Real labor? Ultimately that's what you're interested in learning. I've had six babies. (only one after becoming a labor nurse) So, I know the emotional pain that being sent home from labor and delivery triage can cause. It sucks. I get it. All the excitement of finally having that bundle of joy is crushed by a mean nurse who tells you that she understands you're in pain, but this isn't it, followed up with a, “It will happen Honey!”
How about some advice from a nurse who is one of the ones who decides if you're going to get the golden ticket or get your parking garage ticket stamped on the way out.
Just a little disclaimer: As always, I am just writing my thoughts and what I've learned along the way. Although I am in fact a labor and delivery RN, This is not medical advice. You should always seek and follow the advice of your care provider.
The main sign that it's real labor
Labor is defined as cervical change due to dilation and effacement of the cervix. Cervical dilation is a result of regular uterine contractions. So in all reality, the only way you can know that it's real labor is to have a vaginal exam or if the baby comes out, but let's avoid that one until you are where you want to be. It pays to know a labor nurse who is willing to come over. (Remind me to tell you about the time that backfired on me, and I delivered my friends' son at home)
If someone calls me in triage and asks me if I think they are in labor, I usually think to myself NOPE. However, after assuring myself that you have no strange high risk or critical reasons to be seen immediately, I would then ask a series of questions.
- What is your due date?
- When did your contractions begin?
- How long do they last?
- How far apart are your contractions?
I started assessing you from the start of our conversation. I've listened to your breathing patterns and noted the presence of or lack of pauses in our conversation and noticed if you “seemed” to have had a contraction at some point in our call. If we've been on the phone for six minutes and you tell me that your contractions are 2-3 minutes apart, then you should have had at least one contraction during our call. If you didn't skip a beat at any point in our convo, then I think it's probably not time to come in yet
Related post: 6 Signs of Labor according to a labor nurse
Real labor contractions:
REAL LABOR INVOLVES REGULAR CONTRACTIONS THAT INCREASE IN INTENSITY & FREQUENCY. THEY GET CLOSER, LONGER, AND STRONGER.
So let's talk about regular contractions which are a part of real labor. If you are having contractions that will lead to delivery, they won't ease up. Labor usually starts as mild cramping, and your stomach tightens periodically, hence contractions. The pain felt during real labor contractions can be painful on the top of your thighs, lower back, and lower abdomen. As time progresses, the cramping becomes more recognizable and more regular. You may go from 20-25 min apart and each contractions lasting 30-40 seconds, down to 10 minutes apart lasting 40-50 sec. Getting more and more regular, more prolonged, and increasingly more painful.
Quick note:
A contraction length: Duration is timed from the start to finish of one contraction.
Frequency: Start of one contraction to the start of the next to measure how far apart they are.
This process of contractions getting more regular and more intense can take a reasonable amount of time, especially if this is baby number one. However, they get more and more difficult to bear. Nothing short of an act of God will stop them. If you are having contractions that are causing discomfort yet irregular, they most likely aren't the real thing, or they are in the early stages of real labor. If Tylenol relieves the pain, then you have more days of waddling around pregnant.
Take a warm shower
If it's real labor, this won't do squat except maybe increase the contractions.
Activity will not slow down the progression or stop the real deal. ( Keep in mind: Activity during labor is good for pain “relief”)
False labor is unpredictable.
You may have 30 minutes of 7 minutes apart, then an hour of nothing, followed by every 6-10 min apart. The contractions also sort of stay the same level of intensity with a few more painful ones thrown in, which is entirely different from the increasing strength of real labor.
Personality and Behavioral Changes Occur with Real Labor
One thing labor nurses have seen time and time again is a personality change in patients who are genuinely in real labor (AKA intense pain). I note this upon entering the labor room when I come to check on you. In between early labor contractions you might be laughing and joking with your friends. If you can talk and concentrate during a conversation, then you're staying preggo for a while. I always love a sweet mama who comes in for labor induction or in early labor doting on her man. This is the early stage labor personality. Things are gonna go south after this stage. I always warn husbands/friends not to get their feelings hurt by what happens in the labor room. I also give her permission to forgive herself if she feels like injuring us. What happens in the labor room stays in the labor room. I've seen the most gentle and sweet patient turn exorcist worthy.
