Pre Labor vs.

True Labor
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If you have never experienced labor before, you may find it difficult to know if you are in
labor. Before heading to the hospital, call your physician or midwife to discuss your labor
symptoms.

It is common for first time mothers to make more than one trip to the hospital. If you are
in early labor and sent home, the following activities may be helpful: walking, showering,
resting, drinking fluids, listening to music, etc.

• Pre-labor vs. True Labor

• Onset of Labor
• When to go to the hospital

Pre-labor vs. True Labor

"How Do I know if I'm Really in Labor?"

Pre-labor can only be differentiated from true labor by an internal examination of the
cervix. True labor contractions become stronger, difficult to talk through, last longer, and
are closer together as labor progresses. These will effect changes in the cervix, causing it
to thin out and open while encouraging the descent of the baby through the pelvis.

True Labor
Contractions

• May be irregular at first

• Usually become regular
• Get longer, stronger, and closer together as time progresses
• Walking usually makes them stronger
• Lying down does not make them go away
 • Often begin in your back and move to the front

Cervix

• Changes by becoming thinner and starts to open (dilates)

False (or "Practice") Labor

Contractions

• Usually are irregular and short

• Do not get longer, stronger, or closer together
• Can last several minutes in length
• Walking does not make them stronger, may even cause them to stop
• Lying down may make them go away
• May be felt more in the front area and in the groin area
• Beneficial in preparation for true labor

Cervix

• Very little change or no change; does not thin or open

Prodromal Labor
Contractions

• May begin irregular and become regular

• Usually stay five or greater minutes apart
• May feel strong, but usually do not get closer together
• Lying down does not usually make them go away
• May last 24-36 hours without significant cervical changes
• Resting and sleeping may be challenging
• It is common proactice to be sent home to rest or to await stronger labor

Cervix
May thin out but not dilate more than
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Onset of Labor

Several theories exist as to why labor begins:

• The physical aging of the placenta may cause insufficient nutrients to reach the
fetus.
• The uterus reaches a crucial point of distension, which may cause tension on
muscle fibers and stimulate their activity.
• Nerve impulses from the uterus to the posterior pituitary gland may bring about
release of oxytocin (a hormone which causes the uterus to contract).
 • Decrease in the level of the hormone pregesterone, may cause uterine changes.
• Adrenal glands of the fetus, when mature, may release a substance to stimulate
labor.
• The release of prostaglandin from the wall of the uterus may initiate labor.

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When to go to the hospital

Most physicians and midwives suggest contacting them when your contractions are five
minutes apart and lasting 60 seconds and you have had this activity for about an hour.
When you reach your doctor or midwife, be prepared to tell him/her:

• How far apart the contractions are, their length and intensity, and if you are using
breathing techniques
• Whether or not the bag of waters has broken, the time it broke, and the color of
the fluid
• If a bloody show is present.

Your physician or midwife will instruct you when to leave for the hospital. If you are a
first-time mother and are able to manage the contractions at home, new research is
suggesting that first-time mothers should continue to stay at home until it is difficult to
breathe through the contractions. However, if you live a great distance from the hospital,
are concerned about not getting there on time or have other special concerns, plan on
leaving sooner.

What to Expect when you arrive at the Hospital

When you arrive in labor and delivery, a nurse will check your blood pressure,
temperature, may obtain both blood and urine samples, and place devices on your
abdomen that monitor the baby's heart rate and your contractions. The nurse, your on-call
physician, or midwife will then perform a vaginal exam to evaluate the dilation and
effacement of your cervix. It is best to be admitted when active labor begins, especially if
you are a first-time mother. In active labor, the contractions are less than five minutes
apart, lasting 45-60 seconds and the cervix is dilated three centimeters or more.

Depending on your stage of labor, contraction pattern, how far dilated you are and fetal
heart tracing, your physician or midwife may admit you to the hospital, or suggest
returning home until the contractions are closer together. In the event you are in early
labor and sent home, it is common to feel disappointed, maybe even embarrassed.
Activities such as walking, showering, resting, drinking fluids, renting a video, or
listening to music, can be very helpful in early labor.

If you are admitted and have had a positive culture for Group B Beta Strep during your
pregnancy, or have any risk factors, you will receive antibiotics prior to delivery.
Stages of Labor
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The four stages of the childbirth process are based on changes in the uterus and cervix as
labor progresses. The beginning and end of each stage are described below:

First Stage of Labor

• Begins at the onset of labor and ends when the cervix is 100 percent effaced and
completely dilated to 10 centimeters.
• Average length ranges for a first-time mother is from ten-to-fourteen hours and
shorter for subsequent births.
• Read more in our Health Libarary
o The first stage of labor
o Cerival Effacement and Dilation
o Illustration of Cervical Effacement

Second Stage of Labor

• Begins when the cervix is completely effaced and dilated and ends with the birth
of the baby.
• Average length for a first time mother ranges from 1 to-2 hours and shorter for
subsequent births.
• Read more in our Health Library
o The second stage of labor

Third Stage of Labor

• Begins with the birth of the baby and ends with the delivery of the placenta.
• Average length for all vaginal deliveries ranges from five-to-fifteen minutes.
Fourth Stage of Labor

• Begins with delivery of the placenta and ends one-to-two hours after delivery.

How Will I know if I am Making Progress?

The progress of labor and the baby's position is determined by an internal vaginal exam.
These exams are not done frequently and may be done during a contraction. Internal
vaginal exams assess:

• Cervical effacement (thinning measured as 0 to 100 percent)

• Cervical dilation (opening measured as 0 to 10 centimeters)
• Presentation (part of the baby to be born first, i.e. head, buttocks, feet, etc.)
• Position of the baby's presenting part (anterior: facing your back, or posterior:
facing your front)
• Station (distance of the presenting part from above or below the mid pelvis in
"plus" or "minus" numbers)

For the past 40 weeks you have been waiting for this moment. Your birth plan is written,
your bag is packed, your belly feels like it is about to burst and you are sure that any
minute now you will feel your first contraction. And then... nothing. Not even a twinge.

Now there is something to be said for being patient. Your baby will come out when he is
good and ready and some just like to take their time. But if the possibility of an induced
labor is looming, you may feel like you want to give him a gentle nudge.

Here are some of the alternative methods of bringing on labor. Before you proceed, keep
these in mind:
• There is very little hard scientific evidence relating to either the effectiveness, or the
safety, of any of these methods. The studies that have been done tend to be small and
evidence is difficult to verify: if labor is due anyway, how do you know whether it was
the curry you ate last night that actually brought it on?
• On the safety side, talk to your doctor at your next check up before you try any of these
methods. This is particularly important if there are any complications in your pregnancy.

Nipple stimulation
Nipple stimulation is the gentle rubbing or rolling of the nipple to encourage the start of
contractions. The theory is that oxytocin, a hormone that causes contractions, is released
in the body when the breasts are stimulated.

Is it safe?
Nipple stimulation has been reported to produce very strong contractions and for this
reason you should use it with care. However, a study of 719 women found that there were
no problems of this sort following nipple stimulation.
Does it work?
The study mentioned above was thought to be too small to draw concrete conclusions
from. However, it did show a significant benefit from nipple stimulation: 37.3 percent of
women who had tried it went into labor within 72 hours as compared to just 6.4 per cent
of those who had not.

How do I try it?

The idea is to simulate the suckling of a baby so you need to massage the whole areola
(the dark area around the nipple), not just tweak the nipple. Place your palm over the
areola and move in a circular motion, applying a firm but gentle pressure. This may need
to be continued for some time. The usual recommendation is 15 minutes of continual
stimulation on each nipple each hour for several hours.

Sex
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Sex as means of getting labor started is thought to work in three ways.
Firstly, the movement may help to stimulate the uterus into action. Secondly, sex can
trigger the release of oxytocin, the 'contraction' hormone. Thirdly, semen contains a high
concentration of prostaglandins which help to ripen, or soften, the neck of the womb
(cervix) ready for it to dilate when labor starts.

Is it safe?
Sex is safe as long as your waters have not broken. Once this has happened, making love
may increase the risk of infection. You should also avoid sex if you have a low-lying
placenta or have had vaginal bleeding. Men often feel uncomfortable making love to their
partners with a baby so obviously in the way but the baby will not know what is
happening and will not be harmed.

Does it work?
Not enough studies have been done but, if nothing else, it will take your mind off the
waiting.

How do I try it?

At this stage in your pregnancy sex is easier said than done. Try spooning, with your
partner entering from behind or use the bed as a prop: your bulge isn't an obstacle if you
lie on your back at the side or foot of the bed with your knees bent, and your bottom and
feet perched at the edge of the mattress. Your partner can either kneel or stand in front of
you. Alternatively, giving your partner oral sex may work better. It is thought that
prostaglandins are absorbed more efficiently through the gut than through the vagina.
(Note: you may prefer to keep this piece of information to yourself.)
Eating pineapple
Pineapple contains the enzyme bromelain which is thought to help to soften the cervix
and so bring on labor.

Is it safe?
There is very little available research. Each pineapple contains only very small amounts
of bromelain so you would need to eat as many as seven to have any effect. The most
likely side-effect of eating large amounts of pineapple would be a severe case of diarrhea.

Does it work?
There is some debate about the role played by bromelain on prostaglandins, which soften
the cervix to prepare it for labor. Some studies actually suggest that bromelain inhibits
prostaglandin activity while others think the opposite. Regardless of this, eating large
quantities of pineapple is likely to stimulate the gut and bowel and could kick-start the
uterus into action by that means.

How do I try it?

The pineapple must be fresh: bromelain is destroyed by the process of canning or juicing.

Eating curry
Spicy food is often suggested as a means of bringing on labor. There are no scientific
theories relating to this, but it may be that it stimulates the gut and bowel and so
encourages the uterus to get going by that means.

Is it safe?
Spicy foods can cause heartburn and, if you are not used to them, irritate the bowel. For
this reason you should probably avoid extra hot dishes if you're more used to milder
flavors.

Does it work?
There is no evidence either way though many women swear by it.

How do I try it?

Have it prepared for you at home or take out an order from a reputable restaurant. This is
not the time to be slaving over a hot stove.

Acupuncture
Acupuncture involves the insertion of very fine needles into specific points of the body.
According to traditional Chinese philosophy, this stimulates the energy within the body
to restore balance and boost healing.

Is it safe?
Studies into this are limited but all show that acupuncture is safe for mother and baby.

Does it work?
The limited studies that have been carried out so far suggest that acupuncture may be
effective. Anecdotally the evidence is much stronger.

How do I try it?

You need to find a qualified practitioner. Ask your doctor or hospital for a
recommendation. Make sure you choose someone with the right credentials. You will
probably need treatment daily until you give birth.

Red raspberry leaf

Raspberry leaf can be taken as a tea or in tablet form. It is often mentioned alongside
other methods for bringing on labor. This is a myth.

Is it safe?
It is very important not to use raspberry leaves until the last two months of pregnancy
because of their stimulating effect on the uterus.

Does it work?
There is no evidence to show that red raspberry leaf will encourage labor to begin.
However, an Australian study has shown that it will speed up the second stage of labor
and reduce forceps delivery.

How do I try it?

If you want to help to prepare the uterine muscles for labor start with one cup of tea a day
or one tablet and build up gradually to a maximum of four cups of tea or tablets daily.
The tea can be sipped freely during labor, too. The tea and tablets are available from
health food stores or from herbal suppliers.

Walking
The explanation appears to be that the pressure of your baby's head pressing down on the
cervix from the inside stimulates the release of oxytocin, hopefully bringing on labor.
Also, just being upright gets the forces of gravity working for you, encouraging the baby
to move down onto the cervix.
Is it safe?
Yes, but you should be careful not to wear yourself out. Labor can be exhausting and you
don't want to use up all your energy before you have begun.

Does it work?
There is, as yet, no evidence. If your baby has not 'dropped' or is still high in the pelvis,
walking is thought to encourage your baby into a better position so that labor is more
likely to start on its own.

How do I try it?

This is not the moment to take up power walking, particularly if you have not done much
exercise earlier on in your pregnancy. A gentle stroll is probably the best you will be able
to manage.

