How to know when to go?

This post is in regards to all the new mama’s that are approaching their due date and feeling overwhelmed with excitement and anticipation of the birth, and anxiety over when it will happen or “how will I know if I’m in labor.” Some signs of impending labor (not real labor just yet!) include:

-increased vaginal discharge: this discharge is usually clear or white-ish, and may be tainted with blood, indicating bloody show. This is totally normal, and it does not mean you are in labor. As our bodies instinctively prepare for birth, we experience increased secretions of vaginal fluid that helps to sort of “cleanse” the birth canal and attempt to “wash away” any harmful pathogens. This discharge is usually scant in amount and will come and go. My preceptor recommends to use a regular period pad, and if you soak through more than one pad an hour, you should notify your healthcare provider.

That being said, if it is obvious that your water broke (ruptured membranes), evidenced by a gush of fluid, persistent draining from the vagina, or soaking through more than a pad an hour, first remember to stay calm! The media is forever portraying water breaking as this huge stat emergency that they need to get to the hospital as soon as possible. Not usually the case. If you are ruptured and go to the hospital, they will sit you in triage, perform a speculum exam, hook you up to the monitor, test the fluid to make sure its amniotic (IT IS NOT UNCOMMON TO UNKNOWINGLY PEE ON YOURSELF!!) There is a lot of pressure down there, and lots of different sensations, and yes, many people come in swearing their water broke, because they would know if they peed themselves, and when all is said in done, it turns out its just urine. So before you get all crazy about  your baby coming, here is some advice we give:

Meconium stained amniotic fluid

1. If the gush of fluid is clear, and baby is moving as usual, take a breather. Have a small meal, take a shower, brush your hair, call your best friends, and gather what you need to bring for the hospital. Don’t wait all day obviously, but 1-2 hours give or take is probably ok.

2. If the fluid is green, brown, or any other funky color, this is probably an uh-oh moment…just go right on up to the maternity unit.

-Some women will start experiencing uterine contractions within a few weeks of their due date. Most people may have heard the referred to as Braxton-Hicks contractions.

Credits to Mark Parisi

Even if they start getting more uncomfortable, especially in addition to all the other discomforts going on around this time, it is important to remain calm, and not let your anxiety/excitement get to you. If you start feeling contractions that are annoying and uncomfortable, relax a minute and take a time out to think. Literally. If you have been up on your feet getting things ready for the baby or just running around aimlessly because you cant think of anything else to do, go sit or lay down in a nice quiet, comfortable area. Put your feet up. Drink a bottle of water or two. If its night, take a benadryl or a tylenol PM, and just try to get some rest. Conversely some women may feel more discomfort when resting, and it may help to get up and walk around. If any of these methods work for you and make the contractions even a little bit better, then you are most likely not in real labor. That being said, do be weary about potential urinary tract infections, as these frequently present with the same discomforts associated with false/early labor, and often go undiagnosed; notify your provider if you have any [abnormal] increases in urination or urgency (well, duh, if you’re pregnant thats a no brainer), if there is any burning, or bleeding with urination, any local irritation, or dull persistent lower abdominal or flank pain.

Physiologically, our uterus is preparing for its big day, practicing so to speak. Although not trying to push a baby out just yet, the uterus will move and adjust to move the baby from up in the abdomen to down into the pelvis. Naturally, this puts more pressure on our already sore pelvic bones, and puts the cervix at a funny angle, causing annoying discomfort. I have had some women describe the feeling as “it feels like she is trying to push her hand right through my vagina.” Not entirely likely, but thats a common feeling. If you call your doc or midwife complaining about contractions and discomfort etc., they will probably tell you exactly the same thing mentioned above. Save yourself the worry of overanalyzing, and just take a chill pill. Literally and metaphorically. You are going to need to save your energy and strength for when you do go into labor, so don’t sweat the petty things. If after trying to drink plenty of water, taking some tylenol PM, and resting (or getting up and walking), you are still feeling unusually uncomfortable, again, don’t panic. Pull out your watch and time the contractions (or have someone do it for you that is trustworthy to accurately keep time, i.e. don’t ask baby daddy during March Madness, and your 3 year old toddler will probably be as useful as your dog). What you will want to time is (and it may help to record it as follows), a.) when a contraction starts, b.) when the contraction ends,  and c.) when the next one begins, and so on and so forth, so that when you do call your provider, they can accurately assess your contraction pattern. Making a chart like this may be useful to keep track and stay organized. My preceptor came up with a clever method counting 3-2-1 to know when it time to call. She explains to call if “contractions happen every 3 minutes, for at least 2 hours, lasting at least 1 minute in duration.”

I hate to use the term “false labor” because it still has many of the same bothersome discomforts of “true labor,” but its just too soon to make significant physical changes; I personally think of it as “practice labor,” because in essence, it could go on for days and weeks, and you are still experiencing “labor sensations.”  In true labor, contractions will gradually happen closer together, lasting longer periods of time, and they will gradually become more intense, and rest and home remedies will not give any relief. If you haven’t already, start timing them now, before you call your healthcare provider, so even if it is true labor, we have a baseline to evaluate progression.

Now, as a very important disclaimer to anyone that reads this, recommendations mentioned in this blog are exactly that, JUST RECOMMENDATIONS. They are tips and advise for addressing early labor concerns, and should not be used as primary management. Although probably there is evidence in the literature to support one strategy over the other, this post is strictly an informal recommendation from me to you. ALWAYS talk with your prenatal care provider, and discuss signs of labor, what is “false labor,” and what criteria calls for immediate evaluation. Every provider has their own experiences and opinions on this topic, and different institutions follow different policies, so it is important to know the specific protocols and recommendations of your provider and hospital regarding onset of labor.

Thanks for reading, stick around, I will probably do some research and see if I can get actual real evidence based facts and references, but for now, the recommendations described are only a reflection of supportive strategies and critical thinking in practice. Have a great week!

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