When Labor Starts

I sometimes ponder that we can travel to the moon, but we don't know what actually triggers a typical childbirth. What is believed today is that it is a kind of interaction between the fetus and the woman, with signals between them that we are currently unaware of. How childbirth starts varies from woman to woman, but also whether it is the first time giving birth or if one has done it before. No childbirth is the same as another, that can be confidently stated.

When is it for real? How do you know labor starts?

I often get asked by women I meet in my work in the delivery ward how to know if they are in active labor. When do you know when to call? When do you know it's time? Most women experience more or less contractions, especially during the later stages of pregnancy. Sometimes they are painful, sometimes not. Many find them uncomfortable and distressing. So how do you know if it's the real deal?

How do you know when it's time?

I often jokingly say that "you'll notice it." It sounds simple, but it's not always that easy. Not even for me with 35 years of experience in the field. I have met and examined a woman several times, told her it's a false alarm, and sent her home. Then she returns to the clinic in active labor within an hour. It can be a bit embarrassing, you might think. I have also experienced the opposite. Examined a woman and told her she is in labor, time passes, and nothing happens. Embarrassing again!

Braxton Hicks contractions

The "real contractions" usually become more painful and occur regularly over time. Many also find that they change in character. A "real contraction" spreads across the uterus and exerts pressure downwards (which is how the uterus, with its strength, helps the fetus find its way out through the pelvis). The contractions during pregnancy are called "Braxton Hicks contractions." These are a kind of "practice contractions." As you know, the uterus is a smooth, involuntary muscle. It prepares itself before the actual labor begins. "Braxton Hicks contractions" often occur during physical exertion or when the fetus moves. The classic pattern is that they subside with rest. They are also usually similar and do not become more intense.

False alarm

I often meet pregnant women who say, "I have so many Braxton Hicks contractions that this baby will come early." I also meet women who do not have a single contraction before labor starts for real. As you understand, we cannot predict the start of delivery. Some start earlier, some go overdue. Again, we cannot interpret the signals that initiate labor. However, one may have a sense that each woman has her own pattern. If one gives birth prematurely once, it often happens again. If one goes overdue, it often happens the next time as well. It's not always the case, but very often.

Labor-inducing drink

I get so sad when I occasionally hear about this mischief. Influencers recommend pregnant women to drink some kind of concoction to induce labor. Because ideally, they don't want to go overdue and they want to "be in control." But please! Labor doesn't start just because the pregnancy hasn't fully matured yet! That's the harsh truth.

Please, please!! Think twice before you start mixing and drinking this. Consuming castor oil in large amounts is dangerous!

If you read the information provided by the Medical Products Agency, it states the following: "The company does not participate in the Medical Products Agency, therefore there is only limited information about the medicine." Seriously! Recommending pregnant women to drink a potent medicine that lacks proper description. It's dangerous! Castor oil can stimulate labor (which I assume is the intention of the drink).

I have had several cases where women attempted to drink this. In a couple of these cases, it ended really badly, with an emergency cesarean section and fetal oxygen deprivation. This is because the contractions simply become too intense. Not to mention how pleasant it is to be stuck on the toilet with diarrhea during a significant part of your labor.

I know that some (most of them unfortunately lacking medical knowledge) recommend this. For most, it may work fine (except for the diarrhea...). But the problem is that you don't know in advance how it will work for you. So please, don't mess with it!

Latent phase

Labor is often divided into four phases: the latent phase, the active phase, the pushing phase, and the placental phase. In this post, we will go through the latent phase; in the upcoming posts, we will cover the other phases.

The latent phase is the first phase of labor and a sign that labor is starting. During this phase, contractions are often more or less painful and irregular. It's important not to forget the significance of the latent phase. It's when the cervix softens, and the uterus and cervix prepare for the more active opening phase. The cervix moves more forward, and the cervical opening begins.

The latent phase can be challenging for many. It can last for hours, sometimes even days. Most women are at home during this period, although they often have contact with the delivery ward and a midwife via phone. It is normal to have a latent phase lasting up to 20 hours for first-time mothers and shorter for women who have given birth before.

The important thing during the latent phase is to feel safe and have an opportunity to rest and nourish yourself. It is also advisable to start focusing on breathing and relaxation from this point. If your partner is nearby, you can start working together. A warm bath or shower can also feel good during this period. If you are scared and worried, you should ask to come to the delivery ward for a check-up. If everything is fine with you and the baby, you may have to prepare to go home again for a while.

During the latent phase, the body releases endorphins, which are the body's own morphine, as well as oxytocin, which makes you feel more relaxed and perhaps even sleepy between contractions. This amazing "feel-good hormone."

The mucus plug

For many women, the mucus plug is released during the latent phase. The mucus plug is usually not an actual "plug." It is a collection of mucus that serves as protection in the cervix during pregnancy. When contractions start, this mucus simply comes out.

To be continued in the next post.

Best regards,

Doctor Eva