Pain is a game-changer. Having a human exit the vagina is a world events changer. I would love to see a man push a walnut out of his penis and keep being polite. (You have to have a pain management plan, epidural or not!, check out my purposeful positioning course- it covers everything from getting the baby into a proper birth position to pain management and coping!) Use LABORQUEEN40 for 40% off.
Listen, if you come into triage laughing and texting, we most likely decide before you change into a hospital gown that you will be discharged soon. When it's real labor and time to be admitted, you stop giving a darn about whether Aunt Nancy knows you're at the hospital or if your husband fed the cat.
In the progressing stages of labor (which means go to the hospital, unless you planned home birth) you will most likely become annoyed by others in between your contractions. For example, My girls were in the labor room for my last birth.
They were hanging out and laughing. I knew it was game time because gradually they and everyone else in the room got on my last nerve. In my case, it would have been too late to go to the hospital. I had Greyson about twenty minutes later.
Real Labor Takes Real Focus
When you are officially in real labor, you will become focused and withdrawn. It's an intense event between you and this little being inside you. You both have roles to play. Having a baby is an incredibly intense experience. If you are planning to have a natural birth, it demands focus and mind control.
Most women in active labor stop caring about the happenings around them and start to shut their eyes and ignore conversations. They may even fall asleep in between contractions. I've seen this happen even when the contractions are 60 seconds apart. It's a blessing.
Being able to watch a movie, read a book or play a card game suggests that
Unusual Labor Examples:
My Friend
Remember earlier I said to remind me to tell you about my friend? I say most women, because my friend whom I delivered at home, likes to laugh and joke until the moment she moans a little bit and then pushes her baby out. (You know who you are) I “accidentally” delivered two of her last babies because of this. One at her house, where she took a major detour from our plan, in which I would be her “doula” at home until it was time to leave for the hospital. The second go-around, because of the previous birth, I agreed I would meet her at the hospital. Which we did according to plan, however, her nurse was new to labor and delivery. Based on the assumption that I was a “doula” and she didn't need to heed my warnings, I caught that baby as well.
My patient
I recently triaged a young girl who came strutting in looking like a supermodel and smiling. She did stop on occasion to take a deep breath throughout her contractions and close her eyes. I thought maybe she was having strong Braxton Hicks contractions. However, I was shocked that she was in fact, 9 cm with a bulging bag of water. AKA her amniotic sac was exploding like a water balloon out of her cervix and ready to pop, and my assumption was wrong. She was in fact in real labor, so keep in mind there are always exceptions to the rule.
If your contractions are less than 4 minutes apart and lasting LONGER than a minute, for at least two consistent hours then head into the hospital (FTM). Remember if you go into the hospital too soon, we will most likely intervene to speed it up, and you don't want that.
Real Labor usually includes:
- Contractions that get longer and stronger indicate real labor.
- There is nothing you can do can decrease or stop real labor contractions.
- You will feel increasingly more moody, aggravated and your demeanor will change.
- You will become a bit introverted and need a deeper concentration to cope with real labor.
I also suggest reading these related posts:
Be prepared for postpartum with this insanely clever postpartum essentials kit.
Labor is predictable for the most part. However, there is always one of you who throws all the rules out the door and does it totally unique. Trust your inner voice if you think it might be real labor and defer to your provider's recommendations on when to head to the hospital.
Keep in mind, the earlier you get to the hospital, the more interventions we will do. I know I've said it twice, but sorry, it's true!
As always, EDUCATE YOURSELF (like a birth class at your hospital or online from the comfort of your home) and KNOW YOUR RIGHTS!
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