If you are pregnant, one of your first concerns might be what labor and delivery are like.
This information will help answer the most common questions about labor, especially if this is your first pregnancy. For detailed information on delivery, see Methods of Delivery.
Signs of Labor
Some women experience very distinct signs of labor, while others do not. No one knows what causes labor to start or when it will start, but several hormonal and physical changes may indicate the beginning of labor:
- Lightening
- Passing of the mucus plug
- Contractions
- Water breaking
- Effacement and dilation of the cervix
Lightening During Labor
The process of your baby settling or lowering into your pelvis just before labor is called lightening. Lightening can occur a few weeks or a few hours before labor. Because the uterus rests on the bladder more after lightening, you may feel the need to urinate more frequently.
Passing of the Mucus Plug
The mucus plug accumulates at the cervix during pregnancy. When the cervix begins to open wider, the mucus is discharged into the vagina and may be clear, pink, or slightly bloody. Labor may begin soon after the mucus plug is discharged or one to two weeks later.
Labor Contractions
During contractions, the abdomen becomes hard. Between contractions, the uterus relaxes and the abdomen becomes soft. The way a contraction feels is different for each woman, and may feel different from one pregnancy to the next. But labor contractions usually cause discomfort or a dull ache in your back and lower abdomen, along with pressure in the pelvis. Contractions move in a wave-like motion from the top of the uterus to the bottom. Some women describe contractions as strong menstrual cramps. Unlike false labor contractions or Braxton Hicks contractions, true labor contractions do not stop when you change your position or relax. Although the contractions may be uncomfortable, you will be able to relax in between contractions.
What's the Difference Between True Labor and False Labor?
Before "true" labor begins, you may have "false" labor pains, also known as Braxton Hicks contractions. These irregular uterine contractions are perfectly normal and may start to occur in your second trimester, although more commonly in your third trimester of pregnancy. They are your body's way of getting ready for the "real thing."
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What Do Braxton Hicks Contractions Feel Like?
Braxton Hicks contractions can be described as a tightening in the abdomen that comes and goes. These contractions do not get closer together, do not increase with walking, do not increase in duration, and do not feel stronger over time as they do when you are in true labor.
How Do I Know When I Am in True Labor?
To figure out if the contractions you are feeling are the real thing, ask yourself the following questions.
| Contraction Characteristics | False Labor | True Labor |
| How often do the contractions occur? | Contractions are often irregular and do not get closer together. | Contractions come at regular intervals and last about 30-70 seconds. As time progresses, they get closer together. |
| Do they change with movement? | Contractions may stop when you walk or rest, or may even stop if you change positions. | Contractions continue despite movement or changing positions. |
| How strong are they? | Contractions are usually weak and do not get much stronger. Or they may be strong at first and then get weaker. | Contractions steadily increase in strength. |
| Where do you feel the pain? | Contractions are usually only felt in the front of the abdomen or pelvic region. | Contractions usually start in the lower back and move to the front of the abdomen. |
How Do I Know When to Go to the Hospital?
When you think you are in true labor, start timing your contractions. To do this, write down the time each contraction starts and stops or have someone do it for you. The time between contractions includes the length or duration of the contraction and the minutes in between the contractions (called the interval).
Mild 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. Active labor (the time you should come into the hospital) is usually characterized by strong contractions that last 45 to 60 seconds and occur three to four minutes apart.
What Can I Do to Relieve Labor Pain?
The first stage of labor (called the Latent Phase) is best experienced in the comfort of your home. Here are some tips to help you cope:
- Try to distract yourself -- take a walk, watch a movie.
- Soak in a warm tub or take a warm shower. But, ask your health care provider if you can take a tub bath if your water has broken.
- Try to sleep or take a nap if it is in the evening. You need to store up your energy for active labor.
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What Happens When My Water Breaks During Labor?
The rupture of the amniotic membrane (the fluid-filled sac that surrounds the baby during pregnancy) may feel either like a sudden gush of fluid or a trickle of fluid that leaks steadily. The fluid is usually odorless and may look clear or straw-colored. If your "water breaks," write down the time this occurs, how much fluid is released, and what the fluid looks like, and then notify your health care provider. Your health care provider can advised you what to do next.
Lastly, keep in mind that not all women will have their water break when they are in labor. Many times the doctor will rupture the amniotic membrane in the hospital.
What Is Effacement and Dilation of the Cervix?
During labor, your cervix gets shorter and thins out in order to stretch and open around your baby's head. The shortening and thinning of the cervix is called effacement. Your health care provider will be able to tell you if there are changes to the cervix during a pelvic exam. Effacement is measured in percentages from 0% to 100%. If there are no changes to the cervix, it is described as 0% effaced. When the cervix is half the normal thickness, it is 50% effaced. When the cervix is completely thinned out, it is 100% effaced.
The stretching and opening of your cervix is called dilation and is measured in centimeters, with complete dilation being at 10 centimeters.
Effacement and dilation are a direct result of effective uterine contractions. Progress in labor is measured by how much the cervix has opened and thinned to allow your baby to pass through the vagina.
When Should I Call My Health Care Provider or Go to the Hospital?
When you suspect you are in true labor, call your health care provider. Also, call:
- If you think your water has broken.
- If you are bleeding (more than spotting).
- If the baby seems to be moving less than normal.
- When your contractions are very uncomfortable and have been coming every five minutes for an hour.
Your health care provider will give you specific guidelines about when you should get ready to come to the hospital.