So Is It Labor, Or Isn't It?
I have had a couple of clients recently who have had early labor patterns that don’t fit the usual pattern, so I thought it would be helpful to give a more thorough guide here than what can be found on most pinterest articles on how to tell the difference between braxton-hicks, prodromal labor, and ‘real,’ or early labor (also called early stage 1, phase 1 of labor).
The Short Answer:
Basically what you’re looking for in early labor is contractions that are getting longer, stronger, and closer together. That is the basic formula, but sometimes what that looks like is different for different people, so it can still be hard to tell if that’s what is happening.
If you’re a first-time mom:
Identifying when early labor is happening isn’t as important in this case, mostly because 1st time labors are longer, and early labor should really be ignored until it can’t be ignored anymore. Even if you’re sure you’re in early labor, the best response should be to keep the lights low, the energy down, and rest as much as possible to prepare for when you can’t rest any more. It’s more important to wait for active labor for most first-time moms before making the jump for the hospital bag. The best way of knowing if active labor is happening is when your contractions start to hurt like hell. When you can no longer talk through them, or you’re doubling over to get through a contraction, that is definitely active labor (though that still isn’t a sure-fire prediction of how soon a baby will come, unfortunately). Some first-time moms find the 5-1-1 rule to be helpful for knowing when active labor is happening, but again, it’s not always reliable. For reference, here is a public education video on the (very general) stages of labor from the Merck manual:
It may also be helpful to read about how to time your contractions:
On 1st time VBAC labors:
It should be noted that there are observational studies showing that first VBAC labors show similar, and sometimes even slower, labor patterns to first-time moms. In other words, give yourself and your body time to explore uncharted territory, especially if you are being induced. Time is your friend, medically speaking.
If you’re an experienced laborer:
You’re more likely to experience ‘practice contractions’ of some sort, whether it’s braxton hicks contractions, or prodromal labor. This sucks, I know. The only way to cope is to do all the same things you would do to soothe yourself during ‘real’ labor. Please know that if you’re going through this, it’s not for nothing. There is a purpose for prodromal labor - sometimes it’s to build uterine tone, sometimes it’s causing a bit of effacement (see below), or to produce endorphins to prepare for labor. Even though it is hard, you will get through it, and your baby will come when he or she is good and ready. Anecdotally, many women feel that prodromal labor helped to make the main event happen more quickly and easily. Some women find that drinking water and resting, and/or taking a bath with Epsom salts helps to stop the contractions if it’s not quite time yet.
If you’ve had very quick labors before:
This guide will be especially helpful for you, because you’ll need to look at every sign as a possibility that it’s time to get the birth team together. You may want to be prepared to catch your own baby, JUST in case.
Some signs of late pregnancy:
These are commonly called ‘signs of labor,’ but really, they usually just mean that you’re in third trimester, and approaching full-term. For some people these things can happen in labor as well, or not at all.
Losing your mucus plug: a thick, mucousy wad of cervical fluid might pop out of your vagina while on the toilet. Don’t freak out. This is the stuff that is inside, literally ‘plugging’ your cervix to seal it closed. If some of it is coming out, it can still rebuild itself if it needs to, or if it isn’t time yet. This can happen sometimes in response to prostaglandins (sex or meds), from surgical procedures (membrane sweeping), or from changes in the cervix.
Aches, pain, and exhaustion: The hormone relaxin begins to loosen up the tendons and muscles, especially around the pelvis, to prepare for birth, usually anytime during 3rd trimester. Back pain is especially common if you haven’t had an established pattern of exercise through pregnancy.
Breaking of the waters: read this evidence-based birth article on why this might not necessarily mean labor is soon, the causes of term (>37 weeks) pre-labor rupture of membranes, why the 24-hr rule shouldn’t apply anymore, and how to prevent infection.
Nesting: this is a burst of energy some women get near the end of pregnancy that inspires them to organize, clean, and buy things. This is a great time to make last-minute preparations, pack a to-go bag, or hire a doula, if you haven’t done that yet.
Diarrhea/hemorrhoids/GI issues: Again, with the hormones. Prostaglandins can also cause diarrhea, and baby’s growth and positioning can mean squished tummies that make it hard to hold down food.
Braxton Hicks and/or prodromal labor: Sad news, but many women experience prodromal labor that starts and stops for weeks before the big day. These can be brought on by a number of things, including hormones, but the most common is dehydration, over-activity, and magnesium deficiency.
Dilation: Yep. Even being dilated a little (like to a 2 or 3, or even a 4) can be the case for many women (especially if they’ve had a baby vaginally before) for weeks before early labor begins.
Some other definitions of early labor (that I don’t necessarily like):
The APA describes ‘real’ labor as contractions that are causing dilatation (an increase in dilation) of the cervix over time. This means you would have to have someone checking your cervix multiple times to tell whether or not your contractions are causing your cervix to dilate or not. This sucks for a number of reasons.
As mentioned earlier, there is the 5-1-1 rule, but that doesn’t apply to women with precipitous (fast) labors, and it may not work for anyone experiencing prodromal labor, or unusual labor patterns.
It should be noted that ACOG recently changed their guidelines in 2017 to define ‘active labor’ as starting at 6 cm of cervical dilation. So, if you’ve ever been diagnosed with ‘failure to progress’ (who decided on that term? yuck!) before reaching 6 cm in dilation, it is no longer considered an accurate diagnosis.
The difference between Braxton Hicks vs. Prodromal Labor vs. early labor:
Generally, it goes like this:
Braxton Hicks are usually a painless tightening of the abdomen, moving from front to back. This has its exceptions: some people have painful Braxton-Hicks.
Prodromal labor is usually painful, radiating from the back to the front, and can be rhythmic or not. It sometimes will stop if you rest and drink water or take an epsom salt bath. Contractions may even go on for a long time (weeks) on and off. You can be dilated a little (up to 4 cm) and still be in prodromal labor and not early labor, if the dilation is not progressively widening. This stage can blend with, get confused with, and generally can look really similar to early labor.
Early labor. Which is rhythmic contractions causing changes in the cervix, including effacement and dilation up to 6 cm.
The general pattern:
What you’re looking for, are painful contractions, that are getting longer, stronger, and closer together. MOST women experience ‘real’ labor this way, so if that’s what is happening, it’s probably go time. If you’re wanting to avoid cervical checks, you can also take a look at the purple line. Generally, just know that regardless of what stage of labor you’re in, labor is labor, and it deserves support, care, and attention. Time your contractions, rest, hydrate, and feed yourself. Go pee. Take a bath, then go to sleep or rest, if you can. And call your doula. :)