Published - July 01, 2024
The end of pregnancy is a stage full of expectations and anxiety for many future mothers. One of the most confusing parts can be identifying the prodromes of labor and knowing when is the right time to go to the clinic.
In this blog, as a doctor specializing in obstetrics, I want to offer a clear and understandable guide on these first signs of delivery, provide recommendations on when to seek medical attention, and explain the phases of labor.
What are Childbirth Prodromes?
The prodrome of labor They are the initial signs that indicate that the body is preparing for labor. These symptoms may appear weeks, days, or even hours before the start of active labor. Although they can vary between women, some of the most common signs include:
- Braxton Hicks contractions: Also known as false contractions, they are irregular and generally painless. They may feel like a tightening of the abdomen and usually decrease with rest or hydration.
- Descent of the Baby: Also known as “dropping,” this refers to the baby dropping into the pelvis. This can relieve pressure on the diaphragm, making breathing easier, but it can increase pressure on the bladder.
- Increased Vaginal Secretions: It is common to see an increase in vaginal discharge, which may be clear, pink or slightly bloody. This is due to the expulsion of the mucous plug that has sealed the cervix during pregnancy.
- Cervical Changes: During prenatal visits, your doctor may notice changes in the cervix, such as softening (ripening), thinning (effacement), and dilation.
- Need to Prepare the Nest: Many women experience a sudden surge of energy and the urge to prepare the home for the baby's arrival.
When Should I Go to the Clinic?
Although the prodromes of labor can be exciting, they do not always indicate that it is necessary to go to the clinic immediately. However, there are certain signs and circumstances that do require attention when beginning active labor:
- Regular and Painful Contractions: If contractions are every 5 minutes, last 60 seconds, and have been constant for at least an hour (5-1-1 rule), you are likely in active labor and should go to the clinic.
- rupture of membranes: If you notice a flow of clear, watery fluid, your bag of waters may have broken. Regardless of whether there are contractions or not, it is best to go to the clinic for an evaluation.
It is also important to go, and especially without delay, to any of the following signs:
- Heavy Vaginal Bleeding: A little spotting may be normal, but heavy bleeding similar to menstruation may signal a problem and requires immediate attention.
- Decreased Fetal Movement: If you notice a decrease in the baby's movements, it is crucial that you consult your doctor or go to the clinic.
- Intense or Persistent Abdominal Pain: Any severe and persistent abdominal pain should be evaluated by a doctor.
- Preexisting Medical Conditions or Pregnancy Complications: If you have medical conditions such as hypertension, gestational diabetes, or any other pregnancy complications, your doctor may have given you specific instructions about when to come to the clinic.
In the maternal education classes that we carry out at the Dra. Gómez Roig Institute, Clínica Corachán, we explain all this information to you when it emerges and we attend to any doubts that may arise. Information prior to the moment of delivery can help manage emotions and how to act.
The Phases of Labor
Labor is divided into three main phases: the dilation phase, the expulsion phase and the delivery phase.
Each of these phases has different characteristics and it is important to recognize them to better understand the process of natural birth.
- Dilation Phase
- Latent Phase: This is the longest stage and can last from several hours to days. Contractions become more regular, but may still be mild and spaced apart. The cervix slowly begins to dilate and efface.
- Active Phase: Here, contractions become more intense, frequent and regular. The cervix dilates from 4 to 7 centimeters. It is common for women to enter the clinic in this phase.
- Transition Phase: The most intense phase of labor, with very strong and frequent contractions. The cervix dilates 8 to 10 centimeters, preparing for the expulsion of the baby.
- Expulsion Phase
- During this phase, the cervix is fully dilated (10 centimeters) and the pushing process begins to help the baby descend through the birth canal. This phase can last from a few minutes to several hours. The mother follows the instructions of the specialized equipment to push with each contraction.
- Lighting Phase
- After the baby is born, contractions continue to help deliver the placenta. This phase usually lasts 5 to 30 minutes. It is crucial that the placenta is delivered completely to avoid complications.
Duration of Labor
The length of labor can vary significantly depending on several factors, including whether it is the first birth, whether the mother has given birth before, and the use of epidural anesthesia.
Here are some average times to give you an idea:
- Nulliparous (first time giving birth):
- Without anesthesia: Complete labor can last between 12 and 24 hours. The dilation phase is usually longer, with an average of 8 to 12 hours to reach 10 centimeters.
- With Anesthesia: With the pain relief (4) Labor can last a little longer, lasting between 14 and 28 hours in total, since an epidural can slow down contractions in some women.
- Multiparous (Have given birth before):
- Without anesthesia: Labor is usually shorter, lasting 6 to 12 hours total. The dilation phase can be faster, averaging 6 to 8 hours.
- With Anesthesia: Although the use of an epidural can lengthen labor, in multiparous women the total duration is usually 8 to 16 hours.
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Conclusion
understand the prodrome of labor, knowing when to go to the clinic, knowing the phases of labor and having an idea of the expected duration can help expectant mothers feel more prepared and calm during the last weeks of pregnancy.
Always remember that every pregnancy is unique, and there are no "dumb" questions when it comes to your health and that of your baby. Maintain open communication with your medical team and don't hesitate to seek care if you have questions or concerns. All of this helps us offer a safe and healthy life. respected delivery and humanized.
Wishing you a healthy and safe delivery!
Bibliography
World Health Organization. WHO recommendations: intrapartum care for a
positive childbirth experience. Geneva: WHO; 2018.
https://www.ncbi.nlm.nih.gov/books/NBK513805/
National Institute for Health and Care Excellence (NICE). Intrapartum care for
healthy women and babies. NICE guideline NG235. London; 2023.
https://www.nice.org.uk/guidance/ng235
Rydahl E, Declercq E, Hegaard HK, Juhl M. The duration of spontaneous active
and pushing phases of labor in 25 000 nulliparous and multiparous women
with normal perinatal outcomes. BJOG. 2022;129(8):1333-43.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9249551/
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- About the Author
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Head of the Obstetrics and Gynecology Service at the Sant Joan de Déu Hospital in Barcelona. Associate Professor of Obstetrics and Gynecology and Coordinator of the Sixth Course of Medicine at the University of Barcelona, UB. Director of the Dra. Gómez Roig Institute and Coordinator of Obstetric and Gynecological Processes at the Corachan Clinic in Barcelona.