It always seems so easy in the movies. Somewhere after midnight, the pregnant woman sits up in bed, and reaches over to arouse her sleepy husband with a calm, ‘Honey, it is time’’. But we may wonder or even ask how did this woman know that it is time? How does she recognize labor with such confidence when this is her first pregnancy? What made her so sure it’s not a false labor or Braxton hicks?
No one knows exactly what triggers labor. A group of natural substances produced by the body called prostaglandins are believed to be important in the process. Prostaglandins produced by the uterus during pregnancy are known to increase during spontaneous term labor; they stimulate uterine muscle activity and trigger oxytocin release by the pituitary gland, both important factors in the initiation of labor.
Many women who are expecting their first baby are worried that they may fail to recognize the signs or symptoms indicating the onset of labor, but the vast majority of women do recognize the early symptoms easily and know that labor has started. Labor usually begins in one or more of these distinctive ways:
- Onset of powerful, regular uterine contractions.– The first stage of labor begins with the onset of regular uterine contractions. Uterine contractions in labor have a definite pattern which is easy to recognize. Uterine contractions are probably a progression of Braxton hicks’ contractions which become more powerful, although at the onset of labor they maintain the same time interval of approximately every 20- 30minutes and will only be appreciated if a hand is placed on the abdomen.
- Rupture of the membranes.- In 20% of labors the water breaks in a gush or trickle before labor begins. Quite a few pregnant women have genuine fear that the membranes will rupture while they are out shopping, walking the street, in a bus and other public place. If the fetal head is engaged then the rupture will result in loss of a little fluid, which is unlikely to cause embarrassment. It is understandable than this can cause acute embarrassment, but in the circumstances everyone will be willing to help and make you feel comfortable until the doctors come.
- The ´´show’’.- The passage of a small quantity of blood known as a “show’’ is one of the commonest symptoms of the onset of labor. This show is nearly always a small amount of pinkish blood mixed with mucus. It is seldom pure blood and it is seldom bright red. The show may appear without any previous sign or warning. It is important to remember that a show either at the onset or in the early part of labor is perfectly normal phenomenon and is nearly almost associated with the passage of the operculum (the plug of mucus that fills the cervical canal throughout pregnancy).
- Lower back pain. – Pain begins in the lower back and spreads to the lower abdomen; it may also radiate to the legs. Contractions may feel like gastrointestinal upset and be accompanied by diarrhea.
When in doubt, call. Even if you have checked and rechecked the above lists. You may still be unsure whether you are in true labor. Don’t wait to find out for sure. Call your practitioner. He or she will probably know through your voice and what you tell them, if it is time or not.Fear of embarrassment if it turns out not to be labor shouldn’t prevent you from calling your practitioner. If it turns out to be a false alarm, no one is going to grumble. You wouldn’t be the first patient to misjudge her labour signs, and definitely won’t be the last.