The biggest confusion when it comes to labor is that it can be hard to distinguish between false and real contractions. As you approach your due date, you may feel something labor-like -- namely, contractions that are mildly uncomfortable and vary in intensity. Unlike the benign, preparatory contractions of false labor, real contractions are painful. They build in intensity so "you can't walk or talk through them," says Susan Warhus, MD, an ob-gyn and author of Countdown to Baby (Addicus Books).
You can time them. "When contractions are five to seven minutes apart for at least an hour, with each one just as intense as the last, you're in labor," says Myron Bethel, MD, chief of staff at Good Samaritan Hospital in Los Angeles.
Does that mean it's time to head to the hospital or birthing center? Not necessarily. A lot depends on your medical history, whether this is your first labor, and whether your cervix is already dilated. Also factor in how far you live from the medical facility. Your best bet is to call your doctor. If this is your first labor, you can probably wait until your contractions are about five minutes apart to call the doctor. But be sure to go over this as your due date approaches, as she may have a different protocol. If this isn't your first labor, call your doctor when your contractions are 10 to 15 minutes apart. In general, "a second labor tends to be half as long as the first," says Ted Peck, MD, a specialist in high-risk obstetrics at Gunderson Lutheran Medical Center, in La Crosse, Wisconsin, so you have less time to hang out at home.
When calling your doctor, don't forget to mention any progress you've made since your last visit. "Say, for example, 'When I saw you on Tuesday, I was already 5 centimeters dilated,'" Dr. Warhus says. If you're told to stay home a while longer, try to relax. This will keep your muscles loose, which will help labor progress and ease pain, Dr. Peck says.
A gush or a persistent trickle of musty fluid is a major sign that your membranes have ruptured and that labor has begun. What's confusing here is that women in the latter stages of pregnancy can become somewhat incontinent as the baby's head presses against the bladder, which causes urine leakage. How can you tell if it's urine or amniotic fluid ("water")? "With incontinence, a pad won't immediately become saturated because the fluid leakage isn't continuous," Dr. Bethel says. Keep in mind that you don't need to be having contractions for your water to break. What to do? Again, call your doctor. Be prepared to discuss the color of the fluid and the status of your Group B strep test, which most obstetricians perform in the last month of pregnancy. If the fluid is clear and your Group B strep test is negative, that's a good sign that everything's normal. On the other hand, if your Group B strep test is positive and/or the fluid is brown or green, your doctor will probably advise you to head to the hospital right away because it could be a sign of fetal distress or of the need to have the baby monitored closely.
In the end, it's difficult to predict exactly what your labor will feel like and how long it will last. But knowing the signs that indicate when it's finally begun will make you feel more confident about what's ahead.
You get the runs. Sometimes women will have diarrhea a day or two before going into labor. "That's the body's way of emptying the bowels so the uterus will contract well," surmises Rochel Lieberman, a Brooklyn, New York, nurse-midwife. "Indigestion and vomiting prior to labor are also possible."
You're carrying especially low. When the baby's head drops into the pelvis, lining itself up for labor, this is known as lightening. The weight of your baby is no longer pressing on your diaphragm, and you may be able to breathe more freely as a result.
You get a burst of energy. You're exhausted, but suddenly you want to cross everything off your to-do list. "The sense is that you don't want to leave any unfinished business at home," Lieberman says. If you do feel a spike in the nesting instinct, "don't knock yourself out," adds Barbara Moran, a nurse-midwife in Dunn Loring, Virginia. "You'll need your energy for labor."
Originally published in American Baby magazine.
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