Friday, September 4, 2009

Signs Of Labour

How do I know when I am in labour?

Everyone's labour is different, and pinpointing when it begins is not really possible. It's more of a process than a single event, when a number of changes in your body work together to help deliver a baby (Winter and Cameron 2006).

In early labour, also called the latent phase you may experience the following:

• Persistent lower back or abdominal pain, often accompanied by a crampy premenstrual feeling.

• A bloody show (a brownish or blood-tinged mucus discharge). If you pass the mucus plug that blocks the cervix, labour could be imminent or it could be several days away. It's a sign that things are moving along.

• Painful contractions that occur at regular and increasingly shorter intervals and become longer and stronger in intensity (NCCWCH 2007: 139)

• Broken waters, but you're in labour only if it's accompanied by contractions that are dilating your cervix (Walsh 2004: 438-9)

How you will feel in early labour depends on whether you've had a baby before, how you perceive and respond to pain, and how prepared you are for what labour may be like (Walsh 2004: 438; Cheyne et al 2006).

When should I contact a midwife?

You and your midwife have probably talked about what to do when you think you're in labour. But if you're not sure whether or not the time has come, don't be embarrassed to call. Midwives are used to getting calls from women who are uncertain if they're in labour and who need guidance; it's part of their job.

The truth is that they can tell a lot by the tone and tenor of your voice, so verbal communication helps. The midwife will want to know how close together your contractions are, whether you can talk through a contraction, and any other symptoms you may have.

If you're planning to have your baby in hospital or a birth centre, she may ask you to come in so that she can make an assessment. If she thinks you're still in early labour, depending on how you're coping and whether you've got a birth partner to support you, she may encourage you to go back home until you're in stronger active labour.

You should contact your midwife or doctor if:

• your waters break, or if you suspect you're leaking amniotic fluid (NCCWCH 2007: 206;)
• your baby is moving less than usual (NCCWCH 2008: 276)
• you have vaginal bleeding (unless it's just a small amount of blood-tinged mucus) (NCCWCH 2008: 251; Lindsay 2004a: 772; Lindsay 2004b: 856)
• you have fever, severe headaches, changes in your vision, or abdominal pain (NCCWCH 2008: 228).

See our list of other pregnancy symptoms you shouldn't ignore, in case anything else is worrying you.

What should I do early on in labour?

This will depend on what time of day it is, what you like doing and how you're feeling. Keeping calm and relaxed will help your labour to progress (McNabb 2007: 415) and help you cope with the contractions (NCCWCH 2007: 93-4) so do whatever will help you to stay relaxed.

This could mean watching a favourite film, relaxing, or asking a friend or relative over to keep you company. You could alternate between walking and resting, or try taking a warm bath or shower to ease any aches and pains. If you can, try to get some rest to prepare you for the work ahead.

During early labour, you may feel hungry so eat and drink if you feel like it (McNabb 2004: 415). This will help to comfort you and help you to rest.

Early labour is a good time to try out different positions and breathing techniques to see if they help you cope with the contractions, now that you're having them for real! If you've got a TENS machine, early labour is the time to use it (NCCWCH 2007: 93; 100).

Can I have contractions and not be in labour?

Yes. When you are in labour your cervix becomes progressively thinner (called effacement) and dilated. Some women are sensitive to the pain of contractions before the cervix has started to dilate (NCCWCH 2007: 145; Winter and Cameron 2006: 455-6). A midwife can confirm whether cervical changes have started during an examination.

If your baby is in a posterior position (with his head down but his back to your back) it can take longer for your baby's head to engage and for labour to get started properly (Lewis 2004: 890). Your contractions may be erratic and low in intensity, and you may have a lot of backache.

Your midwife will advise you on ways to cope at home until labour becomes stronger (NCCWCH 2007: 145). You could try a warm bath or massage to relieve the pain.

Can I tell if labour is about to happen soon?

Maybe. Signs of the approach of labour include:

• lightening (when the baby's head begins to drop into position in your pelvis); you may notice that you can breathe more deeply and eat more, but you'll also need to urinate more frequently

• vaginal discharge becomes heavier and more mucous

• more frequent and noticeably more intense Braxton Hicks contractions

• loose bowels (McCormick 2003: 435-6; 446)

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