Early Labour or Confusion

This blog is a about the signs of early labour and the very often mixed messages women are given which can lead to confusion. Each individual woman’s body is unique and so is her labour pattern.

Antenatal classes www.antenatalonline.ie should advise women to stay at home for as long as possible in labour. Having worked in labour suites for many years, women phone to ask if she should come in, and she is advised to take 2 paracetamol, have a bath or go for a walk and call back in an hour. Very often she is told to come in when her contractions are coming every so many minutes and again this is not a reliable indicator of progress in labour. If the woman is admitted and in early labour but not established labour she is put in a bed and diagnosed as ‘niggling’ or ‘not in labour’ and really she should be given the option of going home.

When I speak to women they say they were nervous at home and thought they were further on in labour. They were phoning for reassurance and advice. Some were happy to be sent home but some were nervous and reluctant to go back into hospital in case it was another ‘false alarm’. Some women just feel they need the security and reassurance of knowing a midwife is close by.

Labour and birth are broken down into stages, these stages are determined on clinical assessment of pattern of contractions and how much dilated is the cervix. To be able to say following this assessment how long labour will be and how it will progress is very difficult because everyone is an individual.

The process of labour can be complex.

If we think about early labour behaviour, you may feel excitement, relief, anticipation, uncertainty or even fear. You might be relaxed and chatty. All these reactions are normal.

Early or also called latent stage of labour can last for hours or even days during which your cervix begins to dilate and thin out. You may experience: backache, period type cramps, pressure, diarrhoea or a show. Once you do progress into active labour it is only with hindsight that you realise you were experiencing early labour.

Women can experience a detachment from what is happening around her. She releases hormones to support this detachment. During early labour she is preparing for active labour. When you watch a woman in labour you can monitor progress from her behaviour and reactions. It is not always reliable but can be a good guide.

Many women look for a private safe place where they can avoid distraction and focus in on labour. Once she is settled and not stimulated by talk or distraction the part of her brain the neocortex will produce oxytocin which will bring on contractions, however once disturbed the neocortex will stop producing oxytocin and contractions will stop. This often explains why contractions slow down or stop when a women goes in to hospital in early labour. However, once in established labour the neocortex is supressed, nothing stops her contractions and she is often unaware of who is around her until after the birth.

Perhaps we should be concentrating antenatal education on how to explore women’s needs in early labour and support them in the hospital setting rather than centre on how to keep them at home for longer.

By allowing women to find their safe place and begin their birth process in early labour without involving invasive clinical assessment is giving early labour respect. However, in busy maternity units this is not always possible. Very often when talking to women they tell me I knew I was doing something but I was told I wasn’t in labour.

One of our roles as a midwife is to educate and empower women, antenatal education should centre on building self -trust and reinforce the woman’s own power and ability in giving birth to her baby. If she has the ability to understand and assess how she is feeling and what progress she is making she is perhaps less likely to rush into hospital too early.

There is some evidence in a study by Carlson (2012) which found that women who managed to remain at home during early labour expressed a sense of power. The women felt this power was very important and it also involved a sense of authority over their bodies.

The following is some advice I give pregnant women on what to do during early labour:

If you are anxious, it is important to get some sleep especially if it is night time, because when your contractions become more insistent you won’t be able to sleep. If you can’t sleep you are better to get up and distract yourself for example do some cooking or some ironing anything to help with distraction.

If it is during the day go for a walk or go about your usual routine. Watch television, finish packing your bag and keep busy. Don’t go too far away from home and always bring your mobile phone with you.

Call your partner or whoever is going to be with you for your labour, let them know what is happening. They don’t need to rush to your side unless you want the company.

Eat light diet, for example toast and jam or a banana. Avoid fatty foods and don’t overeat. Drink water and stay hydrated.

Be aware of you contractions but don’t worry about timing them at this point as you can get bored and frustrated. Instead check them periodically to see if they are getting closer. Many couples head into hospital as the early phase ends and active phase begins, regular, painful contractions getting closer and lasting longer.

Go to the bathroom regularly and empty you bladder, as a full bladder can get in the way of labour.

Remember your relaxation technique you learned during your antenatal class www.antenatalonline.ie . Practice it regularly as it helps you maintain control and help progress in labour.

You and your partner will discuss when to call the hospital, but usually when you are in active labour.

However, you must call the hospital if:

You are bleeding from your vagina

Your waters break and the amniotic fluid is green

Your baby is not moving.

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