Sunday, February 21, 2010

The Most Common Question

After coaching for labor and delivery for almost thirty years, I have identified the most common question. " How do I know when I am in labor?" Not "How will it feel?" or "Will it hurt?" or even "How do I get the doctor I like in my group to come in to the hospital for me?"

Labor starts with contractions. They cannot be manipulated the way Braxton- Hicks contractions can be by drinking more water or taking a warm bath. Labor contractions may start with a low backache and they may feel like menstrual-type cramps deep in your pelvis. Over time, real labor contractions get longer and stronger and closer together. They may start irregularly and be short, maybe just ten or fifteen seconds in length. But over time, that may mean hours, you will notice a regularity to the rhythm. Contractions are timed from the start of one, including the interval in between, until the start of the next contraction.

At the start of labor, you are excited and energized. You can move and sing and dance and call everyone you know. Over time, as the contractions become more regular and last longer, perhaps forty-five seconds, you will know that you are truly in labor. When you can no longer talk through a contraction or the contractions are five minutes apart ( ten minutes for subsequent pregnancies ), there is still plenty of time to call your doctor and head over to the hospital. If you are still unsure, for whatever reason, call your provider. Obstetricians and nurses know just what to ask to determine if you may need a labor check or if you should just go on into your maternity hospital, following all the rules of safe driving with a seat- belt firmly fixed.

Occasionally, labor doesn't start with contractions. Your bag of waters may rupture and you may not experience anything but a trickle or gush of fluid. The fluid should be clear and odorless. If not, contact your provider. If you are unsure if your water has indeed broken, call your provider. There are simple means to ascertain if it is truly amniotic fluid.

That famous mucous plug is not really a sign that labor is impending. There are a lot of reasons why you may notice increased secretions, even blood- tinged. Intercourse or simply the baby settling down into the pelvis may cause increased mucous discharge. A vaginal exam or straining at the stool might cause a bloody discharge. This is considered to be expected and doesn't necessarily mean that your day has arrived. It always permissible to contact your provider for direction. And you should do so, if you have bright red bleeding that is in the amount of a mentrual period.

Your providers are a phone call away. Make sure that you understand the protocols for contacting them after office hours, on weekends and holidays. Be calm and be prepared, first labors generally last hours, so there is plenty of time to get to the hospital, after you have decided that you are really in labor!!