How do I know I'm in labor?

With my first pregnancy I remember sitting on the exam table when the nurse practitioner I was seeing asked me, "do you have any questions?" To which I asked, "How will I know I'm in labor, and what if I don't notice?" She smiled and responded, "you will know." I remember thinking how unhelpful that was, and then when I was in labor I remembered our conversation and smiled. Now, I find myself in that same situation as a doula when clients ask, "how will I know I'm in labor?"


This question comes from a desire to have control of the situation, as humans we don't like not knowing when something will happen and what it will feel like. The comparison we hear most often is that the contractions will feel like period cramps when they begin.


Each stage of labor has its own indicators or symptoms, let's take a look:

Early Labor

0-6cm, lasts approximately 2-24 hours

Nagging backache: My first encounter with labor gave me a nagging backache. Every time it started bugging me, I switched my position in bed to try to continue sleeping. After an hour of this I gave up and got out of bed. It was more annoying than anything, so I continued on with my day just earlier than I had anticipated.


Loose stools: let the poop come! A big fear people have in pregnancy is pooping in labor, but the truth is your body tries to clear itself out before pushing starts. You will likely experience more loose stools than normal if you are in early labor.


Losing your mucous plug and or blood mucous discharge: you won't necessarily lose the whole mucous plug, but you may notice more discharge than normal. Technically, the mucous plug can regenerate so this alone isn't always a sign of labor. Your discharge may be accompanied with a little bit of blood. This is usually nothing to be alarmed about, but if you have any concerns contact your provider.


Contraction pattern: your contractions will not last very long, you may not notice them at all and the contractions will be a very inconsistent pattern. For example, you may have a few 10 minutes apart and then the next one might be 30 minutes apart.


Water breaking: it's possible your water will break, but only 1 in 10 labors starts this way. It is possible for your water to break without contractions starting, in fact some people don't experience contractions for up to 24 hours after the water has broken. If your water breaks take note of the color, smell, and how much fluid there was because your provider will want to know. Your water breaking doesn't mean you need to rush to your birth place.


Demeanor: it will be easy to distract yourself, you will still be chatty and can keep up with a TV show or movie you are watching.


What should I do during early labor? Honestly, if you can ignore it the better of you are. If early labor hits in the middle of the night try to go back to sleep. To do this, you can try taking a bath or shower or call your provider to see if you can take something like Benadryl to help you sleep. If you are in active labor, sleeping through it will prove difficult, so don't be worried about missing labor by using a sleep aid.


During the day, this is a good time to finish up those nesting projects or make something to eat to bring with you to the hospital for after your baby is born. Continue to eat and drink during this stage because the fuel you put in your body now will be beneficial for later. Continue to rest during the day by watching a favorite TV show or movie and taking naps if you can.


Active Labor

6-8cm, lasts approximately 2-12 hours

Contraction pattern: things start to pick up in active labor. Contractions will last at least 1 minute and should be about 5 minutes apart. Most hospitals urge you to come when your contractions are every 5 minutes, lasting 1 minute for at least 1 hour (5-1-1) rule. If you feel comfortable with it, you could wait until this pattern hangs out for 2 hours versus 1. This may depend on the weather and the drive time to your birth place.


Water breaking: if your water hasn't broken before you arrived to the birthplace then it's likely your provider will offer to break it artificially, you do not need to constant to this at any stage in labor because it is not necessary for it to be broken for your baby to be born.


Demeanor: In active labor, your demeanor will change. You likely won't be very chatty and you probably won't be laughing at your support peoples jokes anymore.


When a contraction starts you will find yourself getting up from a sitting position and getting into a position that feels best while going through the contraction.


You will not be concerned about contacting anyone during this stage, setup a plan for your support person to make calls to the birth place, doula, and any other support people to help manage things and take stress off your plate.


