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I had a patient a while back who was caught by surprise when I suggested her labor might last a couple of days before she had her baby. "But why? I'm in labor now, aren't I?" She was contracting but not "in labor." She was uncomfortable but not "in labor." "What's the difference?" she asked. The difference is in the intensity and effect of contractions. Though my patient was pretty convinced the regular, cramps she was feeling was labor, it wasn't until the next day that she knew what I really meant by "in labor."
My husband and I practically wore out the stopwatch, timing contractions all night long with our first baby. Though mildly uncomfortable, our time would have been much better spent sleeping than timing. After a couple of nights of this, I went to my doctor's appointment and discovered my cervix hadn't budged from the previous week's exam—one centimeter. My doctor told me to call him when the contractions "changed." I asked, "How will I know?" "Oh, you'll know. You'll just KNOW." He replied with only a speck of smugness. Oh silly me, I thought all that early stuff was labor. Nuh-un. Not even close. The next night the contractions kicked in but good. He was right, I Knew. Still, that baby didn't come for another day—for a total of 30 hours "in labor."
In Labor means the contractions are causing cervical change in effacement, station and, last but not least, dilation. Prodromal or Pre-Labor means all the contractions that get you ready for Early Labor. This can go on for days. Don't start adding them to your total "labor count" though. No fair. You're not in labor until you're actually "in labor." Some women'll say, "I was in labor for a week," when no, actually, they were in prodromal labor for 6 days and "in labor" for one. Early labor is all the work that gets you to 4 centimeters. For most of us, it's really hard work. It's hard to believe that it's going to get harder for the next 6 centimeters —what we call Active Labor. Some lucky women get to 4 centimeters without even noticing. They can walk around at 4 centimeters for weeks and not be in labor. That's pretty uncommon for first time moms. Most first timers have to work for every centimeter they get.
So what do all those contractions do that aren't causing cervical change? They're getting the cervix and baby ready for the big show. They're flexing the muscles, softening the cervical tissues and positioning the baby. It's important work and underappreciated since it doesn't get all the attention that dilation does. Dilation is the star of the show but the show won't go on without all the preliminary work. Don't underestimate the importance of preparation. Otherwise, it's going to be a lousy show.
A recent patient came in for an induction because her baby was very late and her blood pressure was very high. Her cervix, however, wasn't sticking to the game plan and when told it might be a couple of days before she had her baby, she blinked. We explained that since her cervix was firm, long and not ready for labor, we'd use a cervical ripener overnight. This comes in the form of a pill, gel or tiny tampon-like applicator filled with a hormone similar to those naturally secreted in prodromal and early labor. Then we'd use pitocin for a day; turn it off in the evening and repeat the cervical ripener overnight. The next day (day two), we'd use pitocin again and she should expect to have her baby that evening. Sure, enough, she delivered right on schedule, two days after she first came in for induction.
Please don't take that to mean that cervical ripening medications are a better option than letting nature take its course. Mother nature's original game plan is usually your best bet. Even if she takes her time about it. Sure, prodromal labor can be annoying and time consuming but that's just the way it is. Cervical ripening medications are a good tool when labor needs to be induced but aren't a short cut that's appropriate for everyone. They do, however, sometimes mean the difference between an induction that leads to a vaginal birth versus one that leads to a cesarean delivery.
For those of you with stopwatch in hand, wondering if you're "in labor"—when you're really "in labor," you won't be wondering. You'll know.
Got a question for Jeanne? E-mail it to firstname.lastname@example.org and it may be answered in a future blog post.
This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.