The question “How do I know that I am in labor?” can be answered as follows: There are usually two mechanisms that indicate signs of early labor, a bloody show and uterine contractions (labor pains).
1. A bloody show is a passing of the mucous plug from the cervical canal followed by “rupture of the membranes“. When a bloody show occurs, labor often starts within 72 hours. However, sometimes nothing further happens and the woman gets nervous that there is no labor and no leaking amniotic fluid. This is normal.
When the water breaks
When the “water breaks” (the amniotic membrane ruptures), it is time to go to the hospital. The rule of thumb is that the baby has to be delivered within 24 hours to prevent a serious infection in the baby or the mother.
If labor does not start on its own, it may have to be induced by an oxytocin drip, which is a hospital procedure.
All this means is that the cervical canal is getting ready for delivery and this happens often in a multigravida (=women with multiple children). In these women or rarely also in a primigravida (=woman getting her first child) there is a sudden leaking amniotic fluid, which has the smell resembling fresh cut uncooked potatoes. There is litmus indicator paper available that turns a pink color into a blue color when amniotic fluid is present.
This needs to be taken seriously: as a rule of thumb the baby should be delivered within 24 hours from passing this initial amniotic fluid. In most women labor pains are coming spontaneously within a few hours and the baby is born within the next 12 to 14 hours. However, if this does not happen there is the danger of an ascending infection as the protective barrier of the amniotic membrane is missing and vaginal bacteria can multiply inside the amniotic cavity and infect the unborn baby.
2. The other mechanism of getting into labor is to get uterine contractions (labor pains). Initially these contractions of the uterine wall may be perceived as stomach pains or abdominal cramps. But by the fact that they are rhythmical, initially perhaps every 15 to 20 minutes, but then shorter and shorter apart (3 to 7 minutes), the pregnant woman will know that she is in labor.
Occasionally there is false labor. This is recognized by its lack of result after 1 or 2 hours of false labor pains. Internal examination by the health professional will show that there was no cervix opening and the labor pains stop. If the amniotic membrane is still intact and the fetal heart rate is O.K., the best is to let the woman sleep to allow her to regain strength for the time when the real labor pains will start.
1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 235.
2. B. Sears: “Zone perfect meals in minutes”. Regan Books, Harper Collins, 1997.
3. Ryan: Kistner’s Gynecology & Women’s Health, 7th ed.,1999 Mosby, Inc.
4. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 245.
5. AB Diekman et al. Am J Reprod Immunol 2000 Mar; 43(3): 134-143.
6. V Damianova et al. Akush Ginekol (Sofia) 1999; 38(2): 31-33.
7. Townsend: Sabiston Textbook of Surgery,16th ed.,2001, W. B. Saunders Company
8. Cotran: Robbins Pathologic Basis of Disease, 6th ed., 1999 W. B. Saunders Company
9. Rakel: Conn’s Current Therapy 2001, 53rd ed., W. B. Saunders Co.
10. Ruddy: Kelley’s Textbook of Rheumatology, 6th ed.,2001 W. B. Saunders Company
11. EC Janowsky et al. N Engl J Med Mar-2000; 342(11): 781-790.
12. Wilson: Williams Textbook of Endocrinology, 9th ed.,1998 W. B. Saunders Company
13. KS Pena et al. Am Fam Physician 2001; 63(9): 1763-1770.
14. LM Apantaku Am Fam Physician Aug 2000; 62(3): 596-602.
15. Noble: Textbook of Primary Care Medicine, 3rd ed., 2001 Mosby, Inc.
16. Goroll: Primary Care Medicine, 4th ed.,2000 Lippincott Williams & Wilkins
17. St. Paul’s Hosp. Contin. Educ. Conf. Nov. 2001,Vancouver/BC
18. Gabbe: Obstetrics – Normal and Problem Pregnancies, 3rd ed., 1996 Churchill Livingstone, Inc.
19. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 251.
20. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 250.
21. Ignaz P Semmelweiss: “Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers” (“Etiology, the Understanding and Prophylaxis of Childbed Fever”). Vienna (Austria), 1861.
22. Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th ed., 1998 Mosby-Year Book, Inc.
23. Mandell: Principles and Practice of Infectious Diseases, 5th ed., 2000 Churchill Livingstone, Inc.
24. Horner NK et al. J Am Diet Assoc Nov-2000; 100(11): 1368-1380.
25. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
26. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier