your own germs (germs you are already immune to) is the best way to avoid infection.  Ironically some care providers recommend mums to come straight to the hospital to reduce the risk of infection.

It is useful to talk to your health care provider beforehand about their policy regarding what to do if your waters release before labour begins. Some may prefer you to go to hospital immediately while others are happy for the woman to stay at home for 24 hours or more. Most women will be in labour within 48 hours so sit tight and enjoy these last few hours of peace and quiet.

If your baby is not yet 37 weeks, breech and the waters are released in a gush you should go to the hospital immediately to make sure the cord hasn’t come down before your baby, in an all-fours, chest-down, bottom up position if possible to avoid gravity pulling the baby downwards onto the cord.

c. The Surges are Consistent and Settle into a Pattern

Mums often have Braxton-Hicks surges for several days or weeks before labour starts, which are irregular, slow down or stop if you rest and have no proper pattern to them. Sometimes they will last for a few hours surging every few minutes before stopping, which can be really frustrating.

In this case rest and conserve your energy, carry on with life as normal, or have a ‘labour project’ to take your mind off the clock.

While these practice, warm-up surges can be quite frustrating, they are in fact helping to soften and thin the cervix and just helping labour start gently.

When the surges start to become longer, more intense and closer together over time, showing a regular pattern, then this is a sign that true labour is underway. Surges are usually felt as a wave, with a gentle start which increases to a peak before fading away gradually.

 Initially the surges may not feel particularly intense, more of a discomfort low down in the abdomen or back, which can be ignored or you can easily talk through. Usually they last for around 20-30 seconds at the start, increasing over time to 90 seconds long. They may occur at 20-30 minute intervals increasing over time, or they can start straight away at 3-4 minute intervals. As labour progresses, you may need to focus more on each one, using slow rhythmic breathing to help get through it. 

Going to hospital:

Some women labour better at home because they feel more relaxed and comfortable in familiar surroundings, while others feel safer in the hospital – each woman and pregnancy is different. As long as you’re having a normal pregnancy it’s recommended that you stay home longer to ensure labour is well established before going into hospital, moving to the hospital sometimes slows labour which can then lead to interventions being suggested to get things going again. 

Congratulations! Your baby is on its way ....

For more information on preparing for the birth of your baby visit www.doulaireland.ie or pick up a copy of The Better Birth Book.