And finally:
Here is a selection of other methods (some of them a little bizarre) that other moms are
said to have found helpful. There is no evidence for any of these and, frankly, we are not
convinced!

• Blowing up balloons: the theory is that the build up of abdominal pressure encourages
labor to start.

• Bouncing on your birth ball or driving your car down a bumpy road would seem to put
the same faith in shaking things up a little. (If you plan to go for a drive, make sure to
buckle your seatbelt!)

• Get a weepy video and have a good cry.

• Wear your best underwear (sod's law will ensure that your waters break in them).

The Signs Of True Labor

Labor May Be Nearing If You Notice One Or More Of These Signs:

* Lightening: This happens when your baby's head "drops" down into your pelvis. Your
belly will suddenly look lower and you'll have an easier time catching breath than you did
when your baby was crowding your lungs. The downside, though, is that he's now
pressing on bladder, increasing need to urinate. For first-time mothers, lightening usually
occurs a few weeks before birth. For veteran moms, it may not happen until labor has
begun.
* Bloody show: If you have blood-tinged or brownish vaginal discharge, it means your
cervix has dilated enough to expel the mucus plug that sealed it for the last nine months.
This is a good sign, but active labor may still be days away.
* Your baby moves less: Women often notice that their baby is less active the day before
labor kicks in. No one is sure why this might be, but one theory is that the baby is simply
saving his energy for the big event. If you notice decreased movement, contact your
health care provider.
* Your water breaks: When the amniotic sac ruptures, you'll feel fluid leak from your
vagina in a trickle or a gush. For most women, contractions follow shortly thereafter. But
even if they don't, let your caregiver know as soon as you think your water has broken. In
about 1 in 10 women, contractions don't begin on their own within 24 hours. If this
happens, your labor may need to be induced, since the likelihood of infection goes up
once your baby's sterile bubble bursts. For other women, the amniotic sac doesn't rupture
until labor is well underway.
* Diarrhea: If you feel a frequent urge to empty your bowels and your stools are looser
than normal, labor may be imminent.
* Nesting: There's no scientific proof linking it to the onset of labor, but plenty of
mothers-to-be are gripped by a sudden urge to "nest" -- to vacuum the entire house at 3
a.m., say, or put those last, finishing touches on the nursery -- right before labor begins.

False Labor

Most expectant mothers feel mild contractions before they're actually in labor. These are
called Braxton Hicks contractions. It can be hard to distinguish Braxton Hicks
contractions from the real deal, especially if you're near your due date. If contractions
aren't causing your cervix to dilate, though, it's known as "false" labor. While true labor
contractions get longer, stronger, and closer together as time goes on, false labor
contractions tend to be:

* Irregular: Braxton Hicks contractions are sporadic, have no predictable pattern, and
usually stop if you rest or change positions.
* Felt in your belly and your groin: True labor contractions, on the other hand, usually
"wrap around" from your back to your belly. If Braxton Hicks contractions are making
you uncomfortable, take a warm bath and drink plenty of fluids to ease discomfort.

Gillian Fletcher answers:

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Swimming is a wonderful way for pregnant women to exercise. However, your wife
should check with her doctor or midwife before she takes the plunge. If she swam
consistently before she got pregnant, she should be able to continue. If she did not
exercise at all, she should still be able to start swimming now even if she's in her second
trimester. She'll need to start slowly, stretch well before and after, warm up and cool
down gradually, and not overexert herself.

Swimming is great exercise because it uses both large muscle groups (arms and legs).
Though low-impact, it provides good cardiovascular benefits and allows expectant
women to feel weightless despite the extra pounds of pregnancy. It's also a very safe form
of exercise because the risk of injury is low.

Any type of aerobic exercise helps increase the body's ability to process and use oxygen,
which is important for your wife and the baby. It also improves circulation, increases
muscle tone and strength, and builds endurance. Swimming burns calories, helps people
feel less fatigued, and sleep well. Regular exercise like swimming also helps women cope
with the physical and emotional challenges of pregnancy.

Pregnancy exercise guide

Written for BabyCenter Philippines

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• Does exercise help during pregnancy?

