■ 3rd trimester

When you're about to go into labor, you'll notice an increase in contractions, the tightening and relaxing of the uterine muscles. During labor, the uterus repeatedly contracts, causing the cervix to thin (efface) and open up (dilate) so that you can push your baby out. The contractions gradually dilate the cervix until it's wide enough for the baby to pass through.

During the early phase of labor, contractions can vary greatly from one woman to another. They might last 15 to 30 seconds at the beginning and be irregularly spaced, 15 to 30 minutes apart. Or they might start out fast and then slow down. But they will continue to increase in frequency and duration as the cervix dilates.

Contractions may be relatively painless at first but gradually build in intensity. You may feel like your uterus is knotting up. Or the pain may feel like an aching sensation, pressure, fullness, cramping or a backache.

For more information about contractions and labor, see Chapter 11, "Labor and childbirth."

■ False labor vs. true labor

If you've never given birth before, you might assume that having contractions is a sure sign that you're starting labor. Not necessarily. Most expectant mothers feel occasional painless contractions before they're actually in labor. Occasionally these can be uncomfortable.

In the last weeks of pregnancy, your uterus might start to cramp. When you put your hands on your abdomen, you can sometimes feel your uterus tighten and relax. These mild contractions are called false labor (Braxton-Hicks contractions). Your uterus is warming up, preparing for the big job ahead.

As you approach your due date, these contractions become stronger and may be uncomfortable or even painful at times. It can be easy to mistake them for the real thing.

The difference between false labor and true labor is that in true labor the contractions cause your cervix to dilate. But you might not be able to tell the difference. And false labor often happens just when you expect to go into labor.

One good way to distinguish true labor from false labor is to time the contractions. Using a watch or clock, measure how long each lasts and how long it is from the start of one to the start of the next. As indicated in the chart below, such timing can reveal a pattern to the contractions if you're truly in labor.

Even after monitoring all these signs, you may not know whether you're truly in labor. Sometimes the only way to know is to see whether the cervix is dilating, which requires a pelvic exam. The start of labor is different for everyone. Some women have painful contractions for days

Is it false labor or true labor?

Contraction characteristic

False labor (Braxton-Hicks contractions)

True labor

Frequency of contractions

• Don't get consistently closer together

• Regular pattern

• Grow closer together

Length and intensity of contractions

• Don't get stronger

• At least 30 seconds at onset

• Get stronger

How contractions change with activity

• Usually stop if you walk, rest or change positions

• May grow stronger with activity, such as walking

Location of contractions

• Centered in lower abdomen and groin

• Wrap around from back to abdomen

• Radiate throughout your lower back and high on abdomen

with no cervical changes, while others may feel only a little pressure and a backache. You might leave for the hospital with regular contractions that are three minutes apart, and as soon as you arrive they stop. Or you may go in for your regular checkup, only to find that you're dilated enough for your health care provider to send you to the hospital.

It's possible to have contractions for hours before you're actually in labor. Labor begins when the cervix begins to dilate. But if your contractions continue to get longer, stronger and closer together, you're on your way!

Self-care for contractions

If false labor contractions are making you uncomfortable, take a warm bath and drink plenty of fluids.

If you're in true labor, and walking feels comfortable, go ahead and walk, stopping to breathe through contractions, if necessary. Walking may help your labor. It also helps determine if labor is false or real. You might want someone to support you during contractions while you're walking. Some women find that as the pain intensifies, rocking in a rocking chair or taking a warm shower helps them relax between contractions.

If you feel the urge to push, hold back until you've been told you're fully dilated. This helps to prevent your cervix from tearing or becoming swollen.

When to seek medical help for contractions

Monitor your contractions closely to see if they:

• Last at least 30 seconds

• Occur regularly

• Occur more than six times in an hour

• Don't go away when you move around

If you're in doubt about whether you are in labor, call your health care provider. He or she will want to know what other symptoms you're feeling, how far apart your contractions are and whether you can talk during them. If it's not clear that you're in labor, your health care provider may want to do a vaginal exam to check whether your cervix is dilating. Go to the hospital if:

• Your membranes rupture (your water breaks), even if you're not having contractions. You may not experience contractions even if your water has broken.

• Your contractions come five minutes apart or closer. Frequent contractions may be a sign of a rapid delivery.

• You have constant, severe pain.

If you're having regular contractions or you have a sudden release of fluid from your vagina three weeks or more before your due date, seek medical attention because you may be in preterm labor.

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