Labor & Delivery: When Do I Seek Medical Care?

Labor & Delivery: When Do I Seek Medical Care?

Labor and Delivery Complications

Most people don't consider labor and delivery life-threatening situations. However, in the early decades of the twentieth century, at least one out of every 100 women died during delivery, often from hemorrhage, infection, and other complications. Likewise, newborn deaths were in the 2 to 5 percent range. Fortunately, this happens much less frequently now, but it is still important for you and your family and friends to recognize the signs and symptoms of potentially life-threatening complications that require medical attention.

Over 98 percent of all U.S. babies are born in hospitals.

Spontaneous Labor

Although it's not completely understood exactly how or why labor begins, it's clear a number of preparatory changes have to occur in both the mother and the baby. The following table provides additional information about the onset of labor.

Table 1. Changes Commonly Associated with the Onset of Labor
Symptom/SignWhat is HappeningWhen it Happens
Feeling that the baby has dropped, a sense of increased vaginal pressure, or a sense that it is easier to breathe.Engagement, or descent of the baby's head into the pelvis, indicates there should be enough room for the baby to fit through your pelvis.Usually occurs a few weeks before labor with the first baby. Often doesn't occur until well into labor for women who have previously borne children.
A further increase in vaginal discharge, above and beyond that associated with pregnancy, often associated with blood-tinged discharge or spotting.Early cervical dilation or effacement (thinning). This is often referred to as "losing the mucous plug" or "bloody show." The cervical canal is lined with mucous-producing glands. When the cervix starts to thin or dilate mucous is extruded. Spotting may occur as capillaries near the mucous glands are stretched and bleed.Usually occurs anywhere from a few days prior to the onset of labor to after the onset of labor.
Persistent abdominal cramping, which often feels like menstrual cramps or a severe backache.Contractions. As you progress into labor the contractions become stronger. The contractions push the baby down the birth canal while they pull the cervix up around the baby.Usually occurs at the onset of labor, and is often confused with Braxton-Hicks contractions. True labor and Braxton-Hicks contractions can only be distinguished from one another in retrospect, true labor results in more intense contractions that lead to cervical dilation.

If you are within a few weeks of your due date and you experience the baby dropping or an increase in vaginal discharge you do not need to go to the hospital. However, these sensations are frequently early symptoms of premature labor. If you are more than three or four weeks away from your due date and sense the baby has dropped or that there is a significant increase in vaginal discharge or pressure, you should report this to your healthcare provider immediately. A gradual increase in uterine activity is the foremost change preceding the onset of labor. The uterus contracts irregularly during pregnancy, commonly several times per hour, especially when you are tired or active. These contractions often become uncomfortable or painful as the due date approaches. Although they are often called Braxton-Hicks contractions, or false labor, it is important to remember true labor contractions often feel the same, at least in the early stages of true labor. True labor can only be distinguished from Braxton-Hicks contractions in retrospect. True Labor is marked by the progressive increase in intensity of the contractions and the thinning and dilation of the cervix. It can frequently be helpful to time contractions for an hour or two. Labor has probably started if your contractions are lasting 40 to 60 seconds or longer, are becoming regular enough to predict when the next one will start, and don't dissipate after you've taken liquids or changed your position or activity. If you have any questions about the intensity and duration of contractions you need to talk to your provider, either by telephone or in person at the hospital.

Ruptured Membranes

Between 10 and 15 percent of pregnant women incur spontaneous rupture of the membranes before the onset of labor. This is much more common at or near the due date, but can occur a long time before the due date. Either case warrants a trip to the hospital because of the possibility of infection, compression of the umbilical cord and subsequent injury to the baby, or labor. Women who have spontaneous ruptured membranes prior to labor should be checked for Group B Streptococcus, a bacterium that can sometimes lead to serious infections for pregnant women and/or their babies. If your membranes have ruptured before labor, you should be treated with antibiotics if:

  • The Group B Streptococcus organism is present;
  • You are well before your due date and don't know whether you're carrying the organism;
  • The membranes have been ruptured for a long time (more than 18 hours);
  • You develop a fever; or
  • You've had a previous child who has had a Group B Streptococcal infection.

You can only get this treatment at the hospital. The great majority of women whose membranes rupture before labor notice a continuous and uncontrollable leakage of watery fluid from their vaginas, different from the increases in vaginal mucous often associated with early labor. In diagnosing labor, it is far better to err on the side of caution; staying home could risk a serious infection to you or your fetus. If you're not sure whether your membranes have ruptured you should go to the hospital immediately, even if you're not having contractions.

Vaginal Bleeding

Although any vaginal bleeding during pregnancy requires prompt and careful evaluation, it doesn't always mean there is a serious problem. Vaginal bleeding during pregnancy can occur from problems that develop within the uterus (placenta previa, placental abruption, premature labor-all potentially serious complications), or from problems that develop at or below the level of the cervix (usually less serious for mother and baby). Vaginal spotting, particularly if associated with an increase in vaginal pressure, vaginal discharge, and contractions, is frequently associated with the onset of labor. Vaginal bleeding is generally more serious if there is pain with the bleeding, especially if the bleeding is heavy.

The majority of pregnant women in the have at least one ultrasound examination during pregnancy, in which the location of the placenta, in particular whether or not the placenta is over the cervix (placenta previa), can be assessed. If significant vaginal bleeding occurs in pregnancy and an ultrasound examination has not been performed, your doctor will most likely perform an ultrasound. Pelvic examinations should generally not be done until an ultrasound examination has been performed. If you are having any appreciable bleeding, particularly new onset bleeding that has not been evaluated or that is heavy or associated with pain, you should be seen promptly.

Decreased Fetal Movement

How much your fetus moves during pregnancy depends on many factors, including:

  • How far along the pregnancy is-fetuses are most active at 34 to 36 weeks;
  • Time of day-fetuses are most active at night;
  • Your activities-fetuses are more active when you're resting;
  • Your diet-fetuses respond to sugar and caffeine too;
  • Your medications-anything that stimulates or sedates you has the same effect on your fetus; and
  • Your environment-fetuses respond to voices, music, and loud noises.

One common guideline: the fetus should move at least ten times in an hour during the evening following a meal. However, activity also depends on how much oxygen, nutrients, and fluids the fetus can get from the placenta, as well as the amount of surrounding amniotic fluid. Significant disruptions of oxygen, nutrients, and fluids may result in real or perceived decreases in the fetal activity.

Fetal surveillance testing, commonly employed in hospitals (fetal heart rate monitoring and amniotic fluid volume assessment), should be used if you perceive your baby's activity has decreased and the fetus does not respond to quick caloric intake (like a glass of orange juice), sound, or gentle pushing. Any decrease in fetal movement should be evaluated even if you aren't having any contractions or other problems.

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