Expert: Catherine Beier MS CBE - 12/29/2011

Question
After both speaking with my doctor, two nurses at her office, and the care team at the Labor/Delivery triage center, I am VERY confused about what I should consider the signs of TRUE labor and when to go into the hospital now. This is my third pregnancy, but was induced the first time and second time was having slight contractions for days that stressed the baby - her heart rate dropped and took too long to recover after every contraction - so my water was manually broken after an ambulance ride to the hospital from the Dr's office (gave birth less than 8 hours later with no pitocin or other drugs. I am currently 38 weeks 3 days.

Two nights ago, I had contractions that started to be every 7 minutes, then moved over 2 hours to every 3 minutes. They were not painful other than some twinges at the height of the contraction. I went in to the hospital, found the contractions to be every 2.5 minutes and 2cm dialated. Two hours later, absolutely no changes and I was sent home. Contractions did not increase in strength or time, nor any progress with dialation. Through the night and most of the next day, contractions stayed 3-5 minutes apart. Today, they have been more random but occasionally regular and only slightly more intense.

Now for the question. I've been told when the contractions are regular for an hour and 5 minutes apart to come in. I've been told don't come in until I can't talk through a contraction or walk through it. I've been told to be on bed rest, and I've been told to walk around to encourage my cervix to open. Dr says semi-bed rest (feet up at least 3/4 of the day), and to come in at the 5 minutes OR not being able to talk/walk through a contraction. Everyone of course also says to go in if my water breaks.

With ALL the different advice I'm getting, I don't know WHAT to do. I'm having regular contractions NOW every 6 minutes, and *slightly* worse than when I went in to L/D. I know I may give birth before I have an answer, but what do YOU suggest in this sort of case - when your body is giving such mixed signals. I can't ask my parents to come get my daughter every couple nights and my husband to stay up half the night and still work the next day when I don't know what's really happening. I also worry that my son is stressed by the contractions the way my daughter was, and thus maybe I should be induced just to make sure since I'm obviously contracting a LOT. I didn't WANT to have this happen, but I'm getting sick of everything (which is normal, I know) and don't want to worry about the baby's heart rate dropping like last time.

Should I have the doctor (in the hospital) break my water to prevent the stress on the baby the way that happened before? Should I continue to have these VERY common contractions and wait another 2 weeks just to see what happens? The doctor is checking my cervix tomorrow, and I will ask her what her opinion is as well - which is the opinion that will count anyways. Just wondering what yours is too. Thank you!

Answer
Hello Krystie,

Your body isn't giving you any mixed signals. You are exhibiting classic symptoms of prodromal labor (http://www.givingbirthnaturally.com/prodromal-labor.html) in which your body is preparing for true labor.  While your contractions are not putting you in actual labor at this time, they are helping your cervix to move anteriorly, to help get the baby in the optimal position for birth, and helping to soften and dilate your cervix.

While this can be frustrating and make it difficult to determine when "true" labor has begun, it is actually a welcome sign that your body is nearing labor and is getting much of the work done beforehand, meaning that once labor arrives, it is more likely to go swiftly and smoothly for you both.

Baring any other concerns with your pregnancy, prodromal labor alone should not be a cause for concern regarding stress to your baby.  Breaking your water is more likely to stress the baby as if your body was truly ready for active labor, it would be happening now.  While a woman's body can be forced into labor by artificial means, the least stressful method for the baby is to allow labor to begin on its own.

My best advice would be to accept that this is a natural, normal prelabor process that is helping to bring your baby to you in the safest, gentlest way possible.  Unless other concerns become present, I would wait for labor to begin on its own as induction doubles the risk of unnecessary cesarean section and also doubles the risk of your baby developing respiratory distress at birth.

Rest assured that you will know when true labor has arrived by the intensity of your contractions at that point.  The time between them may not be a critical factor in whether true labor has begun.  When to go to the hospital really depends upon the time it will take you to get your parents to your house to watch your other children and to then get to the hospital.  

The best rule of thumb would be that even if your contractions are 5 minutes or less apart lasting 60-90 seconds for over an hour, but you can still easily talk through them without a problem, then there's probably no need to rush to the hospital.  If you cannot talk through them, even if they're 10 minutes apart, then you should get packing.