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Women Talk: When do pregnant women know they're in true labor?

One of the most commonly asked questions, especially from patients who are about to deliver, is: “Doktora, how do I know if I am in real labor, and when do I go to the hospital? Where do I look for you?”

Often, first time mothers-to-be feel apprehensive on their ninth month when they feel hardening of their uterus, accompanied by occasional pain in the abdomen or even in the low back area. They go into “panic mode,” especially at night, when things are quiet and dark, and it seems that only they are awake, with their abdominal pain.

The sleeping partner is roused, who also suddenly becomes excited. The couple rushes to the emergency room, only to find out it was a false alarm: the cervix is still closed, and the woman realizes that the contractions seem to have abated.

There’s no need to feel abashed, as it happens often.

False labor pains

During the last few weeks of pregnancy, at around the ninth month, some contractions will occur. At times they are so painful that the woman doubles up in agony or wakes up suddenly in the middle of the night. However, after several minutes the pain goes away, and the woman resumes her usual activities or even goes back to sleep. These are called Braxton Hick’s contractions, or false labor pains, that occur often as one approaches full term.

Dilated and flattened cervix

During the last week of the eighth month, approximately around the 36th – 37th week of pregnancy, the obstetrician will do an internal examination to check the cervix. She wants to know whether it has dilated or not. Dilation refers to opening of the cervix, and is usually measured in centimeters. Initially it starts with 1-2 cm (beginning labor), until it reaches 10 cm (full dilatation), when the baby is about to be delivered. At this time, a patient would hear figures like “5 cm dilated” or when it reaches 10 cm, a “fully dilated” cervix. As a rule, obstetricians would admit patients who are at least 4 centimeters dilated.

The doctor would also want to know the effacement of the cervix. This refers to the length of the cervix in relation to its usually long, two-centimeter state. During labor, the muscles of the upper part of the uterus slowly “take up” the cervix, so that what was once a long firm structure (imagine a funnel’s long stem, as seen in item 1) is transformed into a paper-thin orifice (item 2). Hence the measurement of cervical effacement is made in a percentage, as for example, “50% effaced” which means the cervix is 50% thinner compared to its usual 2-cm state.

Position of the baby

The doctor would also want to know the presentation (item 3) of the baby, whether the head is coming out first (cephalic) which is the normal position, buttocks (breech), feet (footling) or shoulder/arm (transverse).

The internal exam would also show whether the baby's head has already “engaged,” (item 4) meaning it has become firmly fixed in the pelvis of the mother; this is a sign that a normal vaginal delivery is very possible. Furthermore, the doctor wants to know whether the bag of waters is intact.  

At this time, an admitting order sheet will be given to the mother, which she needs to keep on hand at all times, because labor can start at any time and place. With this sheet she can come to the Emergency Room which is open 24 hours a day, and her obstetrician will be duly informed of her presence at the ER.

Timing the contractions

When contractions start, observe whether they go away with a change in position, or even when you try to sleep it off. True labor pains do not cease even with rest or sleep.

Observe also the following:
  1. Duration: the length of time of the contractions becomes longer;
  2. Intensity: the contractions become stronger and more painful as time goes on;
  3. Interval: this becomes shorter, and in first-time mothers, usually come within 10 to 15 minutes of each other.

It is best to have a watch to time the contractions. Keep calm, and breathe normally.

One advice I give my patients, especially to first timers, is to visualize what you will do when labor starts. This step-by-step “dress-tech rehearsal” so to speak, even if only in the mind, will make you more confident, knowing what you will do when the time comes. Also, be aware that labor can start at any time of the day or night, so you have to be ready at all times.

Planning for the baby trip

Being ready also means, if you are planning a hospital delivery, assembling the things needed to be brought to the hospital beforehand, even as early as mid-pregnancy. Put them in a suitcase or trolley, or a large bag, as if for a long trip; indeed, having a baby is an exciting and unforgettable trip! Put this aside when completed, or even in the boot of the car, so that when the time comes, while you are doubling with pain, your partner does not run hither and yon for “forgotten things to bring.”

When the bag ruptures without contractions

One word about ruptured membranes: do not wait for labor pains to ensue before coming to the hospital if the bag of waters has broken.

The membranes are the thin, translucent structures (think transparent plastic balloons) that enclose the baby in their protective case, and hold the amniotic fluid where the baby “swims.” Sometimes these membranes rupture even without uterine contractions. There is a sudden gush of water, sometimes with a little blood and mucus, and this is definitely not the usual vaginal discharge nor urine. At times, even the bed sheets become soaked.

When this happens, you need to be evaluated immediately by a doctor, as this means labor is about to start or has already started.

If the part of the baby that is coming out first is not yet firmly fixed, there is a danger of a cord prolapse; that is, the umbilical cord comes down before the baby, and this puts the life of the infant in danger. A ruptured bag also exposes the mother to ascending infections through the vagina.

Knowing that you are really in labor then, is very important, especially when the bag of waters is already ruptured. – Illustrations by Analyn Perez/YA, GMA News

Dr. Alice M. Sun-Cua is an author and practicing obstetrician-gynecologist at the San Juan de Dios Hospital in Pasay City.