What to expect when you're expecting (142 page)

Before there’s labor, there’s prelabor—a sort of preshow that sets things up before the main event. The physical changes of prelabor can precede real labor by a full month or more—or by only an hour or so. Prelabor is characterized by the beginning of cervical effacement and dilation, which your practitioner can confirm on examination, as well as by a wide variety of related signs that you may notice yourself:

Dropping.
Usually somewhere between two and four weeks before labor starts in first-time mothers, the fetus begins to settle down into the pelvis. This milestone is rarely reached in second or later births until labor is about to kick off.

Sensations of increasing pressure in the pelvis and rectum
. Crampiness (similar to menstrual cramps) and groin pain are common—and particularly likely in second and later pregnancies. Persistent low backache may also be present.

Loss of weight or no gain
. Weight gain might slow down in the ninth month; as labor approaches, you might even lose a bit of weight, up to 2 or 3 pounds.

A change in energy levels
. Some ninth-monthers find that they are increasingly exhausted. Others experience energy spurts. An uncontrollable urge to scrub floors and clean out closets has been related to the “nesting instinct,” in which the female of the species—that’s you—prepares the nest for the impending arrival (see
page 346
).

A change in vaginal discharge
. If you’ve been keeping track, you may find that your discharge increases and thickens.

Loss of the mucous plug
. As the cervix begins to thin and open, the “cork” of mucus that seals the opening of the uterus becomes dislodged (see
page 362
). This gelatinous chunk of mucus can be passed through the vagina a week or two before the first real contractions, or just as labor begins.

Pink, or bloody, show
. As the cervix effaces and dilates, capillaries frequently rupture, tinting the mucus pink or streaking it with blood (see
page 363
). This “show” usually means labor will start within 24 hours—though it could be as much as several days away.

Intensification of Braxton Hicks contractions
. These practice contractions (see
page 311
) may become more frequent and stronger, even painful.

Diarrhea
. Some women experience loose bowel movements just before labor starts.

Is it or isn’t it? Real labor probably has not begun if:

Contractions are not at all regular and don’t increase in frequency or severity. Real contractions won’t necessarily fall into a neat textbook pattern, but they will become more intense and more frequent over time.

Contractions subside if you walk around or change your position (though
this can sometimes be the case in early “real” labor, too).

Show, if any, is brownish. This kind of discharge is often the result of an internal exam or intercourse within the past 48 hours.

Fetal movements intensify briefly with contractions. (Let your practitioner know right away if activity becomes frantic or jerky.)

Keep in mind that false labor (though it isn’t the real thing) isn’t a waste of time—even if you’ve driven all the way to the hospital or birthing center. It’s your body’s way of getting pumped, primed, and prepped for the main event, so when the time comes, it’ll be ready—whether you are or not.

No one knows exactly what triggers real labor (and more women are concerned with “when” than “why”), but it’s believed that a combination of factors are involved. This very intricate process begins with the fetus, whose brain sets off a relay of chemical messages (which probably translate into something like, “Mom, let me out of here!”) that kick off a chain reaction of hormones in the mother. These hormonal changes in turn pave the way for the work of prostaglandins and oxytocin, substances that trigger contractions when all labor systems are “go.”

You’ll know that the contractions of prelabor have been replaced by true labor if:

The contractions intensify, rather than ease up, with activity and aren’t relieved by a change in position.

Contractions become progressively more frequent and painful, and generally (but not always) more regular. Every contraction won’t necessarily be more painful or longer (they usually last about 30 to 70 seconds) than the last one, but the intensity does build up as real labor progresses. Frequency doesn’t always increase in regular, perfectly even intervals, either—but it does increase.

Early contractions feel like gastrointestinal upset, or like heavy menstrual cramps, or like lower abdominal pressure. Pain may be just in the lower abdomen or in the lower back and abdomen, and it may also radiate down into the legs (particularly the upper thighs). Location, however, is not as reliable an indication, because false labor contractions may also be felt in these places.

You have show and it’s pinkish or blood-streaked.

In 15 percent of labors, the water breaks—in a gush or a trickle—before labor begins. But in many others, the membranes rupture spontaneously during labor, or are ruptured artificially by the practitioner.

Your practitioner has likely told you when to call if you think you’re in labor (when contractions are five to seven minutes apart, for instance). Don’t wait for perfectly even intervals; they may never come. If you’re not sure you’re in real labor—but the contractions are coming pretty regularly—call anyway. Your practitioner will probably be able to tell from the sound of your voice, as you talk through a contraction, whether it’s the real thing—but only if you don’t try to cover up the pain in the name of good phone manners. Even if you’ve checked and rechecked the above lists and you’re still unsure, call your practitioner. Don’t feel guilty about waking him or her in the middle of the night (people who deliver babies for a living don’t expect to work only 9 to 5) or be embarrassed if it turns out to be a false alarm (you wouldn’t be the first expectant mom to misjudge her labor signs, and you won’t be the last). Don’t assume that if you’re not sure it’s real labor, it isn’t. Err on the side of caution and call.