For first time mamas, previously induced mamas or those who have loads of prodromal labor, getting a handle on the nuances of when labor is going to start or if it is lasting labor can be really confusing. There is no way to know exactly when labor is going to start, but there are many things to look out for that can give clues and signs that onset of  labor is sooner rather than later.

Here are my favorite categories to look at and simple ways to decipher what is going on with your body at the end of pregnancy.

Remember to take a look at the whole puzzle picture not just one piece.

• Vaginal Discharge:

• Loss of mucous plug (after 38 weeks);
• Steady mucousy output;
• Thin and watery mucous;
• Blood tinged – similar to the beginning or very end of a menstrual period. This means there is effacement and ripening of the cervix going on and even a bit of dilation happening.
• Contraction Characteristics:
• Longer and more intense contractions that most often find a pattern;
• They do not stop or even increase with activity change;
• Sudden increase or onset of regular Braxton-Hicks;
• Low period crampiness, pelvic heaviness, off and on backache, thigh achiness.
• Other symptoms
• Increased nesting;
• Insomnia or excessive tiredness;
•  Flu-like symptoms;
• Intuition/Instinct;
• Loose bowels;
• Weight Loss in the last week.

• Testing out contractions for possible labor:
• Change activity level – if resting get up and move, if moving sit down and rest;
• Drink a large glass of water;
•  Eat a snack, preferably higher protein;
• Take a bath or shower.

After doing these things if contractions continue and increase in intensity over another hour or so likely labor is becoming established. Congratulation! As always, contact your care provider at the agreed upon time.

There are always questions on what is the normal length for labor and what is not.  Women in labor are not static.  Though there may be averages, falling outside of those may not be reason to manage labor by augmentation or cesarean.   Patience and individualized care tend to be the biggest keys to better labor outcomes.   Of course, maternal emotions, fetal positioning, maternal movement in labor or lack thereof, use of epidural or other pain management, provider or staff attitudes, over use of vaginal exams, continuous monitoring without risk association, and other can influence the normal course of labor.  There is no one-size fits all time-line to put on a mom and baby.

Generally as long as a progressing labor doesn’t all of a sudden stall out, become unorganized, or stop without a reason (see above), dystocia may not be present at all.

Below is a compilation list of information relating to progression of labor and dystocia.

Dytocia Defined First time Mothers AAFP

diagnostics – reassessing the labor curve.pages

Varney’s Midwifery Book

http://emedicine.medscape.com/article/260036-overview

Spontaneous Vaginal Delivery – AAFP

Labor Progress Handbook excerpt.

http://www.guideline.gov/algorithm/5587/NGC-5587_6.html

Helpful hints for keeping labor progressing:

• If at all possible (lacking medical necessity),  do not arrive at the hospital or birth center prior to well established labor (contractions as close as 3 minutes apart and a minute or more long).
• Eschew labor induction for any reason other than medical.   http://prepforbirth.com/?s=labor+induction
• Decline pain management if at all possible.
• Labor in the water.
• Continue to eat and drink in labor.
• Hire a labor doula.
• Attend evidence-based childbirth classes – not good patient classes.
• Attend meetings in your community who promote natural, healthy birth practices: ICAN, Birth Network, local doula organization, etc.
• Read variety of books – http://prepforbirth.com/products-page/books-videos-and-more/
• Surround yourself with those who believe in you.
• Be confident that you can birth!

Remember, a mother and baby are a unique pairing.  Some labors are short and some are long. Progress is defined by much more than cervical dilation. There is a huge spectrum of normal. No mother and baby will fit into a box.

Lastly, prior to labor also make sure you understand what your provider’s expectations are and how dystocia is defined.  That alone can determine whether or not you will have a successful vaginal birth.