If you have never experienced labor before, you may find it difficult to know if you are in labor. Before heading to the hospital, call your physician or midwife to discuss your labor symptoms.

It is common for first time mothers to make more than one trip to the hospital. If you are in early labor and sent home, the following activities may be helpful: walking, showering, resting, drinking fluids, listening to music, etc.

How Do I Know if I'm Really in Labor?

Pre-labor can only be differentiated from true labor by an internal examination of the cervix. True labor contractions become stronger, difficult to talk through, last longer, and are closer together as labor progresses. These will effect changes in the cervix, causing it to thin out and open while encouraging the descent of the baby through the pelvis.

True Labor

Contractions

• May be irregular at first
• Usually become regular
• Get longer, stronger, and closer together as time progresses
• Walking usually makes them stronger
• Lying down does not make them go away
• Often begin in your back and move to the front

Cervix

• Changes by becoming thinner and starts to open (dilates)

False (or "Practice") Labor

Contractions

• Usually are irregular and short
• Do not get longer, stronger, or closer together
• Can last several minutes in length
• Walking does not make them stronger, may even cause them to stop
• Lying down may make them go away
• May be felt more in the front area and in the groin area
• Beneficial in preparation for true labor

Cervix

• Very little change or no change; does not thin or open

Prodromal Labor

Contractions

• May begin irregular and become regular
• Usually stay five or greater minutes apart
• May feel strong, but usually do not get closer together
• Lying down does not usually make them go away
• May last 24-36 hours without significant cervical changes
• Resting and sleeping may be challenging
• It is common practice to be sent home to rest or to await stronger labor

Cervix

• May thin out but not dilate more than

Onset of Labor

Several theories exist as to why labor begins:

• The physical aging of the placenta may cause insufficient nutrients to reach the fetus.
• The uterus reaches a crucial point of distension, which may cause tension on muscle fibers and stimulate their activity.
• Nerve impulses from the uterus to the posterior pituitary gland may bring about release of oxytocin (a hormone which causes the uterus to contract).
• Decrease in the level of the hormone pregesterone, may cause uterine changes.
• Adrenal glands of the fetus, when mature, may release a substance to stimulate labor.
• The release of prostaglandin from the wall of the uterus may initiate labor.

When to Go to the Hospital

Most physicians and midwives suggest contacting them when your contractions are five minutes apart and lasting 60 seconds and you have had this activity for about an hour. When you reach your doctor or midwife, be prepared to tell him/her:

• How far apart the contractions are, their length and intensity, and if you are using breathing techniques
• Whether or not the bag of waters has broken, the time it broke, and the color of the fluid
• If a bloody show is present

Your physician or midwife will instruct you when to leave for the hospital. If you are a first-time mother and are able to manage the contractions at home, new research is suggesting that first-time mothers should continue to stay at home until it is difficult to breathe through the contractions. However, if you live a great distance from the hospital, are concerned about not getting there on time or have other special concerns, plan on leaving sooner. 

What to Expect when you Arrive at the Hospital

When you arrive in labor and delivery, a nurse will check your blood pressure, temperature, may obtain both blood and urine samples, and place devices on your abdomen that monitor the baby's heart rate and your contractions. The nurse, your on-call physician, or midwife will then perform a vaginal exam to evaluate the dilation and effacement of your cervix. It is best to be admitted when active labor begins, especially if you are a first-time mother. In active labor, the contractions are less than five minutes apart, lasting 45-60 seconds and the cervix is dilated three centimeters or more.

Depending on your stage of labor, contraction pattern, how far dilated you are and fetal heart tracing, your physician or midwife may admit you to the hospital, or suggest returning home until the contractions are closer together. In the event you are in early labor and sent home, it is common to feel disappointed, maybe even embarrassed. Activities such as walking, showering, resting, drinking fluids, renting a video, or listening to music, can be very helpful in early labor.

If you are admitted and have had a positive culture for Group B Beta Strep during your pregnancy, or have any risk factors, you will receive antibiotics prior to delivery.