What should I do during active labor? Switch up positions every 20-30 minutes and take periods of rest. For example, if you have been on your feet try laying on your side or in a butterfly position. Taking a rest in the tub is a good idea as well. Make sure you are emptying your bladder during this stage of labor because it helps make room for your baby to come down the birth canal. Your birth team should be offering you bites of food and sips of liquids in between contractions.


Transition

8-10cm, lasts approximately 5 minutes-2 hours

Transition is often referred to as the "I can't do this anymore phase." As a doula, when we hear that phrase we usually guess transition has arrived (this depends on other factors too). If you are planning an unmedicated birth this will also likely be the time you say you want the drugs...even though you probably don't.


Hot/cold flashes: being in the tub may be uncomfortable because it's hard to adjust the temperature quickly. Having a cool washcloth to switch out to put on your face or the back of your neck can be helpful. Handheld fans come in handy here too and sometimes hospital have these available for laboring families as a parting gift. If you experience cold then using heat packs and asking for warm blankets is an option. Shaking isn't necessarily indicative of being cold but of the flush of hormones, you can stick your tongue out to try to stop "the shakes."


Nausea and vomiting: there is a lot going on here when it comes to what your body is doing, so some people react by feeling nauseas or even vomiting. Pack some peppermint, spearmint, or even citrus essential oils to help combat nausea in labor. At your birth place they may have aromatherapy options but will also have pharmacological options like Zofran to help calm excessive nausea and vomiting.


Contraction pattern: contractions are coming in hot at 1-2 minutes apart. It may feel like you aren't getting a break. Using hydrotherapy during transition can help you feel more relaxed during and after contractions no matter how short of a break you get.


What should I do during transition? stay centered, tap into your positive mindset. Your birth team should be providing you with words of encouragement. Your team should help keep you on track for whatever you desired in your birth plan. Stay focused!


Pushing

lasts approximately 10 minutes-3 hours

The majority of birthers find pushing to be motivating. While the rest of labor you never know how long things are going to take with pushing you can feel what is happening more clearly and you can even use a mirror to watch what's going on depending on your pushing position. If you are in a position where a mirror isn't an option feel free to touch with your hands to gauge progress.


When it's time to push, you will feel pressure during and in between contractions. The urge to push will be hard to ignore and can become involuntary if it's go time. If you have an epidural, you will likely still feel these sensations because an epidural cannot take away pressure. How epidurals are being administered have changed a bit in the last few years, so it allows pushers to be more present and able to feel what is happening when pushing.


There are different types of pushing, most commonly you will be encouraged in the hospital to hold your breath, curl around your baby and push 3 times for 10 seconds each. This isn't necessary, you can make low deep noises while pushing your air down while pushing. Think about how you poop when you are constipated, do you hold your breath? Try to think about this when you are pushing or ask for reminders to push your air down and make low deep noises. Listen to what your body is telling you to do, that's powerful.


What should I do during the pushing stage? Don't let anyone whisk you onto your back for pushing your baby out, it's not necessary and in most cases isn't very comfortable for the pushing person. This position is, however, really great for your provider because it gives them the best view and makes it easiest to catch your baby. You get to do whatever feels comfortable for you, standing, squatting, in the water, hands and knees, on the birth stool, on your side etc. Your support team that isn't employed by the hospital should be encouraging you to change positions.



All of that to say, you are absolutely going to know when labor hits. In the beginning stages it may feel hard to decipher. If you are feeling uncertain you can take a minute to sit and be present with your baby, hands on belly and just be still and quiet. Put on your birth playlist and you will have the answer you need, provided by you and your baby, intuition is more powerful than anything.


If at anytime you have concerns during your laboring process you should contact your provider. If at anytime your intuition is telling you it's time to go to the birth place, GO. Remember, if you get to the birth place and you consent to a cervix check and decide that the information you are given makes you want to go home, then you can go home provided all is well with you and the baby.


Share this post with a pregnant friend and tell us in the comments what you plan to do in early labor to keep distracted OR let us know how you knew you were in active labor.



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