Pre-labour

Pre-labour is the period before labour begins when the woman experiences irregular uterine tightenings or contractions which soften and thin the cervix, a process called effacement. These tightenings can sometimes be experienced as contractions. The key difference between pre-labour and early labour is that pre-labour does not progress. The tightenings stay the same length, intensity and time apart. When pre-labour contractions begin to change, this is called early labour.

During pre-labour there may be some other signs that labour is close. A bloody 'show' often occurs during the pre-labour period. This is when the changes in the cervix result in the mucous plug coming away. Sometimes a woman's waters will break before labour begins. This might lead to a change in the pattern of tightenings and accerlate the woman towards early labour.

What is Pre-labour?

Pre-labour is the period before labour begins. The balance of the hormones, oestrogen and progesterone changes and the natural level of prostaglandin increases. This increases the sensitivity of the cervix to oxytocin. Oxytocin is the hormone which creates uterine contractions. These hormonal changes can create irregular uterine tightenings or contractions. The tigtenings create changes in the cervix, moving it forwards, shortening it (effacement) and softening it. Depending upon how powerful the contractions are, they may even open the cervix up a couple of centimetres.

During these final weeks of pregnancy, the baby moves lower into the pelvis, as the uterus relaxes under the influence of pregnancy hormones. This effect might give you more room to breathe and is sometimes called 'lightening'. The baby's position can affect the experience of pre-labour. The better the baby's head is applied to the cervix, the more it will stretch the cervix and stimulate the body to release oxytocin. The more oxytocin released into the blood stream, the stronger the pattern of tightenings or contractions.

Pre-labour contractions

Although pre-labour is not really considered to be 'real labour', you might experience mild or moderate intensity tightenings or contractions. During ‘pre-labour’, contractions can come 15 – 30 minutes apart. They might be felt as period-like cramps with or without backache. They do not get closer together and they do not get longer or stronger. Contractions will often show up during the evening when the body's background adrenaline level naturally drops. Adrenaline release interferes with oxytocin release. Your uterus will respond to whatever levels of oxytocin are circulating in your blood, by become 'irritable' with irregular pre-labour contractions. When the sun comes up in the morning, your background adrenaline level will rise again. If your oxytocin level has not risen enough to maintain a pattern of contractions, they will fade off until levels have risen further. These on and off contractions, which happen through the night and disappear during the day, can leave women feeling tired and frustrated.

Baby's position

Pre-labour contractions passively rotate the baby. Babies generally rotate in a clockwise direction due to the asymetrical shape of the body's internal spaces. The asymetry of the space available to the baby is created by liver. A long pre-labour, can suggest that the baby still needs to move into a better position in order to stretch the cervix evenly. Oxytocin release is stimulated by the cervix stretching. The more tucked in the baby's chin is (flexed), the better the baby's head will be applied to the cervix. A well applied head will provide a more even pressure to the cervix and a stronger stretch. When the cervix is stretched evenly the trigger for oxytocin release is greater. Rising levels of oxytocin will generate a stronger the pattern of contractions. Labour will begin to establish!

Other signs of labour approaching

Your waters may break ahead of labour. It is important to check the colour of the amniotic fluid. It is normal for the fluid to be clear or have a pink tinge. If the fluid is stained yellow, green or darker the baby has had its first bowel movement (called meconium) in the amniotic fluid. This could mean a number of things for your baby and so you might be advised to give your midwife, doctor or the hospital a call. They will probably ask to see you so that they can check the baby’s heart rate. When there is meconium in the waters it might mean that at some point the baby has been distressed. It does not necessarily mean that the baby is currently distressed. Babies who have passed their ‘due dates’ sometimes pass meconium into the water as their digestive systems get ready for the big day. Babies who are in a breech position might also pass meconium as their abdomen is squeezed by the pelvis and birth canal.

