How will I know I’m in labour? FAQ
How will I know I’m in labour?
How will I be able to tell that I’m really in labour?
The one completely sure sign that you are in labour is that you are experiencing regular contractions that are causing your cervix (the neck of womb) to dilate or open, and this can only be determined by your midwife or doctor during an internal examination.
True labour contractions are usually painful, occur very regularly and grow stronger and more frequent as time goes on There are other signs that labour could be on its way, such as a mucous vaginal show or discharge (see below), but these are not true indicators that labour is actually underway.
If you are unsure about whether you are in labour, you could try timing your contractions from the beginning of one to the beginning of the next and note how often they occur. If you are in labour. then you will notice them becoming closer together and increasing in duration If you think you are in labour, always call your midwife or your nearest delivery unit for guidance and advice.
What is a “show”?
During pregnancy, a plug of jelly-like mucus seals the lower end of your cervix and this prevents infection getting into your womb. This “plug” comes
away towards the end of pregnancy, and although this can mean that labour is going to start soon, it
can also dislodge up to six weeks before your labour actually starts. When the plug comes away, this is commonly referred to as a ‘’show’.
There was some blood with my show - is that OK?
Yes, it’s normal for a show to contain a small amount of either fresh blood or dark old blood (like at the end of your period) as part of the clear or cloudy mucus of the plug.
At which point should I ring the hospital?
If you are experiencing regular contractions that are getting closer together and increasing in the amount of time that they are lasting, then labour may well have started. When your contractions are around 5-10 minutes apart, you should phone the birthing unit for further advice
Other situations when it is recommended that you phone are if you think your waters have broken, your baby’s movements have slowed and become less frequent, you experience any bleeding, or you are in pain and not due for delivery
Never worry about phoning for advice; it is better to be well informed than to sit at home worrying about things Always carry essential contact numbers in your bag and keep them by the phone at home, as you never know when you may need to seek advice or when your labour may begin
What do people mean when they talk about your “waters breaking”?
The ”waters’ are the amniotic fluid contained in the membranous sack surrounding and protecting your
baby in the womb These membranes usually split or break towards the end of the first stage of labour. This means that the fluid continues to cushion the baby’s head and prevents direct contact with the cervix at first, helping you to cope with the pain. Eventually, the pressure causes the membranes to burst, releasing the amniotic fluid, which leaks or gushes through the vagina.
What should I do once my waters have broken?
If there is quite a large gush then you will be in no doubt about what has happened Sometimes, however, the waters break and produce a small trickle, which leaves you in some doubt as to whether they have broken If you think your waters have broken, I suggest putting on a sanitary pad and examining it after a short while to see if there is amniotic fluid visible If you are still unsure then always phone your midwife or local maternity unit for individual advice. Occasionally, the membranes can break early for other reasons, for example if the mother has an infection, or they may break for no apparent reason.
Can I have a bath after my waters have broken?
If there are no complications in your pregnancy and labour then you should be able to have a bath which you may also be using for pain relief. Indeed, using water in labour has been assessed in many trials and most show that women report a significant reduction in pain (see p.156)
Studies have found that there is no increase in the risk of infection rates in women who bathe in water following the spontaneous rupture of their membranes If you are unsure about this, ask your midwife about your local hospital’s guidelines, as most maternity units have specific policies to ensure safe practice regarding the use of water for both labour and birth.
What is a false labour?
