Sunday, February 07, 2010

Signs of Labor, What should I be watching for? (2 Days to Go)


With only two days remaining to my due date, I realize that little Hedvig could be making her entrance at any moment. To a schedule minder anal retentive like myself, this is utterly frustrating. Is it too much to ask God to just put a little appointment reminder in my blackberry so I can plan accordingly?

I have no reason to think that Hedvig will be early, and in fact, most first time mothers are late. So I don’t know why I still wake up in the middle of the night with a cramp thinking, “Is this it”?

I’ve Googled ‘determining when you are in labor’ several times, but that doesn’t give me any more control over the situation. What it does give me, are a few obvious signs of labor that I thought I would share with my readers.

Unfortunately, not on this list are the types of signs I was hoping to find. For example, “You will crave Mexican food. You will get a small ache in your lower back that grows in intensity until you start to feel contractions. You will suddenly start walking with a limp. Your mother-in-law will arrive. Mother Nature will drop 18 inches of snow making it impossible to catch a cab to the hospital.” I feel confident I will know when I am in labor, but what about pre-labor?

Effacement and Dilation of the Cervix
Before you can have your baby, I guess your cervix has to both thin out and open. The thinning is called effacement. You don’t feel it happening and you can’t really tell if it has, but your doctor will tell you at your next exam. Effacement is often expressed in percentages. When you're 50 percent effaced, your cervix is half its original thickness. Your cervix must be 100 percent effaced, or completely thinned out, before a vaginal delivery.

The Doctor refers to the opening of the cervix as dilatation and gives you a number from 1- 10cm to let you know where you are at. You have to be at 10 to deliver, but the process of dilation can occur very inconsistently. For example, I was a 1cm at 37 weeks, 3cm at 38 weeks, and by now I could be walking around at 5 cm and not even know it.

At first, these cervical changes may be very slow. Your progress isn't a good indicator of when labor will begin, but rather a general sign that you're getting ready for labor. Once you're in active labor, I expect to dilate much more quickly.

My doctor said, “I don’t even know why we tell people at their weekly exams. It really can change at any moment and usually it’s the last three that happen all of the sudden.”

The Mucous Plug
I totally didn’t know what this was until Gabe and I took the pregnancy class offered by the hospital. During pregnancy, a thick plug of mucus blocks the cervical opening to prevent bacteria from entering the uterus. When your cervix begins to thin and open, this plug may fall out. You may notice stringy mucus or a thick discharge. It's typically brown and sometimes tinged with blood. And it’s kinda gross.

Losing the mucous plug is a sign of labor, but doesn’t mean anything is imminent. I lost mine three days ago and have an unfortunate feeling that actual active labor is still days away.

I’ve heard that “nesting” is a typical sign that labor is on the way. Well, I’ve been nesting for the last month and clearly not in labor. But what they say is that this instinct is increased as you get closer to actual labor and that typically you wake up one morning feeling a special burst of energy, ready to re-arrange the furniture, clean out the cabinets, bake four dozen cupcakes, dust above the cupboard and paint the nursery. And then, apparently, you are in the middle of one of these projects and you go into labor.

Well, that sounds like no fun at all. Coming home to a half painted nursery or uncooked cupcakes sounds miserable. I’m starting to wonder if my compulsive need for perfection has prevented this instinct from being an effective sign of impending labor. Sort of like I will the baby back up into the body rather than consider the possibility of coming home to a dirty house or half finished project.

Water Breaking
This is the sign they always use in the movies. The woman is usually standing somewhere like the line at the grocery store and then suddenly she looks down and there is a puddle beneath her and she runs off to the hospital to have her baby. My sister tells me that its more like you are sitting in the car and you feel like you wet your pants, then you go to the bathroom to check and find something like turkey giblets in your underwear. With my luck, I’ll be sitting on my white couch when it happens. And considering how many times I’ve wet my pants in this pregnancy, it could have happened months ago. Seriously, I sneeze, cough, laugh or take a deep breath and I’m likely to have a puddle underneath me. So I have no idea how I will know when my water actually breaks.

On my last visit, the doctor gave me a test to check if one of my puddle incidents was actually my water breaking. Alas, it hasn’t happened yet. The “water” is actually the fluid inside your an amniotic sac that cushions your baby in the uterus. Our Doctor says that your water can break and that doesn’t mean contractions will follow. It’s best to have the baby within 24 hours of your water breaking, because the longer the membranes are ruptured, the greater the risk of developing an infection. Of course, they test you in week 37 to find out if your fluid is prone to infection. Mine is not. Therefore, our doctor told us that we should stay home as long as we can if the water breaks.

“If you call, they will tell you to come in. And if you come in with your water broken and aren’t in labor, they will induce. So you might want to wait it out a little. Don’t call right away but definitely get in before 24 hours.”

Now for the most obvious sign of labor and the one I keep waiting to happen. Contractions. During the last few months of pregnancy, they told me I may experience occasional, painless contractions — a sensation that your uterus is tightening and relaxing. These are called Braxton Hicks contractions. Our doctor says that they help push the baby down to get in position.

As your due date approaches, Braxton Hicks contractions may become stronger or even painful. Eventually, Braxton Hicks contractions will be replaced by the real thing. To tell the difference, ask yourself these questions:

  • Are the contractions regular? Time your contractions from the beginning of one to the beginning of the next. Look for a regular pattern of contractions that get progressively stronger and closer together. The contractions of false labor will remain irregular.
  • How long do they last? True contractions last more than 30 seconds at first and get progressively longer — up to 90 seconds. The contractions of false labor vary in length.
  • Can you stop the contractions? True contractions continue regardless of your activity level or position. In fact, they often grow stronger with increased activity, such as walking. With false labor, you may be able to stop the contractions by changing your activity or position, lying down or taking a walk.

Well – to be perfectly honest, I don’t think I’ve had a single contraction this entire pregnancy. I have these moments where the baby presses really hard on my belly and then releases and I wonder, “Is that a contraction?” But I don’t really think it is.

In summary – this baby isn’t coming any time soon. I’m failing in the pre-labor signs department. So sit back, buckle up and get ready for the -1 days and counting blog coming on Wed. And if anything changes, I’ll let you know.

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