Ways Labor Can Begin

Regardless of whether a movie is a comedy or a drama, the onset of labor in film is often shown as having a painful and powerful beginning.  Usually, everyone is minding their own business, when suddenly, the expectant mom doubles over, clutches her abdomen and begins to yell loudly.  If that isn’t the directors’ preferred way to start labor, then it is usually depicted by showing an unexpected gush of amniotic fluid coming from an embarrassed mom in a public place.  (Every pregnant woman’s fear!  Ha.) While labor can begin either of those ways, neither is the most common way to start labor.

Here are 5 of the more common signals that labor is beginning (or soon to begin), followed by a brief explanation of each one:

Short, relatively easy contractions

Sporadic contractions/irregular pattern (sometimes quite strong)

Backache that recurs and fluctuates in intensity

Light spotting mixed with discharge of mucus

Amniotic fluid leaking

Short, relatively easy contractions:

Web small contraction imageBelieve it or not, labor often starts off with fairly mild contractions.  Because of that, it’s not uncommon for moms-to-be to wonder if “this is really it” or not.  Contractions may start off lasting only 20-30 seconds and coming every 10-20 minutes.  That’s only 3 or 6 contractions an hour, and most women find that pretty easy to deal with (especially if they’ve had good birth preparation and are not afraid).  Contractions like that may continue for a few hours or several hours, and they may graduate to stronger, longer contractions, or they may take a break and rest for several hours before kicking back in again.  If your labor is starting this way, a good idea is to use these easier contractions to practice relaxing and breathing, and just hang in there and see what happens in the next few hours. (This is pretty much how my labor with my second baby started.  And sort of my first baby, too.)

Sporadic contractions/irregular pattern:

Labor doesn’t always begin with a clearly defined pattern.  Sometimes labor starts with contractions that seem to have a mind of their own…(Well, actually, all contractions feel like they have a mind of their own!) Mom may have some short, easy contractions and then out of the blue, have some much longer, much stronger contractions.  BUT…a clear, regular pattern doesn’t really develop.  In other words, the textbooks tell us that the contractions should gradually get longer, stronger and closer together.  But what if a mom has contractions that are short and hard, then short and easy, then longer and stronger, and then…?  What? It’s puzzling!   This type of early labor is often regarded as “false labor,” but in my book, it’s the real deal, baby!  And any woman who has experienced this kind of start to her labor would agree with me, I think.  There is actually a fairly common cause for this type of labor, but that’s a topic for another page.  (See “Puzzling Labor Pattern”) On this page, I just want you to know that this is one way labor can begin. (This is how my labors with my 4th and 5th babies started.)

Backache that recurs and fluctuates in intensity:

Back Labor no background small for webSometimes labor starts with what can only be described as a weird backache.  Generally, moms experiencing this type of early labor will just be going about their regular day (or trying to sleep through the night) and they find themselves shifting around because man, their back hurts!  But it doesn’t feel like the typical low backache of late pregnancy…this backache has a sort of “wavelike” pattern to it.  The discomfort is felt in a specific place in the low back, then it seems to sort of grow in intensity, and then about the time Mom decides she’s going to ask for a back massage, the discomfort fades away.  “Hmmm,” Mom thinks.  “That was odd, but at least my back feels better now.”  Then, a few minutes later, the backache returns!  Depending on the baby’s position, labor contractions can be felt primarily in the back.  If your backache seems to keep returning at regular intervals, and if it feels as though it gets stronger and stronger and then eases off (like a wave building in intensity and then sliding over the curve), it could very well be labor! (My labor with my first baby started like this.)

If labor continues to be felt primarily in the back, it is referred to as “back labor.”  Although most women will feel a tug in her low back or a sense of pressure in her low back during contractions, back labor is a much more intense sensation.  The likely cause of back labor is an inflamed nerve (or two or three) most often due to the baby’s position.  I’ll discuss what to do about that in “Back Labor–What’s a Gal to Do?”

Light spotting mixed with discharge of mucus:

(Don’t you just love pregnancy sites, where you can read all about vaginal mucus?) Well, this is definately one of the most common signs that Mom’s body is preparing for labor.  The lovely and incomparable cervix is filled with protective mucus during pregnancy.  That mucus serves pretty much the same function that mucus in the nose serves–it traps those pesky microorganisms that can make us sick!  During pregnancy, the cervical mucus does a pretty good job of keeping the intrauterine area free and clear of bacteria.  As the cervix begins to thin and soften (see page on Cervical Action in Labor), the tissue changes in the cervix cause some of the cervical mucus to loosen up and glop out. Because tiny capillaries in the cervix can break when the cervix changes, the mucus that comes out is sometimes pinkish or mixed with streaks of blood.  (Another lovely word picture from your down home doula. No thanks necessary.)  If Mom notices a slippery discharge (often described as  a “blob”), it is a sign that cool things are going on, getting her body ready for labor!

Now here’s the kicker–this mucus discharge doesn’t mean that labor is imminent.  Mom may not start having contractions within the next few hours…or even the next few days…but, the cervix is definately changing and it is often a sign that labor is not too far away.  (With my third baby, my labor began this way.  A few hours after the lovely sign, I started having some significant contractions.  No doubt then!)

Amniotic fluid leaking: Web small black green dress

Well, now…everyone’s favorite way to begin a good labor story!  “She was just standing at the check-out counter, when all of a sudden, her water broke!”  : )  Quite often, I find that many people think the most common way for labor to begin is with the amniotic sac breaking.  In reality, most of the time, if left alone, the amniotic sac doesn’t break until the mom is 8-9 cm dilated.  Really!  It’s very common for that marvelously strong membrane to hold out until the very end.  In fact, some babies are born with the amniotic sac intact!  (My fourth baby was born that way.  Intact membranes can make for a wonderfully slippery escape for the baby–take it from someone who knows!)  But, it is certainly not uncommon for labor to begin with the spontaneous rupture of the amniotic membranes (fondly referred to as SROM by “those in the know.”)

The membranes can leak just a trickle of fluid or they can make a much more dramatic scene with a low break and cause a nice, noticeable gush of fluid.  If the sac breaks with a gush, it’s pretty clear what happened and most moms know they need to notify their caregivers and get down to business.  If it breaks with a trickle, however, it can be much more confusing!  “Is it pee or is it amniotic fluid?”  That is the question.  And it’s one of the more common questions I get asked at 2 AM from my beloved preggies.

One way to discern if the leak is urine or amni fluid is if the fluid continues to leak.  If it’s urine, you’ll eventually run out, but if it’s amni fluid, your body just keeps making it, and it will leak like the Energizer Bunny.  It keeps going…and going…and going…  : )  Occasionally, I’ll have a mom tell me that she thinks it’s her amni fluid, but it still seems to start and stop.  “But mostly it still seems to be leaking,” she tells me.  With that scenario, of course mom can always contact her caregiver and have a simple litmus paper test done to determine if it’s fluid or urine.  One simple way that can help decide the issue at home is to have Mom lie down on her side for 15-20 minutes (with a fresh pad on) and then stand up.  If she notices a little mini-gush of fluid discharge, then that’s a pretty good sign that it could be her amniotic fluid leaking.  The reason is because the fluid will continue to leak while Mom is on her side, but it will pool up inside her body.  When she stands up, it will naturally leak out.  Mucus can sometimes be rather thin and be easily confused with fluid, too, especially with first-time moms.  So it’s perfectly acceptable to go have the litmus paper test done if there is any confusion at all.

One more important thing about leaking amniotic fluid–the fluid should always be clear.  If it has a greenish or brownish color to it, be sure to contact your caregiver (OB or midwife) and describe the color of the fluid.  That discoloration is an indicator that the baby has had a bowel movement (called meconium) prior to birth, and that can indicate that the baby is in distress.  Your caregiver will give you further instructions.

One other thing (okay, I’m sharing two more important things)–once the amni sac has broken, there is now a pathway for bacteria to get into the uterus, causing a possible infection. The main thing you must remember is not to put anything into your vagina after your water has broken or even if you think it might have broken.  No tampons, no fingers, no nothing.  This is very important because you don’t want to risk introducing bacteria to your baby’s environment.  During your labor, your caregiver may do vaginal exams after your amni sac has broken, but they will use sterile gloves and take precautions.

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