Pregnancy is an exciting time for parents to be. It is also a time of the unknown and unexpected. From the time a woman first learns she is pregnant, the delivery of her child is on her mind.

Many questions arise. When is the baby coming? How big will the baby be? Will I have a vaginal delivery or need a cesarean section? Is the baby a boy or a girl? So many unknown variables can be a cause for definite anxiety. With advancements in medical technology, specifically ultrasound, we are able to tell women within a few weeks when the baby will arrive. However, we are not able to tell women how labor will happen. This makes women very nervous as the due date approaches.

By learning about some of the processes of normal labor and delivery, women may be able to gain more insight into what is happening to their bodies.

A normal pregnancy is generally an average of 40 menstrual weeks long. This is often confusing because a positive pregnancy test will typically not appear until she is at least four menstrual weeks pregnant.

We begin counting the pregnancy duration from the last menstrual period. If the last menstrual period is not known, an ultrasound is used to date the pregnancy and estimate a due date. Pregnancies are considered full term beginning at 37 weeks. Although some pregnancies will last as long as 42 weeks, 40 weeks or the due date is an average pregnancy length.  Some women will deliver before their due date, and some women will deliver after.

A pregnancy is divided into three trimesters. The first trimester is the first 13 weeks of pregnancy. The second trimester ends at around 28 weeks gestation. The last or third trimester is the final 13-14 weeks of pregnancy. One of the hallmarks of the final trimester is a woman’s body preparing for labor and delivery. Pregnant women often notice signs that they are progressing toward labor. Lightening is one of the first signs women may notice as they progress toward labor. This describes when the baby “drops.” This actually means the baby’s head has settled down into the pelvis. Women will often notice it is easier to breath after lightening. Some women will report that their reflux or heartburn symptoms improve after the baby has dropped because there is not as much pressure on the stomach. After lightening, there may be more complaints of pelvic pressure or back pain. This is due to the baby’s head being lower in the pelvis and placing pressure in the vagina. Lightening may occur anywhere from a few weeks to a few hours before labor begins.

An increase in vaginal discharge is frequently reported before labor begins. A thick mucus plug accumulates in the cervix during pregnancy to protect the baby. As the cervix begins to dilate, the mucus plug is pushed out. This may be seen as a thick discharge that may have some blood mixed in it. This can occur several days prior or during labor. Some women may not even notice that the “mucus plug” has been expelled.

During the third trimester, and often before this, women may experience contractions. The uterus is a very powerful muscle designed to contract to push out the baby. The uterus may contract without labor happening. This is often called Braxton Hicks contractions or “practice contractions.” Braxton Hicks contractions are usually much milder than labor contractions. They can be painful but usually do not progress or become regular. Braxton Hicks contractions will often change if you rest or change position. For example, some women notice when they are up moving around, they have more contractions but after sitting the contractions seem to lessen.

Women will often ask what contractions feel like. This is different for every patient. Most women describe contractions as a menstrual like cramp that causes their abdomen to become hard. Contractions can feel as if they are starting in the back and come around to the abdomen or can be more localized to the front of the pelvic area.

A daunting task is differentiating labor contractions and Braxton Hicks contractions.

Labor contractions will increase in intensity. Each contraction usually lasts about 30 to 70 seconds.

One way to tell if the contractions are Braxton Hicks or labor is to time the contractions. To time contractions, you should time from the start of one contraction to the start of the next contraction. Writing down the times of the contractions is a helpful way to keep track of timing. If the contractions are about five minutes apart for an hour, it may be time to be evaluated at the hospital.

Labor is divided into different stages. The first stage of labor is when the cervix begins to dilate. This is called stage 1 of labor. It is further divided into early and active labor. Contractions begin in early labor. Early labor is very un-predictable. For first-time mothers, it can last up to 12 hours. Active labor begins when the cervix is 5 centimeters and contractions are regular.

Some women will choose to stay at home for early labor. Others prefer to be in a hospital setting for this portion of labor. If you choose to stay at home for early labor, you can lessen the discomfort by taking a warm shower or bath, drinking fluids, applying heat to your lower back and practicing breathing techniques during contractions.

Once the contractions become painful enough that you feel that you need pain relief, you should present to labor and delivery. Once your cervical dilation has been assessed, you will be advised about what options you have for pain relief.

Every labor and delivery is unique. No matter how many children a woman may have, she will likely have a different experience each pregnancy. As your pregnancy progresses, learn as much as you can about normal labor and delivery. Ask your health-care professional if you have questions. Understanding the normal sequence of events will help to ease some of your anxiety about delivery. Knowing what to expect will also help you to know when it is the appropriate time to go to the hospital.

 

Jennifer Calfee, MD, is an obstetrician and gynecologist at Vidant Women’s Care-Washington.