It is normal to feel both excited and scared about labor and delivery. We hope that this handout helps answer your questions so you will know what to expect during labor. It is important to talk with your healthcare provider during one of your pregnancy visits about when you should come into the hospital in labor.
When does labor begin?
Labor begins when the cervix begins to open (dilate) and thin (called effacement). The muscles of the uterus tighten (contract) at regular intervals, causing the cervix to thin and open. During contractions, the abdomen becomes hard. Between contractions, the uterus relaxes and the abdomen becomes soft.
How will I know if I'm in labor?
Many women have a number of pre-labor signs, such as backache, diarrhea, weight loss, and nesting, that indicate that their body is getting ready for labor. No one knows what causes labor to start, but several hormonal and physical changes may point to the beginning of labor. These changes include:
The process of your baby settling or lowering into your pelvis is called lightening. Lightening can happen a few weeks or a few hours before labor. You may have some increased lower pelvic pressure. Because the uterus rests on the bladder more after lightening, you may feel the need to urinate more frequently. You may also notice that you are not as short of breath once your baby drops.
During pregnancy, a thick piece of mucus called a plug blocks the cervical opening. The mucus plug helps prevent bacteria from traveling into the uterus. When the cervix begins to soften, thin, and open, the mucus is expelled into the vagina. The mucus may be clear, pink, or slightly bloody. Labor may begin soon after the mucus plug is expelled, or might begin a few weeks later.
Braxton Hicks Contractions
Braxton Hicks contractions are often referred to as practice contractions, as they do not cause cervical changes. They usually are irregular and are not painful.
True labor is marked by contractions that come at regular intervals and increase in frequency (how often contractions occur), duration (how long contractions last), and intensity (how strong the contractions are) over time. As time progresses, the contractions come at closer intervals.
Labor contractions cause discomfort or a dull ache in your back and lower abdomen, along with pressure in the pelvis. Some women may describe contractions as strong menstrual cramps. You might have a small amount of bleeding from your vagina caused by the rupture of small blood vessels in the cervix, called bloody show. True labor contractions can become longer and stronger with activity or a change in position. Although contractions might be uncomfortable, you will be able to relax between contractions.
Early labor is described as dilating from 0 to 6 centimeters. Many women are at home during this time. It is important for each woman to discuss with her healthcare provider about when to come in to the hospital. Active labor is from 6 to 8 centimeters, and transition is from 8 to 10 centimeters.
Timing your contractions
Your healthcare provider will need to know how long your contractions are lasting (duration), how often are they coming (frequency) and how intense they are. You will need to time your contractions from the beginning of one to the end (duration), as well as from the start of one to the start of the next (frequency). Intensity depends on each woman, but contractions are said to be intense when you cannot walk, talk, or laugh through them.
The following suggestions may help you cope during contractions:
- Try to distract yourself: take a walk, go shopping, watch a movie.
- Soak in a warm tub or take a warm shower. Ask your healthcare provider if you should take a tub bath if your water has broken.
- Sit on a birth ball.
- Listen to music.
- Dim the lights.
- Use aromatherapy.
- Get a massage.
- Stay in upright positions to help with descent and rotation of your baby.
Try to sleep if it is in the evening. You need to store up your energy for labor.
Rupture of the amniotic membrane
The rupture of the amniotic membrane (the fluid-filled sac that surrounds the baby during pregnancy) is also referred to as your "bag of water breaking." The rupture of the amniotic membrane may feel either like a sudden gush of fluid or a trickle of fluid that leaks steadily. The fluid is usually odorless and may look clear or straw-colored.
If your "water breaks," call your healthcare provider. Do not use tampons if your water has broken. Let your healthcare provider know what time your water broke, the amount (a trickle or a gush), the color, and the odor. Labor may or may not start soon after your water breaks.
It is also common to be in labor without your water breaking.
Effacement and dilation of the cervix
Your cervix gets shorter and thins out in order to stretch and open around your baby's head. The shortening and thinning of the cervix is called effacement and is measured in percentages, from 0% to 100%. The stretching and opening of your cervix is called dilation and is measured from 1 to 10 centimeters. A vaginal exam is done to determine effacement and dilatation.
Effacement and dilation are direct results of effective uterine contractions. Progress in labor is measured by how much the cervix has opened and thinned to allow your baby to pass through the vagina.
When should I call my healthcare provider or go to the hospital?
Please call your healthcare provider during early labor or when you have questions or concerns. Also call:
- If you think your water has broken (if there is a sudden gush of fluid or a trickle of fluid that leaks steadily).
- If you are bleeding (more than spotting).
- When your contractions are very uncomfortable and have been coming every 5 minutes, they are lasting for 1 minute, and have been like this for 1 hour.
Your healthcare provider will give you specific guidelines about when you should get ready to come to the hospital.
What happens when I get to the hospital?
When you get to the hospital, you will check in at the Labor and Delivery Desk. Most patients are first seen in a Triage Room for admission to the hospital or for testing. Please have only 1 person go with you to the Triage Room.
From the Triage Room, you will be taken to the Labor, Delivery, and Recovery (LDR) room.
You will be asked to wear a hospital gown. Your pulse, blood pressure, and temperature will be checked. An external fetal monitor will be placed on your abdomen for a short time to check for uterine contractions and measure the baby's heart rate. Your healthcare provider will also examine your cervix to see how far labor has progressed.
An intravenous (IV) line might be placed into a vein in your arm to deliver fluids and medications.
Types of delivery
Vaginal delivery is the most common type of birth. Sometimes a cesarean delivery is necessary for the safest outcome for you and your baby. A cesarean delivery may be necessary if:
- Your baby is not in the head-down position.
- Your baby is too large to pass through the pelvis.
- Your baby is in distress.
- The placenta (the sac in the uterus that supplies nutrition and oxygen to the fetus) blocks the cervix (a condition called placenta previa).
- You have health issues.
- There is some type of emergency situation.
Most often, the need for a cesarean delivery is not determined until after labor begins.
What are the stages of labor?
The average labor lasts 12 to 24 hours for a first birth and is usually shorter (8 to 10 hours) for other births. Labor happens in 3 stages — early to late, or first to third stage. You will be guided through these stages by your healthcare provider.