With your due date just days away, it can be tempting to make a mad dash for the delivery room the moment you feel contractions kick in, but—as ready as you are to meet your babe—knowing when to head to the hospital can save you a lot of frustration.
According to Nannette Jenkins, CNM, RN, a midwife with Riverside Midwifery in Shepherdstown, West Virginia, and mom of two, it’s important not to come too early “because there is a subconscious ‘pressure’ that often slows down early/ active labor.” Jenkins also adds, “There is an increased incidence of vaginal exams, dehydration and exhaustion—and the need for associated interventions—when women arrive too early to the hospital.”
Knowing what to expect can keep you from showing up too soon only to be sent home again or, worse, not making it in time.
Ready, set …
Labor, which is typically broken down into three phases, can last several hours or even days. The first phase, otherwise known as early, latent or prodromal labor, is the longest. But, mamas-to-be can take comfort in the fact that it’s also the least intense by a long shot.
“There will often be periods of prodromal labor on a daily basis, often at the same time of day or night, for several days or even weeks prior to active labor,” Jenkins says.
During this period, light contractions— sometimes called practice contractions or Braxton Hicks contractions—will help your cervix to dilate (open) and efface (thin out). You might not even notice these mild to moderate cramps at first. Over time, however, they’ll become stronger and more frequent, lasting 3 to 45 seconds and coming every 5 to 20 minutes. Keep in mind: Your body isn’t a stopwatch, so “regular contractions” doesn’t necessarily mean perfectly spaced intervals. They should be fairly consistent, though.
By moving your baby farther down the birth canal, these practice contractions are prepping your body for the real thing. Most women describe the sensation as a dull ache in their back or abdomen, similar to menstrual cramps but far more intense. Others say it feels more akin to extreme gas, like a buildup of pressure that comes and goes. A few expectant moms also experience pain in the upper thighs. However your pain presents itself, try to focus on the end result: your babe in your arms.
Feeling those first contractions will likely come with a rush of excitement (and anxiety) because it means your wee one is on the way, but try to relax as much as possible. You’ve got to save your strength for later—trust us, you’ll need it.
If it’s late, lie down and rest. The more sleep you get now, the better, because you might not be able to snooze once you’ve progressed to active and transitional labor.
If it’s the middle of the day and you’re too energized to nap, tackle some simple tasks to keep busy. Now’s the perfect time to finish the last load of baby’s laundry, double-check your hospital bag or whip up a few more reheat-and-eat meals to add to your freezer stash. Every item you cross off your list is one less thing you have to worry about when you bring your new bundle home—because, let’s face it, you’ll be enamored and in no mood to deal with a full hamper.
“The most important thing I can say is that [moms] need to rest,” notes Jenkins, who suggests warm baths, lavender oil, calming teas and massages to encourage relaxation and sleep—particularly for first-time moms who can expect a long labor. “Expending energy at this time only makes the active labor and pushing more difficult. … It’s exciting, but you have to be in marathon mode!”
Follow the signs
Ideally you want to make it to the hospital right in between early and active labor— the second phase. And don’t worry: There will be plenty of signals to let you know when it’s go time.
- Deep breather. During pregnancy, a mama is prone to experience some shortness of breath, thanks to baby putting pressure on her diaphragm. But when it’s almost time for your little one’s grand entrance, you might get the sensation that you can finally breathe again—a sure sign that your baby has dropped lower into your pelvis to prep for birth.
- That gotta-go feeling. Now that your bambino has settled into your pelvis, he’s likely putting the squeeze on your bladder more than ever before. Extra trips to the bathroom might mean a trip to the hospital soon. “Usually in the 24 to 48 hours before labor starts, there is a period of loose stools as the body ‘cleanses,’” adds Jenkins.
- Take action. For many expectant moms, pregnancy is exhausting—you are making a tiny human in there, after all. But one day you’ll wake up with plenty of energy and the sudden urge to get things done. Whether you’re cleaning or doing last-minute shopping, this nesting instinct could indicate that your body (and your brain) knows a baby is coming soon.
- Unplugged. When your cervix starts to thin, the thick plug of mucus that protected your uterus from bacteria for the past nine months will be released. (It might act like a cork, so to speak, but it won’t look like one. Expect to see thick discharge that’s pink or tinged with blood.) Losing your mucus plug can happen minutes, hours or even days before you’re in active labor, and not all moms-to-be will notice when it passes.
- Water ways. What most call “water breaking” is your amniotic sac rupturing. For some women, it’s a persistent trickle; for others, it’s a dramatic gush. Just make sure it’s not urine, which is possible with your uterus resting on top of your bladder.
Know to go
The surest sign that you are in labor is consistent uterine contractions. When they start, grab a pen and paper (or a handy smartphone app) and record the exact time of each contraction, so you know how long they last and how far apart they are.
Keeping track of your contractions doesn’t require you to obsessively time every single one. You’ll get bored and discouraged because progress takes time, particularly for first pregnancies. In early labor, contractions could be as far apart as 20 or 30 minutes, but they will eventually come at shorter and shorter intervals. Time them periodically, so you’ll
know when the gap between each one starts to shrink.
Most practitioners will ask that you call them when contractions are consistently five minutes apart; however, talk with your health care provider about this beforehand because some, like Jenkins, encourage expectant moms to call earlier and more often, so they can keep tabs on how labor is progressing.
Your practitioner will ask you a few questions to determine whether it’s time to hitch a ride to the hospital or birthing center. (This is when you’ll want that log of contraction times on hand.) Doc’s decision will be different for every mom and depends on a number of factors, such as how far you live from the hospital, your medical history, how your baby is positioned, how dilated your cervix was at your last exam and if you have any high-risk complications, such as preeclampsia or gestational diabetes.
If you’re told to wait it out a little longer, know that your care provider is looking out for your best interest. By delaying your arrival, she could be trying to reduce the amount of time you’ll spend hooked up to monitors and IVs.
If you’re given the go-ahead, a vaginal exam is the only way to know if your cervix has dilated and effaced, so expect to be checked out upon arrival. You’ll likely be admitted if your cervix is open about 4 centimeters. Otherwise, you might be instructed to take a long walk to get things moving or told to hang in there a bit longer.
While you’re laboring the hours away, take heart. Your baby is coming soon, so try to rest up and enjoy the ride. The finish line of your marathon toward motherhood is in sight.