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Anytime you feel it is necessary.
Premature Labor Warnings
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There are two characteristics of a
contraction: frequency and duration.
True labor
- contractions occur at regular
intervals
- intensity increases
- intervals shorten
- discomfort experienced in the lower
back & abdomen
- pain increases, doesn't stop with
walking or medication
- cervix dilates
False labor
- contractions occur at irregular
intervals
- intensity relatively unchanged
- intervals not shortened
- abdominal discomfort
- pain usually relieved with changing
position or medication
- cervix doesn't change
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Frequency (minutes)—is timed
from the start of one contraction to the start of another
contraction. |
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Duration (seconds)—is timed
from the start of one contraction to the end of the same
contraction. |
Premature/Preterm
Labor
Real labor
has three distinct stages. The first stage is the longest.
This is when the narrow passage way to the uterus opens to let
the baby out. For many women this progresses slowly and
smoothly over many hours. The muscles around the top of the
uterus supply the strength behind the baby. This creates a
thrusting action to push the baby out. When the baby passes
through the cervix it is similar to getting a tight sweater on
over your head. This is the transition to the second stage of
labor when the baby travels down the vagina, emerging at the
vaginal opening. You will bear down with each contraction to
contribute to the strength of the uterus. The journey through
the vagina may take up to two hours. When the baby is born,
the third stage of labor begins.
STAGE 1
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Early Phase—this is the longest part
of labor but also the least uncomfortable and lasts 2–9 hours. This
phase begins with the first contraction and ends when the cervix dilates
3–4 centimeters. The contractions usually are irregular, and you may
have a strong contraction followed by a weaker one. You may not know
this is true labor. In fact this phase can be confused with false labor.
You may most certainly be more comfortable at home during this phase. |
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Active Phase—this is the beginning of
true labor. The contractions are regular (3–5 minutes apart), and no
matter what you do they will not stop. The cervix dilates 5–7
centimeters. Most women know they are in labor at this point. Expect
cervical progress of 1 centimeter every hour or two for about 3–6 hours.
Shaking of the extremities and nausea is normal as the body works hard
to dilate the cervix in order for the baby to be born. |
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Transition Phase—this is the most painful stage of labor. Most women consider this
"hard labor". The cervix dilates 8–10
centimeters.
Contractions are 1½–3 minutes apart. The pressure you feel in the
rectum as the baby descends into the vagina can be overwhelming—like
a strong urge to move your bowels. The good news is that this is the shortest
phase of labor, lasting 20 minutes to one hour. |
You may
hear stories about someone who had a one-hour labor. As this
is true, there are also women who have 40-hour labors.
When
contractions first begin, you may question yourself, "Is
this it? Am I really in labor?" It is important for you
to know the difference between true and false labor. To decide
if your contractions mirror true labor, record the time at the
start of one contraction and the start of each following
contraction. If your contractions are spaced evenly and are
occurring closer together, and if walking or changing your
position does not give any relief, you are probably in true
labor. Only true labor will efface and dilate the cervix. True
labor pain increases in intensity; you may lose your appetite
and forget about your personal appearance.
The
difference between true and false labor contractions is that true labor
- contractions
occur closer together,
- contractions
last longer
- contractions
become
increasingly more uncomfortable.
With false labor the contractions
are:
- irregular
with no particular pattern
- there
is no cervical changes
- there
is no descent of the
baby.
There is no harm to the baby, but the contractions may be painful
and prevent you from resting. Many women gain relief from false labor by
walking, rocking in a rocking chair, or your doctor may order a mild
pain medication to help you get some rest.
Length of labor
The time in labor depends on many things:
the size of your baby; the size of your pelvis; the position of your
baby in the uterus; the strength of your contractions; the duration of
your contractions; the intervals between the contractions; and also your
ability to work with labor and not against it. The early phase
of labor is the longest when the cervix is dilating from 1–4 centimeters. This is the most comfortable part of labor, meaning you are
aware of cramping in the lower part of your abdomen and possibly your
lower back. You may also be using the bathroom more often (loose
stools). The active phase of labor is when the cervix dilates from 5–7 centimeters. There is no doubt that you are in labor. The contractions
are regular, meaning you can time them at regular intervals. You will
feel cramping and a consistent pressure in your lower abdomen. The need
to use relaxation and conscience breathing techniques are useful tools
now. The transition phase of labor is the shortest length. Your
contractions become very intense and concentration on your breathing
technique takes every effort on your part and incredible support from
your coach.
