Labor and Delivery: When Do I Seek Medical Care?

Problems during labor and delivery

Most pregnant women don’t experience problems during childbirth. However, problems can happen during the labor and delivery process, and some may lead to life-threatening situations for the mother or the baby.

Some potential problems include:

• preterm labor, which is characterized by labor that starts before the 37th week of pregnancy
• prolonged labor, which is characterized by labor that lasts too long
• abnormal presentation, which occurs when the baby changes position in the womb
• umbilical cord problems, such as knotting or wrapping of the umbilical cord
• birth injuries to the baby, such as a fractured clavicle or lack of oxygen
• birth injuries to the mother, such as excessive bleeding or infection
• miscarriage

These issues are serious and can seem alarming, but keep in mind that they’re uncommon. Learning how to recognize the symptoms of medical conditions that can occur during labor and delivery can help protect you and your baby.

Spontaneous labor

Although it’s not completely understood exactly how or why labor begins, it’s clear that changes have to occur in both the mother and the baby. The following changes signal the onset of labor:

Engagement

Engagement means descent of the baby’s head into the pelvis, which indicates there should be enough room for the baby to fit through for birth. This happens a few weeks before labor in women who are pregnant with their first baby and well into labor in women who have been pregnant before.

Symptoms include:

• a feeling that the baby has dropped
• a sense of increased vaginal pressure
• a sense that it is easier to breathe

Early cervical dilation

Early cervical dilation is also called effacement, or cervical thinning. The cervical canal is lined with mucus-producing glands. When the cervix starts to thin or dilate, mucus is expelled. Spotting may occur as capillaries near the mucous glands are stretched and bleed. Dilation occurs anywhere from a few days before the onset of labor to after the onset of labor. The main symptom is an abnormal increase in vaginal discharge, which is often associated with blood-tinged fluid or spotting.

Contractions

Contractions refer to persistent abdominal cramping. They often feel like menstrual cramps or a severe backache.

As you progress into labor, the contractions become stronger. The contractions push the baby down the birth canal as they pull the cervix up around the baby. They usually occur at the onset of labor and are sometimes confused with Braxton-Hicks contractions. True labor and Braxton-Hicks contractions can be distinguished by their intensity. Braxton-Hicks contractions eventually ease up, while true labor contractions become more intense over time. These severe contractions cause the cervix to dilate in preparation for childbirth.

Feeling the baby drop or experiencing an increase in vaginal discharge usually isn’t a cause for alarm if you’re within a couple of weeks of your baby’s due date. However, these sensations are frequently early symptoms of preterm labor. Call your doctor immediately if you’re more than three or four weeks away from the due date and you sense the baby has dropped or see that there’s a significant increase in vaginal discharge or pressure.

A gradual increase in uterine contractions is the main change that occurs before the onset of labor. The uterus contracts irregularly during pregnancy, commonly several times per hour, especially when you’re tired or active. These contractions are known as Braxton-Hicks contractions, or false labor. They often become uncomfortable or painful as the due date approaches.

It may be difficult to know whether you’re having Braxton-Hicks contractions or true labor contractions because they can often feel the same in the early stages of labor. However, true labor has a steady increase in the intensity of the contractions and the thinning and dilation of the cervix. It can 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 that you can predict when the next one will start, or don’t dissipate after you’ve taken liquids or changed your position or activity.

Call your doctor if you have any questions about the intensity and duration of contractions.

Ruptured membranes

During a normal pregnancy, your water will break at the onset of labor. This occurrence is also referred to as the rupture of membranes, or the opening of the amniotic sac that surrounds the baby. When the membrane rupture occurs before 37 weeks of pregnancy, it’s known as premature rupture of the membranes.

Less than 15 percent of pregnant women experience a premature rupture of membranes. In many cases, the rupture prompts the onset of labor. Preterm labor can lead to a preterm delivery, which poses many risks to your baby.