False labour can be a number of things It can be a series of contraction-type pains that subside after a number of hours and that do not have the length, strength, or regularity to actually dilate the cervix, or neck of the womb. Braxton Hicks contractions very close to your due date can also be
Relaxing in early labour
You will probably spend early labour at home with your partner, timing contractions and deciding when to travel to the hospital if that is where you are giving birth. As this part of labour can continue for a considerable amount of time, possibly with periods when contractions stop altogether, try to spend time relaxing in between contractions to conserve energy for later. There are simple things you can do at home to help you relax. You can have a warm bath, get your partner to massage your back, stay mobile but rest if you need to, eat nutritious snacks, and drink fluids to give your body fuel to work well later. Contact the maternity unit or your midwife if you have any questions confused for tabour. With these, you do experience your uterus tightening and relaxing and there is a degree of discomfort. Braxton Hicks contractions are a sign that your uterus is preparing for the contractions of tabour If this is your first pregnancy, you may be unsure how to tell the difference between these practice contractions and the real thing. Real labour contractions are more regular, powerful, and usually more painful Some women barely notice these practice contractions, while for others they are quite uncomfortable. If this is the case, it can help to move around or have a warm bath to ease the discomfort.
Is it true that I will have to go to hospital if my waters break, even if contractions haven’t started?
If your waters break before your contractions have started, most maternity units have a policy that you should be seen by a midwife, either at the maternity unit or at home, to determine if you and your baby are both well. The main concerns when the waters break are the position of the umbilical cord -whether it is stuck in front of the baby’s head - and to rule out any chance of infection, and the answers to these two questions will determine the plan of care you will be offered
You may be offered an examination to look at the cervix to see if there is fluid leaking and, if so, its colour, and to take a swab of the area to determine if there are any bacteria that could pose a problem for the baby A cardiotocograph (CTG) may be performed, which monitors the baby’s heartbeat over a short period to identify if there are any signs that the baby is distressed (see p 192). If all is well with you and the baby, you will be able to return, or stay at, home to await events, although a further appointment may be made to discuss further options should your contractions not start within a specified time. This timescale varies and may be as little as 24 hours or as long as 96 hours if all remains well.
Around 85 per cent of babies are born within 48 hours of the waters breaking, even if there are no contractions initially.
Calling the midwife
Although each woman has a different experience, here is a rough guide for when to call the midwife and when not to call the midwife.
* Don’t worry about calling the midwife if your contractions aren’t regular, occurring just once or twice an hour, as these may be Braxton Hicks (see opposite).
* Don’t call the midwife if you have only had a show (see p.167).
* Do call the midwife if contractions are strong and regular, every 5-10 minutes * Do call the midwife for advice if your waters have broken.
How will I be able to tell the difference between real contractions and Braxton Hicks?
Labour contractions have several specific characteristics. They are very regular and over time increase in regularity and length, and they are also painful Most start as a period-type pain or backache that again increases in intensity over time. The other difference that you may or may not be aware of is that the cervix dilates (opens up) in response to true labour contractions, but does not with Braxton Hicks. One thing that may indicate this is happening is if you experience a show (see p 167)
What do labour contractions feel like?
Generally speaking, women feel contractions as a painful tightening of the muscles of the uterus Although they actually start at the top of your bump and progress to the bottom of the bump, you may experience more pain and a feeling of pressure in the lower part of your abdomen and pelvis as the baby is pushed down by the contraction.
Some women experience the pain in their tummy, while others experience labour pain as backache Generally, contractions tend to start as something that can be compared to a severe period pain,
gradually increasing in intensity; however, the degree of pain felt will be different for all women.
We’re having a home birth -what if the midwife doesn’t show up?
Arrangements for contacting the midwife when you are having a home birth will vary depending on where you live; however, certain things will be the same no matter where you are. Once you are 37 weeks pregnant, the midwives will be ”on call” for your delivery Your midwife will talk to you about the local procedure for contacting the midwife on call, which may be directly through a mobile phone or pager, or indirectly through the labour ward at your local maternity unit If you experience labour before you are 37 weeks, you will be asked to go to hospital as this is considered ”preterm ‘ labour (see p.161).
Once you are experiencing strong regular contractions, contact your midwife via the route you have been advised. If your labour starts in the daytime, midwives will be on duty m the area; if ifs evening or nightime, it might take them a little while to reach you, so bear these differences in mind Also, bear in mind factors like the traffic on the roads during rush hours, which may make it advisable to let the midwife know about your contractions sooner rather than later!