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So much emphasis is put on the due date.
Half of all first time mothers go past their due date. Unfortunately,
family and friends often make things worse when they say things like—"How long is that doctor going to let you go"? Or "Can’t
your doctor see your getting so big—that baby needs to come out"!
Remember babies are born within a two-week window of your original due
date. And as long as your baby is moving normally (10 kicks in an hour)
relax and enjoy your pregnancy. It’s easier to care for your baby in
utero than when you take them home. However, if your doctor thinks it is
better for you to have the baby before natural labor begins, an induction
of labor may be recommended.
Induction of labor—your doctor may schedule
an induction of labor at one of your office visits.
Induction procedures are reserved for pregnancies with special medical
needs. After you arrive in the birth unit, your nurse may start an IV
and draw blood to be tested as your doctor has ordered. After the nurse
establishes the first IV, the nurse will "piggy-back" a second
IV that supplies a medication called oxytocin (ox i toe sin). The
Oxytocin IV runs through a small infusion pump (computer) that
calculates the dosage in milliunit amounts that can be controlled
carefully. This amount may be increased or decreased according to your
labor requirements. You may find yourself becoming
tired or uncomfortable in the last weeks of pregnancy or if your family has
arrived and only has one week to visit—these are not medical
indications for induction of labor.
Pre-induction
treatments—the signs of labor that usually occur in the last
month of pregnancy have not happened yet. Your doctor or nurse
may insert a prostaglandin medication into your vagina to
soften and efface the cervix. This medication may cause
contractions like the ones that occur normally in the last
weeks before you go into labor. And with some women, this
medication may put them into labor. The baby may be monitored
via a fetal monitor intermittently or continuously, according
to your doctor’s order.
Amniotomy
(am knee ot a me)—artificial rupture of membranes. The
doctor, midwife or nurse breaks the sac containing the
amniotic fluid that surrounds the baby. They use a sterile
instrument called an amnihook. The amniotic fluid is straw
colored or occasionally may contain meconium (baby's first
bowel movement) that is odorless and green in color. If this
occurs, special attention may be focused on your baby
immediately following birth to prevent meconium from getting
into the lungs. Direct monitoring may be placed by the doctor
or nurse to carefully monitor the baby more closely.
Pelvic
exam—pelvic, cervical or vaginal exams reveal the condition
and changes of the cervix and fetal head. The average exam is
done every two hours. However, the need for exams varies from
mother to mother. No one likes to endure this procedure, but
the exam may proceed easier if you use conscience relaxation
and breathing techniques. Most women want to know their
progress.
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The fetal
monitor is a diagnostic instrument used to assess the well
being of the fetus—just as the doctor or nurse uses a
thermometer, stethoscope or blood pressure cuff to assess your
vital signs. You may see two numbers on the monitor screen:
the baby’s heart rate and the uterine activity. Your doctor
and nurse have special training in the use of fetal
monitoring. Remember this is a machine; let the hospital staff
worry about the monitoring activity, and you can concentrate
on yourself.
Two common ways to monitor the baby in
utero.
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Indirect
or external uterine monitoring—two gadget are placed
externally on your abdomen and held in place by soft
elastic belts. One of the gadgets is a sensor that gives
information on the fetal heart rate and the other gadget
records the uterine activity (frequency and duration of
the contraction not the strength of the contraction). The
fetal heart rate ranges between 120–160 beats per
minute. The numbers on the monitor may vary greatly, and
at times the sensor may have a difficult time tracing the
baby if you change your position or if the baby moves away
from the sensor. This is normal and should be expected.
The nurse may adjust the belts and sensor devices for you.
Sometimes it looks frightening when the numbers disappear
on the machine! |
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Direct
or internal uterine monitoring—the amniotic sac
surrounding the baby has to be broke before direct monitoring can be
used. Your doctor or nurse may attach the tiniest of filament directly
to your baby to record the heart rate. This may be important if external
monitoring is not tracing the baby’s heart rate consistently. In order
to monitor the uterine activity and strength of the contractions more
closely, the doctor or nurse inserts another small soft catheter (cord)
into the uterus around your baby—similar to the way you would
measure tire pressure with a gauge. Both procedures are performed during
a pelvic exam. |
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