$Unique_ID{PAR00432} $Pretitle{} $Title{Pregnancy: The Seventh Month: Ask the Doctor} $Subtitle{} $Author{ Editors of Consumer Guide Ellis, Jeffrey W Ellis, Maria} $Subject{Seventh Month Ask Doctor recognize labor placenta uterus muscles contraction cervix birth canal prelabor false Prodromes Lightening lungs breathing bladder frequent urination Mucous Plug Passage Bloody Show dilate dilates dilation Increase Vaginal Secretion Secretions Nesting Urge Increased Braxton Hicks Contractions tightening abdomen cramping pain lower back bag waters amniotic fluid sac breaks leaks Visit} $Log{} Miracle of Birth The Seventh Month: Ask the Doctor How Will I Know When It's Time? Nearly every first-time expectant mother wonders and even worries about whether she'll recognize labor when it begins. You may feel quite helpless, since no conscious action on your part can start labor. No one really knows exactly what causes labor to begin. As far as we know, it is neither you nor your baby who decides the time of delivery, but rather the placenta and the muscles of the uterus. When conditions are right, the uterus begins contractions that will open the cervix and press the baby down through the birth canal. How will you know when you are in labor? As basic as this question is, it is often one of the most difficult to answer. It may take hours or even days to figure out whether the sensations you are feeling are labor or something else (prelabor or false labor, for instance). This is because, in most women, labor does not begin suddenly but rather evolves gradually. At some point, you and your doctor will recognize that what you are feeling is true labor. In this section, you'll find descriptions of prelabor symptoms, false labor symptoms, and signs of labor to help you recognize labor when it begins. Prelabor Symptoms (Prodromes of Labor) As your body is preparing for labor, you may experience the following signs and symptoms, called prodromes of labor. The appearance of these symptoms does not mean that labor will start immediately--it may still be several days before you go into true labor. Lightening This is the settling or "dropping" of the lowest part of the baby (head or buttocks--whichever is facing downward) into the pelvis. You can often tell that lightening has occurred because the bulge in your abdomen is lower. As the top of the uterus drops lower, the pressure on your lungs will be relieved and breathing will be easier. At the same time, however, increased pressure on your bladder will cause frequent urination. If this is your first pregnancy, lightening will probably take place about two to four weeks before labor begins. If you have already had a baby, lightening may not begin until you are in labor. Passage of the Mucous Plug ("Bloody Show") As the cervix begins to dilate (open), the plug of mucus that filled the canal of the cervix is expelled into the vagina. Sometimes, this mucous plug is pink or blood tinged and is commonly called "bloody show." Increased Vaginal Secretions Your normal vaginal secretions may increase about two weeks before labor. The "Nesting Urge" Many women feel a sudden burst of energy a few days before labor begins. You may feel a nearly uncontrollable urge to scrub floors, prepare the baby's room, clean out closets, straighten cabinets, and do other household work. Increased Braxton Hicks Contractions During the last month of pregnancy, Braxton Hicks contractions normally increase in frequency and strength. There may be periods in which they become quite strong, making you think that you are in labor. However, Braxton Hicks contractions are usually felt as a "tightening" in the abdomen without much associated pain. Doing something active--walking, for example--usually causes them to stop. "False Labor" Sometimes, a woman will experience what is commonly called "false labor." Although she may be experiencing mildly painful contractions, the pain or discomfort is felt in the lower abdomen rather than in the lower back, and the contractions occur irregularly. Indeed, these false labor contractions, which generally last for less than 30 seconds, may actually start and stop over a period of several days. Also, they usually disappear with activity. Labor Sensations When labor actually begins, the contractions are often felt as a cramping pain that begins in the lower back and spreads to the lower abdomen. If you put your hands on your abdomen when you feel this sensation, you will find that your entire uterus is hard. Generally, labor contractions initially last about 30 to 45 seconds and occur about 15 minutes apart. Over a period of a few hours, the contractions will become stronger and more painful, they will last longer, and they will occur more frequently. They will not stop with activity like Braxton Hicks contractions do. During one of your prenatal office visits, ask your doctor when you should call him if you suspect that labor is beginning (he may, for instance, advise you to call him when the contractions last for at least 30 seconds and have been coming at five-minute intervals for an hour). Do not be afraid to call your doctor if you are unsure. Call the doctor immediately if your bag of waters breaks or leaks, whether or not you have other signs of labor. Make sure that you have your doctor's 24-hour phone number and the phone number of the hospital. This Month's Visit During this month's office visit, your doctor will probably: - Check your weight. By now, you will have gained about 18 to 20 pounds. - Check your blood pressure. This will rise slightly to a normal, prepregnancy level. - Check your urine for sugar and protein. You should still have neither in your urine. - Ask about symptoms of pregnancy. By now, you may have developed varicose veins, hemorrhoids, swelling of your feet, and pain in the hips and vagina. - Ask how you are feeling. - Ask about the baby's movements. The baby's kicking should be noticeable throughout the day. - Check the growth of your uterus with a tape measure. The top of your uterus should be about two inches higher than it was last month. - Listen for the baby's heartbeat with a doppler instrument or a stethoscope. The baby's heart should be beating at about 140 to 160 beats per minute. - Describe what you may feel when you go into labor. He may also arrange for you and your partner to tour the labor and delivery section of the hospital. - Perform no new blood tests.