Labor and Preterm Labor
What is Labor?
Labor is the onset of regular uterine contractions that cause the cervix to dilate and allow the baby to descend the birth canal leading to delivery. Many women however, have a hard time knowing when labor starts because contractions may begin before the cervix actually begins to dilate.
In actuality, the process of labor begins weeks before the delivery. As the uterus begins to have stronger and more periodic contractions, the baby settles into the birthing position, usually head down. This downward pressure then assists in the dilation and effacement (or thinning) of the cervix. Many women describe this as a feeling of pelvic or vaginal pressure and may sense that the baby has "dropped" and may be told that they are having false labor or "Braxton-Hicks" contractions. .
What specifically triggers true labor is unknown, but it is felt to be a complex hormonal and cellular interaction between mother and baby that leads to the sustained, regular and intense uterine contractions that deliver the baby. While this process usually occurs after 37 weeks gestation, it may occur earlier in a process known as preterm labor.
How Do I Know When Labor Starts?
Again, labor is the onset of regular uterine contractions that cause the cervix to dilate. When you are full term there are several signs you can look for that this process may be beginning.
Your water breaks - While it is not always like it is shown in the movies, many women do experience a large gush of fluid from their vagina. Other women just notice continued leaking, or water running down their leg that they can't control. If this happens, don't panic, just proceed to the hospital and let the nurses evaluate you. If your water is broken, you will be admitted.
Contractions - As labor nears, your contractions will become more regularly timed and more intense. If they are coming every five minutes apart and lasting 60 seconds and you have had this activity for about an hour you should come to the hospital and be evaluated.
Mucous Plug/Vaginal Bleeding - Sometimes when a woman starts in labor, the cervical dilation leads to the passage of her mucous plug. This plug serves as a barrier within the cervical canal for the 9 months, but often comes out in the early stages of labor. It may have small streaks of red or brownish blood in it, as well as some small clots. If you begin to have this "bloody show" call our office or come directly to labor and delivery. If the bleeding is heavy, like a menstrual period, or you begin to pass clots, call 911 or get to the hospital immediately.
Preterm labor is defined as the onset of uterine contractions that lead to cervical change prior to 37 weeks gestation. In the United States, about 12 percent of babies (more than half a million a year) are born prematurely and according to the March of Dimes, the rate of premature birth has increased by over 30 percent since the early 1980s. The increasing rates of prematurity are due to multiple factors including the use of assisted reproduction and the rate of multiple gestations, but other risks include:
- Late or no prenatal care
- Tobacco , alcohol or substance use
- Uterine malformations/fibroids
- Domestic violence (including physical, sexual or emotional abuse)
- Infections (including urinary tract, vaginal, and sexually transmitted infections)
- Clotting disorders
- Being underweight before pregnancy or extremely overweight during pregnancy
- Short time period between pregnancies
- Fetal Malformations
- Non-Hispanic black race
- Younger than age 17, or older than age 35
- Low socioeconomic status
- Poor social support
Our physicians will evaluate your risk factors and develop a strategy to help minimize your chance of preterm delivery, but If you begin to have any of the signs of labor such as contractions, bleeding, or water breaking call our office or come to the hospital immediately!