Is it time? recognizing the signs of labor

Click here to view the full magazine article

During the last few weeks of pregnancy, going into labor is all you think about. Whether you are apprehensive or just excited, it is tough to get it off your mind. You question, when will labor start and how will I know it is time to go to the hospital?

Even when expecting my fourth child, I still found it difficult to know when to head to the hospital. My water had broken twice at labor's onset and my third delivery had been an induction. So, I started getting frustrated when I would feel contractions nightly, only to have them go away after a couple of hours. I wondered how I would ever know when to go to the hospital. Then one night, my water broke, and it was finally time.

Labor and delivery are different for everyone, One of my labors lasted only 2 and a half hours. Other women contract for over 24 hours.

It is important to talk to your doctor about labor during your last trimester. She will give you instructions about when to go to the hospital. You may have special concerns with your pregnancy that make it different for you than for other people.

No one knows when labor will start or what causes it to start. Even for the same woman, it can be different in every pregnancy. Hormonal and physical changes can be signs labor is close.

Your baby may lower and settle into your pelvis. This is called lighting. Some people may also say the baby "has dropped." It can occur a few weeks or a few hours before labor.

When the cervix starts to open, the mucus plug that has been accumulating there will discharge. It may be clear, pink, or slightly bloody. Again, it can occur a few weeks before labor, or just before labor.

During your last few doctor visits, your OB will check your cervix for labor progress with a pelvic exam. Your cervix thins out and opens up to allow your baby's head to pass through. This thinning, called effacement, is measured in percentages from 0 percent to 100 percent. When your cervix is halfway ready, it is 50 percent effaced; when it is completely thinned out it is 100 percent effaced. The opening, or dilation, of your cervix is measured in centimeters. It is completely dilated at 10.

Dilation of the cervix is caused by contractions. Most women use the strength and timing of their contractions to determine when it is time to go to the hospital. This can be confusing, because before true labor begins, you may have false labor pains or Braxton Hicks contractions.

Unlike true labor, Braxton Hicks contractions come and go. They do not get closer together and do not increase in intensity and length with regularity.

True labor contractions generally begin 15 to 20 minutes apart and last 60 to 90 seconds. The contractions become more regular until they are less than 5 minutes apart. When the contractions are strong, last 45 to 60 seconds, and occur 3 to 4 minutes apart it is probably time to go to the hospital. Check with your doctor for his or her specific recommendations.

One sure sign your baby will be born in the next 24 hours is when the amniotic membrane, or "your water," breaks. It may come in a sudden gush, or a steady trickle. When this happens, go to the hospital, or contact your health care professional immediately.

For most women, the amniotic membrane doesn't rupture until well into labor when they are already at the hospital. Sometimes the doctor will rupture the membrane himself.

If you ever have any questions about whether or not you are in labor, call your doctor for instructions. Though at the end of your pregnancy you may feel your baby will never come, labor will one day catch you by surprise and you'll know it's finally time.

Return to July 2008 list of articles