You may have a bloody, mucous ‘show’, as the mucous plug which has sealed the cervix during pregnancy comes away. The more the cervix has softened and shortened, the more blood will come away with the mucous plug.

What you could do to help yourself?

• If you have lots of energy and have been sleeping well, carry on as normal, but make sure that you avoid fatigue. If you get tired, sleep.
• Are you planning to use a TENS Machine? TENS stands for Transelectrocutaneous Nerve Stimulation and it is a drug free pain management tool. The TENS machine is a handheld base unit which attaches to two sets of electrodes. The electrodes are placed on the woman’s lower back over the areas where the nerve endings for the cervix and uterus insert into the spinal column. A low frequency pulse is sent into the electrodes via the base unit. The amplitude of the current can be increased or reduced, according to your preference and a boost button allows you to increase the sensation from the TENS machine during contractions. TENS works on the ‘Gate Control Theory of Pain Relief’, in the same way as rubbing an injury makes it feel better.
• If you have hired a TENS machine, now is the time to check that it is working and that you have spare batteries.
• Remaining active during the day will take your mind off things. Don’t forget to eat at meal times and continue to drink with thirst.
• During the night, it is important that you rest. Sleep is obviously the best possibility. If you are unable to sleep, you could take a warm bath or shower to relax your body and then go back to bed with a heat pack. Rest is very important, there is significant work ahead!
• If your pre-labour goes on for more than two nights you might wish to consider intervening in order to improve your baby's position. Both acupuncture and the chiropractic Webster Technique have been shown to increase the likelihood of the baby taking up a position with its back on the mother's left side and slightly forwards of her hip.This is a favourable position for birth and will shortening the length of the labour.

What partners can do to help

• To be at this stage of the pregnancy is very exciting and quite daunting. Your partner has a very unusual mix of hormones flowing around her body and brain which will be supporting her to feel physically and emotionally ready for what is about to happen. Unfortunately, you don't get quite the same hormonal cocktail to help you out.
• The key is to remain calm. Labour and birth are very safe for mothers and babies. You tend to get lots of notice in terms of what is going to happen next, and it can take a long time to have a baby, particularly a first one.
• If you haven’t already done so, make sure that you have the contact details of everyone who will be involved in supporting you and caring for you during the labour and birth.
• If you are planning to give birth in a hospital or birth centre, check out the route so that you can identify any potential obstacles. Fill the vehicle with fuel and fit the baby’s car seat.
• If you are planning to give birth at home, start thinking about which room you might use for the labour and birth. Are you planning to use a birth pool? Now is the time to unpack it and have it set up ready to fill when labour begins to establish.
• Let your employer know that you have reached the end of the pregnancy and will be taking time off for labour and birth imminently.
• You many need to consider how your existing children are going to be cared for during labour and put support people on notice. Any pets you have will also need to be considered.
• Pre-labour can really look the way you expected labour to look if you haven't had a baby before. If the tigthenings or contractions are short (less than 50 seconds long), your partner is not yet in real labour. The difference between prelabour and real labour is that during pre-labour, nothing changes. The contractions do not get longer, stronger or closer together.  Your partner might experience a huge range of emotions during pre-labour which start with excitement and may move on to tiredness, frustration and nervousness. She may need distracting if pre-labour goes on for a long time. These feelings might get in the way of her looking after herself, and so she may need you to remind her to eat and keep up fluids.
• Similarly, excitement might mean that neither of you are able to rest very well even though you know how important it is to do so. If your partner doesn’t need you, take the opportunity to get some sleep if you can. Once the labour gets properly established, there probably won’t be an opportunity to sleep.
• A long pre-labour tends to indicate that your baby is not yet in the best position for birth. If your pre-labour goes on for more than two nights, you might wish to consider intervening in order to improve your baby's position. Both acupuncture and the chiropractic Webster Technique have been shown to increase the likelihood of the baby taking up a position with its back on the mother's left side and slightly forwards of her hip. This is a favourable position for birth and will shortening the length of the labour.