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Dr. Caren Schaecher, St. Luke's Hospital

How to know when labor begins

One of the most common questions expectant mothers have is how to know when they are really in labor. It is not always as obvious as one might think, but there are some key things to watch for, including:

Lightening (also referred to as the "baby dropping"): As the baby moves down into the birth canal and the head settles deep into the pelvis, a woman may feel more pressure on her pelvis and bladder. This can occur anytime from a few weeks to a few hours before labor begins.

Increase in vaginal discharge: As the cervix begins to soften and dilate (open) in preparation for labor, a mucus plug (that developed during pregnancy to block the cervix and prevent bacteria from entering the uterus) is pushed out. It may dislodge at the onset of labor or several days before.

Water breaking (amniotic sac rupturing): Only about 10 percent of women have their water break before the onset of labor. For the majority, it occurs after labor has begun.

Contractions: Contractions may seem like a clear sign of labor, but Braxton Hicks contractions (often called "false" contractions) are very common. They can happen anytime from months in advance to right before labor begins. They occur when uterine muscles tighten but do not cause the cervix to dilate. They are often painless, irregular in frequency and mild in terms of intensity, and they occur more often if a woman is tired or dehydrated.

The contractions of true labor, on the other hand, cause the cervix to dilate. Other key differences include:

Timing: With true labor, contractions usually come at regular intervals and get closer together, lasting 30-70 seconds each. False ones are often sporadic, with no predictable pattern, and do not get closer together.
Change with movement: False contractions may stop when walking, resting or changing positions; true contractions do not.
Strength: True contractions steadily increase in strength.
Pain: True contractions usually start in the back and radiate to the abdomen. False ones are typically felt only in the lower abdomen and groin.

A woman should consult with her healthcare provider regarding any questions and to develop a plan for labor and delivery.

Dr. Caren Schaecher is a board-certified OB/GYN at St. Luke's Hospital. Call 314-576-0930.

This article was published in the St. Louis Post-Dispatch on December 13, 2012.