The majority of women whose membranes rupture before labor notice a continuous and uncontrollable leakage of watery fluid from their vagina. This fluid differs from the increases in vaginal mucus often associated with early labor.

The reason that premature rupture of membranes occurs isn’t well-understood. However, researchers have identified a few risks factors that may play a role:

• having an infection
• smoking cigarettes during pregnancy
• using illegal drugs during pregnancy
• experiencing a spontaneous rupture in a previous pregnancy
• having too much amniotic fluid, which is a condition called hydramnios
• bleeding in the second and third trimester
• having a vitamin deficiency
• having a low body mass index
• having a connective tissue disease or lung disease while pregnant

Whether your membranes rupture on time or prematurely, you should always go to the hospital when your water breaks.

Women who have a spontaneous rupture of membranes before labor should be checked for group B Streptococcus, a bacterium that can sometimes lead to serious infections for pregnant women and their babies.

If your membranes have ruptured before labor, you should be receive antibiotics if one of the following applies to you:

• You already have a group B Streptococcus infection, such as strep throat.
• It’s well before your due date, and you’re having symptoms of a group B Streptococcus infection.
• You have another child who has had a group B Streptococcus infection.

You can only get treatment for ruptured membranes at a hospital. If you’re not sure whether your membranes have ruptured, you should go to the hospital immediately, even if you’re not having contractions. When it comes to labor, it is far better to err on the side of caution. Staying home could increase the risk for a serious infection or other medical issues for you or your baby.

Vaginal bleeding

Although any vaginal bleeding during pregnancy requires prompt and careful evaluation, it doesn’t always mean that there’s a serious problem. Vaginal spotting, particularly when it occurs along with an increase in vaginal pressure, vaginal discharge, and contractions, is frequently associated with the onset of labor. Vaginal bleeding, however, is generally more serious if the bleeding is heavy or if the bleeding is causing pain.

Vaginal bleeding during pregnancy can occur from the following problems that develop within the uterus:

• placenta previa, which occurs when the placenta partially or fully obstructs the opening in the mother’s cervix
• placental abruption, which occurs when the placenta detaches from the inner wall of the womb before delivery
• preterm labor, which occurs when the body starts preparing for childbirth before 37 weeks of pregnancy

You should call your doctor immediately if you have significant vaginal bleeding during pregnancy. Your doctor will want to perform various tests, including an ultrasound. An ultrasound is a noninvasive, painless imaging test that uses sound waves to produce pictures of the inside of your body. This test allows your doctor to assess the location of the placenta and to determine whether there are any risks involved.

Your doctor might also want to perform a pelvic exam after the ultrasound examination. During a pelvic exam, your doctor uses a tool called a speculum to open your vaginal walls and view your vagina and cervix. Your doctor may also examine your vulva, uterus, and ovaries. This exam may help your doctor determine the cause of bleeding.

Decreased fetal movement

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

• how far along your pregnancy is because fetuses are most active at 34 to 36 weeks
• the time of day because fetuses are very active at night
• your activities because fetuses are more active when the mother is resting
• your diet because fetuses respond to sugar and caffeine
• your medications because anything that stimulates or sedates the mother has the same effect on the fetus
• your environment because fetuses respond to voices, music, and loud noises

One general guideline is that the fetus should move at least 10 times within one hour after an evening meal. However, activity depends on how much oxygen, nutrients, and fluids the fetus is getting from the placenta. It can also vary depending on the amount of amniotic fluid surrounding the fetus. Significant disruptions in any of these factors may result in real or perceived decreases in your fetus’ activity.

If your fetus doesn’t respond to sounds or quick caloric intake, such as drinking a glass of orange juice, then you may be experiencing decreased fetal movement. Any decrease in fetal activity should be evaluated right away, even if you aren’t having any contractions or other problems. Fetal surveillance testing can be used to determine whether your fetus’ activity has decreased. During testing, your doctor will check your fetus’ heart rate and assess levels of amniotic fluid.