True labor has begun when certain signs are present. If you notice any of these signs before your thirty-seventh week, contact your caregiver immediately. You could be experiencing preterm labor. The signs of true labor include the followings:
• Progressive contractions. The contractions of true labor become longer, stronger, and closer together as labor advances. When they are timed, they show some regularity or pattern. Persistent contractions that have no rhythm but come less than 7 minutes apart should be reported to your caregiver.
• Rupture of the membrane. The rupture of the amniotic sac may be noticed as a gush or uncontrollable leakage of fluid from the vagina. This occurs as a first sign of labor in a small percentage of women. Most commonly, the membranes remain intact until late in labor. Amniotic fluid can usually be distinguished from urine or heavy vaginal secretions. It is colorless and odorless, and its leakage cannot be stopped by doing Kegel exercises.
If you are uncertain, your caregiver can perform a test on the fluid to determine its source. If the fluid has a greenish appearance, your baby has had a bowel movement, called meconium, usually as a result of an episode of fetal distress. This will require closer monitoring during labor and extra suctioning of the baby after the delivery to prevent aspiration of this substance.
Contractions will generally start within 6 to 12 hours following the rupture of the amniotic sac. Contact your caregiver as soon as the membranes rupture because a passageway will now be open for infection. If contractions do not start on their own, your caregiver may want to induce labor with the drug Pitocin. In addition, do not douche or have intercourse after this time.
- Progressive contractions
- Rupture of the membranes
- Loss of the mucous plug from the cervix
Although most doctors insist that babies be delivered 24 hours or less after the rupture of the membranes to prevent infection, some allow women to labor longer with good results. Frequent temperature checks and white blood cell counts can be used to monitor for infection. Of utmost importance is the avoidance of vaginal exams to prevent the introduction of bacteria into the vagina.
There is no such thing as a “dry birth”. Approximately one-third of the amniotic fluid is replaced every hour. Also, the pressure from the baby’s head acts as a cork against the cervix. You may notice intermittent leakage with the contractions as the pressure forces a small amount of fluid around the baby’s head.
• Loss of the mucous plug from the cervix. Loss of the mucous plug is indicated by the presence of thick mucus, usually tinged with blood from small capillaries that were broken as the cervix began to dilate. This mucus is also called bloody show. Although the mucous plug usually is lost 24 to 48 hours before labor begins, it may be passed as much as a week in advance. Sometimes it is not noticed until labor is well established. The loss of the mucous plug without other signs is not labor.
Once labor is established, notify your caregiver. Be prepared to tell him:
• How far apart the contractions are, their length and their intensity, and if you are using breathing techniques.
• Whether the membranes have ruptured and, if they have, the color of the fluid and the time of the rupture.
• If a blood show is present.
You will be instructed when to leave for the hospital or birth center.