Most NHS Trusts have a policy of two midwives attending your home birth; in some areas, both midwives will be there throughout the labour and birth, while in others the second midwife will be called by the first midwife nearer to the delivery so that two midwives are in attendance at the birth In the worst case scenario, if your labour progresses rapidly and a midwife hasn’t arrived, contact your local maternity unit who may be able to arrange for paramedics to attend you until the midwife arrives. Please bear in mind that it’s very rare to have a home birth without your midwife being present and that babies who do arrive quickly usually do so with very little added complication.
They sent my friend home from the hospital - I don’t want that to happen to me.
Labours differ and are dependent on so many factors, and your friend’s circumstances and your own are likely to vary enormously. Unless you have been specifically advised to go to hospital early once you think labour has started, then the best place to be in the early stages of labour is at home. In first pregnancies, the first stage of labour, when your cervix dilates to around I Ocm (see p. 181), averages at about 12-14 hours. So if you go to hospital very early on they may well suggest you go home until labour is a little more advanced. Although you may feel that you want to stay at the hospital ”just in case”, unless you have to travel a great distance to and from your local maternity unit, you are likely to be more comfortable and relaxed in your own surroundings
Are there situations when you can’t eat or drink in labour?
The recommendations by NICE for labour are that
all women should be allowed to drink water in labour, and that isotonic, or sports water, may be slightly more beneficial because of its higher calorie value and quick absorption into the body, Eating light snacks, even in established labour, is recommended as long as you haven’t had opioid painkillers, which include pethidine and diamorphine, and there are no other risk factors that would make a general anaesthetic more likely. Most women find that they want to eat in early labour, but find that they cannot face food later in the first stage although they still want to drink
Will I be able to drive myself to hospital when labour starts?
Driving while in labour isn’t advisable and could be very dangerous to yourself, your passengers, and any other road users, including pedestrians. If you are in labour, you will be having regular painful contractions and this will interfere with your ability to focus and drive a car and will also diminish your awareness of your immediate surroundings. In other words, -you will be very distracted!
As the general advice about labour is to stay at home for as long as you feel comfortable this means that by the time you are travelling to hospital you will be in very established labour and so your ability to drive would be very much diminished
Another consideration is your insurance cover; if your driving is impaired because of pain you may well invalidate your insurance cover. The safe option is to get someone else to drive or to take a taxi.
How likely is it for a first labour to progress so quickly that you don’t make it to hospital?
In first pregnancies, labour usually lasts for 12-14 hours, with contractions building in intensity and length. Most women are happy to stay at home for the early part of the first stage, and get an idea of when they want to be in hospital as their contractions get more regular It is unusual with first babies, but not unheard of, for labour to be so quick or for you to have no sign of contractions, that you leave it too late to get to hospital Although this also depends on your distance from the hospital, traffic delays, or other factors that may increase your journey time
What are the signs that it is too late to go to the hospital?
Generally speaking, if you are having an uncontrollable urge to push, then that’s the point
where it may be too late to reach the hospital before your delivery If you did find yourself in this unfortunate circumstance, contact your local maternity unit who will arrange for paramedics to attend you for the delivery of the baby In some areas, they will also ask an on-call midwife to attend the birth. Or you can contact the emergency ambulance services yourself
Can I check how dilated I am myself or get my husband to do this?
There is one school of thought that believes that vaginal examination of the cervix shouldn’t be done routinely in a normally progressing labour by anyone, and that would include you and your partner. There are several reasons for this One is that some women find it a very uncomfortable procedure and staff gain very little information other than that the woman’s labour is progressing. Another reason is that it introduces the the risk of infection If you are having strong, regular contractions, your cervix will be starting to dilate, and any examination should be carried out by a trained midwife or obstetrician under ‘’sterile” conditions to limit the risk of infection. There is also the potential that whoever is doing the examination may break the bag of waters that are surrounding the baby before they would have broken naturally.
So although it might be possible to feel your own cervix depending on what stage of labour you are in, this isn’t something that is generally recommended.