Am I in Labor?

The first few contractions can mean excitement and adrenaline are flowing while getting ready for a baby to be born.    The baby is coming!  Friends and family may be called.  Boss may get notice not to expect you because...hold on... here comes another one...
But then that next part doesn't come. 
The part where you go to the hospital and the nurses say, "Yes!  You are in active labor, let's get you admitted!"  They may send you home.  Twice.  They may tell you to rest, and relax.  They may tell you this isn't the hard part yet.
 
What is going on?!
Welcome to the world of contractions.  It may not be THE strongest muscle in the female body, but there is some evidence to show the uterus presents a strong case (other top contenders are said to be the tongue -which is actually 8 muscles, the eye muscles, the heart muscle, and jaw muscles.)

Even if it isn't the strongest, the uterus is a muscle and muscles are designed to contract.  When a woman is feeling her abdomen tighten in a way she has never experienced before, understanding what is expected and normal may require some patience.
The first stage of labor can be described simply as a series of contractions that get longer, stronger, and closer together.

When contractions do not become longer, stronger, or closer together, they are not "labor contractions."  They may be called Braxton Hicks contractions, or if closer to your delivery date -  pre-labor, prodromal labor, or false labor.
What comes to be the distinguishing difference between Braxton Hicks contractions  and pre-labor, (sometimes called prodromal labor) is that Braxton Hicks contractions typically don't cause noticeable change to a woman's cervix.


Braxton HicksSome descriptions of Braxton Hicks:

• Irregular in intensity
• Infrequent
• Unpredictable
• Non-rhythmic
• More uncomfortable than painful (although for some women Braxton Hicks can feel painful)
• They do not increase in intensity, or frequency
• They taper off and then disappear altogether

It is suggested that if Braxton Hicks contractions are being felt, a woman should ease up on activity, or change positions, and drink fluid (as she may be dehydrated).  Use the restroom.  Take a warm bath.  Relax.  After some time, Braxton Hicks contractions will usually stop.
Some believe that Braxton Hicks contractions are how your uterus prepares for labor, and the muscle is "getting ready" so to speak.  I have seen it been described as "bicep curls for your uterus."
Irritating?  Sure.  Harmful on their own?  No.
Pre-Labor, Or Prodromal LaborSome descriptions of pre-labor or prodromal labor:

• Regular contraction pattern, but does not increase in frequency, intensity or length of duration
• Contractions somewhat predictable (perhaps only at night, for example)
• Contractions can be uncomfortable, although some women are able to sleep
• May last several days

One encouraging part of prodromal labor is that there is progress being made during this time.  Typically women are used to hearing about dilation and effacement when in labor (4 cms and 70%!), but labor progresses in six ways. Prodromal labor is believed to have a positive effect on the cervix by helping it to soften and change to a favorable position.
A care provider may tell a client that she has no change in effacement or dilation (thickness or opening).  A care provider can be asked about how soft the cervix is and its position, as those are important parts of progress as well.  Or as one nurse I've worked with says, "You get credit for those contractions!"
So Is It Real, Or Not Real?Regardless of how it is classified, women should be believed when they say they are in pain.  Braxton Hicks and prodromal labor both have the possibility of being strong or cause pain.  A concern may be how long they last, but that varies widely from person to person - just as birth itself varies widely.


If a person believes it is Braxton Hicks:

• Drink a glass or two of water.  Dehydration may be a concern, which can lead to an onset of contractions.
• Rest. Being too active may prompt a body to produce contractions.  Sit instead of stand if possible.  Encourage putting ones feet up.  If sleep is an option, try to get some.
• Relax.  Tension and stress can also encourage Braxton Hicks contractions.  A warm bath or shower may help reduce stress and tension.  Going for a slow walk, or taking a break from stressful activities are good options.
• Heat packs or cold packs can be used to give comfort

If a person has been experiencing contractions for long periods of time but is then told she is not in active labor, it may discourage her and cause fear about what "real labor" will be like.  There is no way to predict what a woman's active labor pattern will take, so remaining positive and encouraging is important.


If a woman is experiencing prodromal labor,  she can do all the things mentioned above for Braxton Hicks PLUS:

• Be aware that a woman's body is not the only thing that may become tired.   Giving regular encouragement, and affirmation can help when a woman becomes emotionally exhausted. 
• Be reminded that the length of prodromal labor has no correlation to the length of time a woman will be in active labor. 
• Prodromal labor is a normal part of birth for many women, and is not an indicator that she will not be able to birth her baby.

 As your doulas, Doulas of Chicago tries to help encourage women to be as rested as possible, and continue to rest even if they are experiencing regular contractions.  Some people can sleep through them,  some can not.

Massage, music, eating and drinking regularly, and rest when possible (between contractions) can help prepare a woman for the time when her body begins to have contractions that are creating measurable change on her cervix.

If prodromal labor lasts to a point where a women does not feel she could sustain the intensity, time, and effort active labor may take, she may consider talking to her care provider about therapeutic rest as an option.
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Having a team in place that is equipped to meet a laboring woman right where she is can help keep a woman encouraged, relaxed, and help renew her energy when necessary.
Remember, you get credit for these contractions!

Authored by Ariel Swift