• Is there any reason why I shouldn't exercise?

• I do a high-intensity workout. Is it safe during pregnancy?

• Which forms of exercise are best for pregnant women?

• If I've never exercised before, what precautions I should take?

• Should I change my routine at different stages of my pregnancy?

• Which sports are not recommended?

• How can I tell if I'm exercising too much?

Does exercise help during pregnancy?

Because exercise promotes muscle tone, strength, and endurance, it can help you carry
the weight you gain during pregnancy, prepare you for the physical stress of labor, and
make it easier to get back into shape after the baby is born. Being active during your
pregnancy can also reduce the physical discomforts of backache, constipation, fatigue,
and swelling; can improve your mood and self-image; and can even help you sleep more
soundly.
Read more about the benefits of exercising during pregnancy, here.

Is there any reason why I shouldn't exercise?

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Some women need to take extra care when exercising. Check with your doctor before
starting any exercise, especially if you:

• have had a threatened miscarriage

• have had a previous premature baby

• know that you are at risk of premature labor this time

• know that you have a low-lying placenta

• have had significant bleeding

• have had problems with your lower back or hip joints

• have a pre-existing medical condition

• have very high blood pressure

• are expecting more than one baby

I do a high-intensity workout. Is it safe during

pregnancy?
If you're in good health, quite fit, and feel up to it, go ahead and continue your routine.
According to a study in the American Journal of Obstetrics and Gynecology, healthy,
well-conditioned women who exercised before pregnancy may continue to do so
throughout pregnancy without compromising their baby's health or development.
Researchers from the University of Oslo, Norway, studied 42 pregnant women who
exercised six times per week at either a high or medium intensity. When the researchers
compared the women's length of labor, maternal weight gain, and the baby's birth weight,
they found no differences between the two groups of exercisers. Remember to let your
doctor know you plan to continue your workout routine.

Which forms of exercise are best for pregnant women?

Walking, jogging, swimming, stationary cycling, and aquanatal workouts are all
considered good, safe exercise during pregnancy, as long as you don't overdo it. Yoga
and Pilates are good, as long as you find a registered practitioner who is experienced in
dealing with pregnant women.

If I've never exercised before, what precautions I should

take?
As long as you get the go-ahead from your doctor, you can engage in mild to moderate
exercise. Stick to low-impact activities such as walking or swimming, and keep workout
sessions short. For specific recommendations, refer to our list of exercises recommended
for pregnancy. You could also try joining a specific pregnancy or prenatal exercise class,
so you know that all exercises are safe for pregnancy.

Should I change my routine at different stages of my

pregnancy?
Yes. Even if you were active before your pregnancy, you will naturally feel inclined to
scale down your exercise routine to accommodate your growing uterus. Additionally, you
should follow general workout guidelines for pregnant women. During the first trimester,
it's especially important that you avoid overheating. After the first trimester, you'll also
need to eliminate exercises that are performed while flat on your back or while you're
standing in one place for long periods, as both can reduce blood flow to the baby.

Which sports are not recommended?

Sports with a high potential for hard falls or ones where you might be thrown off-balance
are not a good idea for pregnant women. These include horseriding, downhill skiing,
gymnastics, and waterskiing. Additionally, most doctors recommend giving up cycling
after the second trimester, even if you're an experienced cyclist, because of the potential
for falls. You can, however, use an exercise bike for as long as you like.

How can I tell if I'm exercising too much?

In general, you shouldn't go for the burn or exercise to exhaustion. Listen to your body
and stop exercising if you feel if you've done too much. Because you'll have less oxygen
available for aerobic exercise, you should generally stick to 60 per cent of your maximum
heart rate while pregnant. Some women like to monitor their heart rate while exercising,
but you should never rely on this alone as heart rates in pregnancy can vary widely. A
good rule of thumb is to slow down if you can't comfortably carry on a conversation
while exercising.

And stop exercising immediately if you experience dizziness, shortness of breath, feeling
faint, vaginal bleeding, difficulty walking, contractions, or unusual absence of fetal
movements. Do bear in mind that your baby is often most quiet when you're exercising.