Guide for a Healthy Pregnancy

LABOR: WHEN TO CALL OR “IS THIS IT?”

As your pregnancy nears its end, you will have many questions. It is our hope that most of them have been answered in your classes and prenatal visits. However, a few crucial points are worth reviewing in writing, and are indicated below.

• Many women have a “bloody show” prior to the onset of labor. This is usually a passage of blood-tinged mucous from the vagina, and occurs a few hours or even days before labor begins. Although this discharge can be red at first, it usually turns brown. This is normal, and you do not need to notify us. However, even if you are near your due date, prolonged bleeding or more than two tablespoons of blood can be abnormal. Please call us if this happens. Before 37½ weeks, all bleeding should be reported to a clinician.
• Between 10 and 20% of women break their bag of water or rupture their membranes before the onset of contractions or in early labor. This usually is an obvious gush of clear odorless fluid. Sometimes it can be continual vaginal wetness. If you suspect this, please call us so we can examine you.
• Many women have contractions – regular, painful uterine tightening that often begins like strong menstrual cramps – on and off for days before they go into active labor. Usually this softens or ripens the cervix. The onset of cervical dilation is somewhat unpredictable, but timing contractions can help you evaluate them. To do this, write down the time of the onset of several contractions in a row, then count the number of minutes between them. It is important not to stay up at night waiting for contractions. No matter how anxious you are for labor to begin, you will not sleep through active labor, and you need rest. With your first baby, when your contractions are regular, less than five (5) minutes apart for at least one hour, you may be progressing in labor and should call. If it is your second, third, etc. baby, call with contractions at five (5) to ten (10) minute intervals.
• When to go to the hospital is a decision you will make with the clinician who answers our phones or the provider at the hospital. We encourage you to stay home as long as you are comfortable and everything seems normal. You can continue most normal activities in early labor. Showers or baths are relaxing. Keep drinking and eating lightly if you feel like it. Try to sleep if you can.
• During routine office hours (8:00 a.m. – 5:00 p.m.), please call our office at 781-682-8000 and state that you may be in labor. After 5:00 p.m., and on holidays and weekends, call the same number 781-682-8000, give your obstetrician’s name and again state that you may be in labor. The on-call obstetrician will be paged to return your call.

Please do not hesitate to call us if you have any questions about your labor or pregnancy.