SIGNS AND SYMPTOMS OF LABOUR.
In all my years as a midwife, the most common question I get asked is "How will I know that I am in labour?"
To which I reply, "You will know!".
The difficulty arises when people think they are in established labour when really they are "effacing", or in the latent phase of labour.
NICE guidelines, (National Institute of Clinical Excellence) define the latent phase of labour as
"A period of time, not necessarily continuous, when
-there are painful contractions, and
-there is some cervical change, including cervical effacement and dilatation up to 4cm.
Established first stage of labour when
-there are regular painful contractions, and
-there is progressive cervical dilatation from 4cm.
Effacement is the process where the cervix becomes anterior, softens and shortens in length prior to dilatation. Unfortunately, this stage can last anything from a few hours to a few days. This being the reason why many women state, and believe, that they were "in labour for days!".
So what can you do to ease the pain and ensure that you attend the hospital or birthing centre at the appropriate time?
Firstly, it is important to realise that you can always contact your community midwife or local labour ward or birthing centre for advice and support on any matters arising during your pregnancy.
You will be asked many questions by the midwife which enable her to determine whether or not you need to be seen and assessed or if it is more beneficial for you to stay at home.
If everything in your pregnancy is normal and low risk and you are in the latent phase of labour, you will be encouraged to stay at home as long as you can.
It is important that you stay mobile, have regular long soaks in the bath with the water level covering as much of your "bump" as possible and have regular paracetamols. (1gm every 4 hours, but no more than 4gm in a 24 hour period).
Try to keep active to take your mind off the pain and have regular light meals and drinks to keep your energy levels up.
Often when baby is laying in the OP position, or back-to-back, the latent phase of labour is prolonged as the baby rotates into the optimal position for labour. This results in severe back pain. A TENS machine or a back massage from your partner may ease this slightly.
You may notice that you have "a show". This is a small amount of mucous that may be clear or blood stained and may come away weeks before the start of labour.
You may also feel that your "waters have broken" (spontaneous rupture of membranes). This can be clear, pink or green if your baby has opened his bowels inside you. If you suspect this has happened, it is important to contact a midwife as soon as possible as this will have to be confirmed to ensure infection does not harm your baby.
If your membranes have ruptured and all is well, you will be offered an Induction of Labour within the next 24-48 hours. This procedure is to make you go into labour to ensure the safety of your baby.
If you start to experience contractions which last approximately 45 seconds, wait until they are strong and are coming every 3-4 minutes for about 3 hours. This is usually a good indication that labour has started. If your have tried the bath and paracetamol route without good effect, then this is the time you should be ringing your midwife.
Always inform the hospital or birthing centre that you are booked with, that you will be attending, that way, they will be ready for your arrival. It is also extremely important that you remember to take your antenatal notes with you as this is often the only information they have of your pregnancy apart from ultrasound scans and blood tests.
The final thing to remember, is that your baby should still be moving, so if you notice a change in pattern of these movements, even if you suspect labour has started, it is important to inform your midwife. It may just be that you haven't noticed the movements due to focussing on your contractions, therefore relax and make sure, as you will be asked about these when you ring.