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.