Labor: How will I know?

Many women who have never experienced labor wonder how they will know labor has begun.  While labor is different for every woman, here are a few things to keep in mind if you think you may be in labor. Full term labor is different from preterm labor. For information on preterm labor, see the previous post. If you are 37 weeks or more along in your pregnancy, this may help you determine if you are in labor.

What are contractions?

Contractions are actually the contractions of the uterus, or a shortening and tightening of the uterus. The uterus is a muscle and contracts just like any other muscle will. In early labor, uterine contractions are usually short (less than 30 sec) and painless. In early labor, contractions may come every 2- 15 minutes. When the uterine contractions become strong enough, they will start to open and thin out the cervix (the opening to the uterus). As labor progresses, uterine contractions become longer (over 45 sec), stronger (increasingly uncomfortable), and increase in frequency (every 2-5 minutes)

                                                     Early Labor              Active Labor

Discomfort                                       Slight                       Stronger

Length of contractions                  10 - 45 sec               45-90 sec

Frequency of contractions          2 -15 minutes           2- 5 minutes

Early labor often mimics what you experience when you have your period, or will be like a very strong period.  If you had backache or menstrual cramps when you had your period, this is most likely what you will experience in early labor. Early labor can be off and on. It can start and stop or it can also be steady.  Early labor in a first time mom can last from 2 to 24 hours. Once early labor is over, the mother usually will experience an increase in the amount of discomfort caused by the contractions as well as an increase in the intensity and the frequency of the contractions.

Quick labors or precipitous labors in a first time mom are the exception and not the rule. Many women hear stories about a friend or sister's labor that was only 2 or 3 hours long. A precipitous can happen, but it is much more likely to happen for women who are having their 2nd or 3rd child. Precipitous deliveries are also more common in a woman who is not yet 37 weeks.  The next time you hear of a story when a woman gave birth very quickly, most likely she was not having her first child or she was not yet 37 weeks.

The water breaking: Always contact your health care provider if your water breaks. The water breaking may bring on the start of labor, or it may happen while you are already in labor. You also can have your water break and labor does not start.  The water breaking does not necessarily mean that labor has begun.

If you think you are in labor, it is good to consult with your health care provider for advice.

Preterm Labor

Signs and Symptoms of Preterm Labor 

These signs and symptoms are not to be ignored

Preterm Labor is labor that starts before 37 weeks or pregnancy

• Contractions - any tightening of the uterus or abdomen that is rhythmic or comes and goes.
• Increased vaginal discharge - vaginal discharge is normal in pregnancy, but if there is a change in the amount of discharge, color, or odor
• Watery discharge - any dischage that is like water which soaks through the underwear
• Backache - a dull lower back ache that is off and on
• Menstrual-like cramps (more than 5 in one hour)- this is the most common symptom of true preterm labor
• Abdominal cramping with or without diarrhea
• Pink discharge
• Vaginal bleeding: Any blood or bleeding from the vagina is abnormal before 37 weeks

If you experience any of these symptoms, notify your health provider right away.

GBS: Group Beta Strep (Streptococcus)

Group B Strep or Group Beta Streptococcus (GBS)  is a harmless bacteria that can colonize in the vagina as well as the gastrointenstinal and respiratory tracts. Approximately, 25% of pregnant women have GBS in the vagina or rectum.  GBS can become hazardous if it colonizes in the urinary tract and causes a urinary tract infection or if it colonizes on the skin of a newborn. This is why all women are screened at 35-37 weeks for the presence of GBS in their vagina and rectum. If a woman is positive for GBS, she will be given antibiotics through an IV during labor to prevent the bacteria from being able to colonize on the newborn's skin.
Screening
All pregnant women are screened at 35–37 weeks of gestation unless preterm labor is suspected. Women are screened by obtaining a single swab (cotton tip) specimen from the lower vagina and rectum. 
Treatment
If a woman's culture comes back positive for GBS, she will be treated propholactically in labor with IV antibootics to prevent the bacterial from colonizing on her newborn's skin. Common antibotics useed are penicillin and ampicillin. Clindamyicin may be used if a patient is allergic to penicillin. Be sure to notify your provider of all medicataion allergies. If  a cesearean is planned, she will not need antibotics for GBS.

Mental Health, Gun Control and Homeland Defense

Maybe I'm a dreamer, but I wish mental health care were as easy to get as, say, a gun. - Andy Borowitz

While I've used this blog mainly for the purpose of giving out information to my patients and to comment on the state of maternity care in the US or talk about child birthing and midwifery, I break now to talk about one thing political that I feel is utterly important. Yes, gun control is an issue here and is a serious issue in relation to what happened today, but so is the lack of mental health services in America.

Today, I need to say something about the state of mental health in our country. I've always told my husband that If we ever won the lottery, I'd like to devote most of these talents to fighting global warming, human trafficking or slavery, and improving mental health in America. For a country that is so "rich" we are so poor when it comes to mental health services.

In 2005, a NIH $20 million study found that one-quarter of all Americans met the criteria for having a mental illness, and fully a quarter of those had a serious disorder that significantly disrupted their ability to function day to day.  This puts American in the number 1 slot for mental health issues in the world.  We also are an "epic fail" when compared to other industrialized countries on mental health services.
Mental illness is really a disease of youth.  Half of those who will ever be diagnosed with a mental disorder show signs of the disease by age 14, and three-quarters by age 24.  However, less than half of youth that need treatment, get it. Those who seek treatment usually don't do so until a decade or more.  The reason for delays include insurance restrictions and lack of access. And the treatment they receive is usually inadequate. These are real brain disorders and they desperately need treatment.

And yes, I'm just going to come out and say it that it is a travesty when you think about how much we spend on defense in this country when we have sick people out there who are like ticking time bombs.

Obama was wrong when he said that the United States spends more on defense than the next 10 countries combined, we spend more the next 13 countries combined. When we allow mental health to rage out of control, we have a real threat to our neighborhoods and schools. We have what happened today in Newton, CT. Good God be with us now, when we are in trouble.

It brings me to a second issue and that is gun control. I'm going to also come out and say: I can accept the right to bear arms. But, my question is: what do you need to bear arms for?  I get that you want to protect yourself, but are you starting up your own military?  The weapons that were used today were a .223 caiber rifle and a Glock, which can carry up to 32 rounds of magazines.  Is that your plan when someone breaks into your home to attack you? To go through 32 rounds? Hardly, the most appropriate weapon for homeowner self protection.  Sure, a handgun or a pistol, but a rifle?  We have to think about when the second amendment was written, they didn't have these types of weapons. Come on, let's get serious about homeland defense and get a little bit more serious about gun control.

 .223 caliber rifle