How Do I Know if I’m Really in Labor?

When I’m on call, I frequently get phone calls from patients concerning whether or not they are in labor. The two most frequent scenarios are:

A. “My contractions have been every 5 minutes for an hour, so I think this is it. Should I come to the hospital?” says the patient quite calmly.

“Which baby is this for you and how far dilated were you at your last visit?” I inquire.

“First baby,” patient says giggling. “I was only 1 cm, but I’m just so excited. All the books say to come in when your contractions are 5 minutes apart!”

“Are you having any pain?” I ask, a little skeptical.

“Oh, I definitely felt some ‘twinges’ with that last one,” she says with more giggling.

“Why don’t we give it a little longer. Wait until they really hurt, then check back with me,” I say {she can’t see the grin on my face}.

B. “Doctor, I think I’m in labor, but I’m not…… huff, huff, pant… sure…..if I should come in yet,” patient asks in obvious distress.

“How far apart are your contractions?” I inquire.

“They are…. just a second….” I hear phone being put down.

{Insert blood curdling shrieks and moans for the next 60 seconds.}

“…. about 6 minutes apart.”

“Yes, please come in right away!” I reply.

I don’t fault these women for not knowing exactly what is going on in their body. A woman’s first labor is a totally new experience. She can’t possibly know fully what to expect.

TV has also given everyone a warped view of the labor process. There are the cheesy sitcoms, where women have one contraction and then nearly have the baby in the car. On the other hand you have “A Baby Story” where they nicely edit an entire pregnancy and delivery into one half hour show*. Real life is not quite so predictable and usually not so fast.

Latent or early labor refers to the time from when contractions first start until you reach 5 centimeters of dilation. For the first time mom, this time period can be upwards of 24 hours with the average being about 12. Also, many moms will have false starts where their labor will kick in and then putter out over a few hours. After 5 centimeters, active labor thankfully kicks in and dilation happens at closer to 1-2 centimeters per hour.

A good rule of thumb for first time moms is that you should come to the hospital when your contractions are every 5 minutes for a hour and so uncomfortable that you can’t talk through them. When you time your contractions, start from the beginning of one contraction until the beginning of the next.

Women often get concerned about WHERE IN THEIR BELLY they should feel contractions. Are real contractions in the back? Pelvis? Everywhere? In active labor, contractions are usually felt as a total abdominal tightening pain that then causes a severe pressure into the pelvis. Real labor contractions CAN be felt anywhere in the abdomen, though more important than where is the intensity in which they are felt. Labor pain has often been described to me as ‘knife like stabbing pains in your vaginal area’ {often there are also expletives in this description…but I will leave those out}.

“But my cousin knows this girl who knows this other girl whose ex-roomate’s best friend didn’t even know she was in labor and she had her baby in the car on the way to the hospital!” you might say.

Ah yes. Everyone’s biggest fear. While crazy things like that DO happen on occasion, in my 11 years of delivering babies it has never happened with a first time mom.**

Now with additional babies, the rules change. By the time you have your sixth, we usually tell you to come to the hospital if you sneeze. I have had few patients deliver en route with third and fourth babies.

When you reach 35 weeks, usually your doctor will begin examining your cervix at each visit. She will use your dilation, combined with which baby it is for you and how far from the hospital you live to determine how soon you should come to the hospital.

And when in doubt, just call.

*Doctors hate it when you say “This isn’t how they do it on ‘The Baby Story’.”

** Full disclosure: While I’ve never had a patient give birth to her first baby in a car, it did happen to a relative of mine. But it’s really rare, so don’t sweat it.