What is prodromal labor? In short, it is contractions that do not just continue to get longer, stronger and closer together until a baby is born. Also sometimes known as "false" labor, prodromal labor contractions may have a pattern, or they may not. They may be painless, similar to Braxton Hicks (practice) contractions, or they may be painful enough to warrant the mother believing this is the real thing.

The reason that the term "false labor" has fallen out of fashion is because it is discrediting the mother's experience. Calling her sensations a "false labor" could make her feel invalidated. She wonders, "Did I imagine that pain?" and "If this was false labor, what's real labor going to feel like?" She might also doubt herself. "They told me when it was time, I would know, but then I was wrong!"

The thing about prodromal labor is that although it can happen in any pregnancy, it is more common in a subsequent one. This can be an extra frustrating to an experienced mom who has already been through labor before and is just sure she will recognize it when it comes again.

Another important reason to shy away from calling it "false" labor is that it incorrectly assumes that the contractions aren't DOING anything. This is simply not true! Every contraction does something, whether it is toning the uterus (like warming up before a long run) or making changes in the cervix.

Labor progresses in six ways, but most people only think of dilation when talking about whether a woman is progressing. Prodromal labor contractions often prepare the body for labor in one of the other ways, such as moving the cervix from posterior to anterior (from back to front) softening/ripening it (it goes from firm like the tip of your nose to soft like your lips) or effacing/thinning it. This is the shortening of the length of the cervix, often measured in percents. If you've ever seen my balloon demonstration, then you understand why effacement is so important!

These changes may all take place in one fluid, linear labor (more common in a first pregnancy) or in choppy pieces (more common in subsequent ones). Often women will notice that contractions will come in the evening, maybe even starting to establish a pattern. If they are smart, these moms will first text or call me to give me a heads-ups, and then eat, drink and go try to sleep. Perhaps they will wake up the next morning and realize, "Guess that wasn't it!"

If it is it, hopefully they can catch a few hours of sleep or even just some rest before things get really intense.

True active labor contractions will get longer, stronger, and closer together. No matter what you are doing. Walking, resting, bathing, showering, thinking about them, not thinking about them, timing them, ignoring them or wishing with all your might that they would go away. It won't matter.

Prodromal labor, however, will usually respond to changes you make. Often drinking more water will help quiet these contractions down. Also, sometimes a long prodromal labor (non-patterned contractions over days or even weeks!) can be because your body is trying to move your baby to a better position. Try the Miles Circuit to help with this one.

And remember, I always want to know what's going on. I would rather have many "false alarms" then have a mother NOT call me when its really time because she isn't sure that this is it. Think of it this way. You can be 100 percent sure that you know when NOT to call.

Am I in labor right now? Nope.
Could I be? Nope.

If you can't answer nope to both of these questions, its a good idea to give me a heads-up. If nothing else, I will listen to you have a contraction or two on the phone and let you know what I think and set a time for us to check in with each other again.

Happy laboring!

The most common question that pregnant women ask me is, "How will I know when it's time to go to the hospital?"

Many express an interest in staying home "as long as possible" especially those who desire a natural birth. But how long is that exactly? And how do you know when its REALLY time to go?

In order to answer these questions to best serve the needs of the individual mother, the first thing I need to find out is how strong is her desire to birth naturally? I use a 0-10 scale, but I have also seen a -10 to +10 scale used. The top of the scale is an unrealistic desire to feel no pain at all, to have medication begin before labor does. The bottom of the scale is an unrealistic desire to not use pain medication at all, even if there is an emergency.

If a mother answers that her desire to for a natural birth is at a 1-3, I will recommend she stay home longer than the hospital tends to suggest, especially if it is her first baby. Hospital policy used to be the 5-1-1 rule, but recently I've heard it being replaced with the 4-1-1 rule, especially for mothers who do not want interventions.

The rule means that when your contractions are four minutes apart, lasting at least one minute each, and have been that way for at least one hour, the hospital would like you to come in. 

The problem is that, especially with a first baby, this 4-1-1 usually doesn't mean you are close to giving birth. It just means that active labor is well established. If a mom expressed a desire to stay home as long as possible before labor started, I will remind her of that when she is laboring well at home and has reached 4-1-1. Of course she can change her mind, and if she truly wants to go in, we will. I remind moms at their prenatals that I am not the hospital police!

A great compromise that can happen when a mom feels that she couldn't possibly bear the car trip with contractions any stronger than the ones she is experiencing now, but maybe isn't quite as far along as she planned to be, is lobby labor! This is exactly what it sounds like. 

She gets the car trip out of the way, but instead of checking into the hospital,
just starts walking around the hospital's lobby. Many hospitals have beautiful
fountains to look at, or if it's a nice day, she can walk outside on the grounds. This way, she is not on the hospital's clock yet, but if something were to suddenly change, she is already right there and ready to check in.

Just to be clear, lobby labor is not the same as going in, getting checked at triage and then being told to walk for an hour. This is what happens when a mother shows up to the hospital too early in labor even for the hospital's standards. In most hospitals, it's usually defined as four centimeters. Lobby labor is driving to the hospital, but not alerting the staff or your care-provider of your presence until you feel that you are ready to check in. It's like you're still at home, but a lot closer. For many mothers, this option can offer peace of mind.

Question: Why make sounds along with the birthing mother? Isn't your calm presence enough?

Answer: It absolutely depends on the individual person, the emotion in the room, and what part of labor she's in. For the beginning of labor, the mother breathes through contractions and I breathe with her. My breathing guides hers. I help her control the speed of her breathing and how deep she is breathing, not by telling her she's doing it wrong, but just by modeling how to do it right.
 
If/when she begins to make noise, the principle remains the same. Deep, low, moaning sounds are productive toward birth. They are empowering. However, high-pitched screaming sounds are not productive toward birth. They are fear sounds, it usually means she is not on top of her contractions, they are on top of her, so to speak. By helping her control her pitch, I am helping her to keep fear and panic away. When I moan with her, I keep my sounds a touch lower and a touch more controlled than wherever she is at. It serves as a guide. Often, she will match me in pitch, as if I am the conductor. But at the same time, she is the one who is choosing the song, since she is the one who is in the experience. 
 
The last reason for moaning and later roaring along with the mom is so that she doesn't feel so self conscious. Many women are afraid of losing control in labor, and afraid of the sounds they might make or that they will look or sound stupid to others around them. They don't want to "bother" others. They don't want to scare their partners or to be judged by people in the hall or lobby. You know how it is much easier to sing in front of a crowd of people if you are part of a group than if you are doing a solo? By making her sounds with her, I am essentially giving her permission to express herself and not feel like everyone's eyes are on her. Her birth is no longer a solo, it becomes a duet! Sometimes partners or nurses will even join in. Most moms love this!
 
I did hear a story about a woman who told her doula to shut it, but it hasn't happened to me yet. If a client told me that she would prefer a quiet birth, I would be happy to support her in maintaining her best birthing environment. But for the most part, these aren't the women who are making the roaring sounds in the first place. Everyone is different, so of course there are mothers out there that would get more out of the doula being quiet, even while they roar, but I just wanted to stress that loud and calm are not necessarily opposites. My presence is both.