It’s 3:00 a.m. and the elevator doors to our labor and delivery unit open with a ding. A young woman, followed by an entourage of people, pillows, and overnight bags, propels herself to the nurses’ station and squats firmly on the ground, gripping the desk for support. Through a series of long moans and groans, her entourage informs us that the young woman has been having contractions every four minutes for the past hour.
Quickly, we move to hook her up to the monitors, look over her chart, and assess her. While her moans progress to full-fledged screams, her friends and family settle in for what they clearly expect to be a long night.
Except for one small detail: she’s not in active labor.
It’s tough to believe labor isn’t the real deal, after heading to the hospital and making phone calls, but it’s a common occurrence for many first-time (and even “experienced”) mothers. So, how can you tell if you are really in labor?
Use this guide — straight from a labor and delivery nurse — to help you decide when to head in to the maternity ward, and what you should expect during your visit.
When should I go to the hospital?
It’s one of the most difficult things to discern, especially for first-time moms. “We definitely get a lot of calls from moms asking if they should come in,” says Jessie Tinglan, Nurse Manager of McLaren Lapeer’s Birth Center. “It can be hard to tell when labor starts.”
Although it can be hard to tell if you’re officially in labor, you can ask yourself the following questions to help you decide:
- Are my contractions real? Many women experience Braxton-Hicks contractions throughout their pregnancy and may worry that they will not know what a true contraction feels like. One of the most effective ways to tell if your contractions are “real” is very simple: stand up and walk. Braxton-Hicks contractions usually occur more while sitting and dissipate with movement. If the contractions worsen or increase in intensity with walking, it’s a good sign that they are true contractions.
- Are my contractions regular? If your contractions are irregular, it’s probably not true labor. In early labor, contractions will begin to become in regular intervals and increase in frequency, although be warned — early labor can last a really long time. Even a day or two.
- Am I bleeding? As your body prepares for delivery, your cervix (the bottom of the uterus that opens for your baby to pass through) softens and may release a mucous-y, blood-tinged discharge, sometimes referred to as a “bloody show.” If, however, you are bleeding, especially bright red blood, get to the hospital ASAP, as it could be a sign of a serious condition called placenta abruption, a rare occurrence that can cut off the baby’s oxygen supply before delivery.
- Am I leaking any fluid? Your baby is encased in what is called a “bag of water” by the medical field, also known as amniotic fluid. As the baby’s head nears delivery, the bag of water breaks. However, this doesn’t always happen like it does in the movies. While it could break this way — suddenly and flood-like — it can also leak through a small hole, like a balloon. As I experienced myself, a hole can even re-seal itself, effectively convincing you that you’ve peed yourself. If you have had any leaking of fluid, you will need to go to the hospital and be tested to see if your water has actually broken. Once it has, the barrier between your baby and the outside world is gone, making him susceptible to infection. This risk increases the longer your water has broken, so it’s important to know when it occurs. Near the end of pregnancy, with normal increases in vaginal discharge, it can be hard to distinguish a slow leak or gush, but do not hesitate to head in or call your care provider if you are unsure.
- Has my baby been moving normally? While your baby’s movements may become a little less active as he moves into position for birth, if you notice any decreased activity of the baby, you need to be evaluated to ensure all is well with your little one.
OK, so you’ve hit all of the above: check, check, and check. It’s time. You grab the hospital bag you so dutifully packed weeks ago and head to the car for what will be the looongest ride of your life. (Seriously? When did all those bumps get in the road?)
What can you expect when you arrive?
Every woman, aside from those that come in screaming their heads off and delivering right off of the elevator (it happens more than you think), is assessed in a triage room before determining if she will be admitted to a room on the labor and delivery floor. You will be hooked up to a machine that will monitor your baby’s heart rate and your contraction pattern. Your nurse will also take your vitals and ask you some preliminary medical questions. Here’s what you need to know about your visit in triage:
- Those monitors aren’t accurate. The monitors that the nurse will place on you look like long straps across your belly — these are called external monitors because they are outside of your body. So although it may look like a monumental contraction is occurring on the screen, it could be a totally different story on the inside. That external monitor is simply picking up the occurrence of a contraction; things like the size of your belly, the baby’s position, the brand of monitor, and your weight can all affect the accuracy of the monitor, so its primary use is to time your contractions. The true intensity of a contraction is measured in units of pressure, which can only be accurately monitored inside the uterus. So, eyes off that screen. If you are on the heavier side or have a large belly, the monitor may have difficulty picking up the contraction at all, so you may have to let your nurse know when you are feeling them. Which leads me to…
- Your pain is your pain. Meaning, no one else can determine what your pain feels like. It’s up to you to let your nurses know how severe your pain is. Most hospitals use a 0-10 rating scale, with 0 clocking in at “no pain” and 10 being a “your arm has just been cut off” kind of distress. As we just talked about, the nurses can’t tell how intense your contractions are, so your pain level can be a key in helping them distinguish the point to where your labor has progressed. Be honest and as accurate as you can, but know that pain is perceptive and no one will interpret pain in the same way — it’s just a guide. We’ve seen women rate full-blown labor as a 1 or 2, so don’t worry about rating your pain “wrong.”
- Check, please. More than likely, if you are full-term, your nurse will “check” you. This means she will perform an internal examination to see if your cervix is dilated (opened) and/or effaced (thinned). Just like in the doctor’s office, your nurse will don a glove and perform a vaginal exam. It’s important for the staff to know where your cervix is at initially, so they can track your dilation or effacement during your stay.
- It could be a while. Usually, once the nurse has checked you and determined your baseline, she will monitor you for at least an hour, watching your contraction pattern and how your baby is responding. After about an hour or so, she will re-check you to see if your cervix has changed at all. This step is one of the most important in determining if you’re in true labor. If you have progressed in dilation or effacement at all, it may be an indication to the doctor to admit you to a room.
- You might be sent home. On the flip side, if the nurses determine that you are contracting, but your cervix has not made any changes and everything with the baby looks fine, you may be sent home. Because normal early labor can last for a day or even stop altogether, your doctor may want you to go home and return to the hospital once your contractions pick up in severity or frequency.
What if I get sent home?
If you want my honest advice as a mom of three and a labor and delivery nurse — rest! You will need your energy for labor and that bouncing bundle of joy when he arrives, so try to relax as much as you can now. Stay in touch with your care provider and be on the lookout for increased pain and frequency of your contractions to help you decide when you should go back in.
The most important thing to remember, however, is this: when in doubt, go in! No one woman labors the same way, and it is far safer to be evaluated and be sent home than to wait too long and have a negative outcome. It’s common for moms to have false alarms — nurses know how it is and the hospital staff will never look down on you for coming in to be evaluated. Although you may want to leave your entourage at home — just until you’re sure.