What should I do when labor starts?
We’ve seen the story countless times, water breaking and cut to dramatic race to the hospital, immediately followed by pushing baby out in a matter of minutes. While this scene is dramatic, tv and movies have warped our image of what labor and birth looks like. If you think labor is starting the best thing to do is ignore it! Read more to learn why.
How long is labor really?
Labor has three stages but often when we are thinking about labor we are thinking of the first stage. This is everything that comes before pushing. This stage of labor is divided into three phases, early labor, active labor, and transition. Early labor alone lasts between 12 to 24 hours. Beyond 24 hours is also a variation of normal. Ignoring the early signs of labor allows you to rest and conserve your strength and stamina for when you’ll need it. Active labor lasts between 4-8 hours while transition is 15 minutes to 1 hour. Pushing for a first timer often takes about 2 hours but for some it can be four hours.
What is early labor?
Early labor is defined by 0-5 cm of dilation. This is the very beginning of labor. During this phase it’s likely you will feel like your normal social self. You will be happy to have conversations and be out and about in the world. Contractions are mild, similar to period cramps and last about 30-45 seconds. They occur every 20-30 minutes.
What should I do in early labor?
Staying hydrated helps to avoid dehydration cramps on top of contractions
Eat nourishing foods
REST! If it’s night time, go to sleep. If it’s during the day, have a nap. It’s not the intensity that makes rest difficult, it’s the excitement.
Distract yourself. Engage in enjoyable activities that will take your mind off of labor. Go for a walk, a massage, or prenatal yoga class. Take a bath or binge watch your favorite series.
Contact your support team. Let your childcare, dog walker, doula, etc know that you believe things may be starting and you anticipate needing their support in the next 12-24 hours.
What should I avoid in early labor?
DO NOT start timing contractions. This will make labor feel longer and likely lead to exhaustion
DO NOT tell all your friends and family you’re in labor. Labor can last a long time and getting inundated with texts and calls asking for updates makes distraction difficult. Save this step for active labor.
DO NOT start utilizing the physical comfort measures you learned. Save these for when you cannot cope through a contraction without them.
What should my birth partner do during early labor?
Rest, eat, and hydrate. You’ll find it easier to support if your own basic needs are met
Refill the water bottle. If your pregnant person hasn’t been drinking water, offer to get them a glass of water with lemon, cucumber, or a cup of tea
Prepare the car. Check that you have enough gas and the hospital bags are in the car. Ensure the car seat is installed. Lean the passenger side seat all the way back, place a towel on the seat, and have a plastic bag in case your pregnant person gets sick.
When do I go to the hospital?
It’s normal for more people to feel a shift in intensity around 4 cm of dilation. This is still early labor. This is when you’ll need all those comfort measures you’ve been practicing. Now is when you begin timing a few contractions. Time 6 contractions or time them for an hour to identify how frequently they are happening and how long each contraction lasts. To avoid unnecessary interventions, especially if you’re hoping for an unmedicated birth, it’s best to labor at home as long as possible. This means waiting until active labor begins - marked by 6 cm of dilation. Most often this looks like contractions coming every 3-5 minutes, lasting for a FULL minute, and they’ve been at this pattern for a FULL hour. Some people will use the 4-1-1 rule to remember this. If when you’ve timed a few contractions you’re still far from 4-1-1 put your phone away and wait until either you or your partner notice a change. This change can look like contractions are more intense, longer, or more frequent. You may also notice you have stopped engaging in conversation. You are focusing all your attention - including the time in between contractions - on labor. This is sometimes referred to as entering into “labor land”.
What if my water breaks?
If your water breaks before contractions start, this is referred to as prelabor rupture of membranes or PROM. This occurs in about 8% of term pregnancies ( 37 weeks or later). Always remember your COAT. This means you ought to take note of the Color, Odor, Amount, Time & Temperature. What comes next will depend on a few factors.
ACOG recommends induction if you aren’t having contractions after your water breaks. However they also state, “Nearly 80% and 95% of patients start labor spontaneously within 12 hours and 24 hours respectively, a period of 12–24 hours of expectant management is reasonable as long as the clinical and fetal conditions are reassuring, and the patient is adequately counseled regarding the risks of prolonged PROM and the limitations of available data.” This means waiting to induce. Expectant management is only deemed reasonable if you are GBS negative. You can also read more at Evidence Based Birth. If you are hoping to avoid induction, I highly recommend having a conversation with your provider during your pregnancy to determine a course of action in the event your water breaks and contractions have not yet started.
Remember that for your OB or midwife to provide evidence based care they must use research evidence, their own knowledge gained from clinical experience, AND take into consideration your values and preferences. You are a member of your care team and your voice matters. You always have the right to decline a recommendation. If you’re feeling unsure about your preferences or how to advocate for yourself during your pregnancy, birth, and postpartum, taking a childbirth education class and hiring a doula can help.
