You spend nine months preparing for your labor and birth, and suddenly it is here, and you are having contractions. Are you sure this is it? It could be prodromal labor. It can be tricky to tell the difference between prodromal labor and actual labor because contractions can have a somewhat regular pattern. They can start and stop at about the same time each day, and this can last for days or weeks before your labor starts. Learn about prodromal labor, how you can cope with it, and how to know when it is a fire drill or the big day you will be meeting your baby.
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What Is Prodromal Labor?
In medicine, the word prodrome is an early sign or symptom of a disease or condition. This comes from the Greek word “prodromos,” which means “running before.” You could think of prodromal labor as a precursor to labor. Part of the challenge in defining prodromal labor is that the American College of Obstetricians and Gynecologists instructs providers to avoid the term “prodromal labor.” Instead, they break the first stage of labor into 2 phases, latent, and active labor. These two phases cover the period from the early signs of labor which start stage one until 10 centimeters, which is the end of stage 1. The latent phase is from the onset of labor until 6 centimeters, and active labor is from 6 centimeters until 10 centimeters. Prodromal labor happens before these two phases.
Prodromal labor is sometimes called false labor. I don’t like this terminology because the contractions that can come with prodromal labor can be intense, and they are real. You should have validation for how you experience labor because everyone has a unique experience. Prodromal labor involves contractions before labor starts. It can be tricky to tell the difference between prodromal labor and actual labor because contractions can have a somewhat regular pattern. They can start and stop at about the same time each day, and this can last for days or weeks before your labor starts.
Braxton Hicks are sporadic uterine contractions that can start as early as six weeks into a pregnancy. Although these could be going on that early, you probably won’t feel them until the second trimester or third trimester, if you feel them at all.
When you have contractions, you are going to feel your uterus, your lower abdomen, or your groin, or some combination of the three, tighten or squeeze, and then relax. When this happens with Braxton Hicks contractions, the muscles of the uterus tighten for around 30 to 60 seconds, and sometimes they can go as long as two minutes. Some women describe Braxton Hicks contractions as tightening in the abdomen that comes and goes, and some say these contractions feel like mild menstrual cramps. In general, Braxton Hicks contractions are irregular and usually more uncomfortable than painful. Occasionally they can be intense and painful, and like everything pregnancy-related, it will be different for everyone. These are unpredictable and irregular in intensity and will not increase in strength, and they will taper off and disappear. Braxton Hicks contractions may be uncomfortable, but they do not cause labor or open the cervix.
Prodromal Labor and Braxton Hicks vs. the Latent or Active Labor Phase
Prodromal labor is sometimes associated with Braxton Hicks contractions, but there are some key differences. There are some basic questions you can run through to tell the difference between prodromal labor or Braxton Hicks and labor contractions.
Timing, Frequency, and Intensity of Contractions
Braxton Hicks can happen as early as six weeks into your pregnancy and are most common in the third trimester. Prodromal labor tends to occur within a month of your due date.
How often are contractions happening? If it is Braxton Hicks, the contractions are often irregular and do not get closer together. Prodromal labor can be trickier because these contractions tend to be stronger than Braxton Hicks and can happen with some regularity. Typically, prodromal labor contractions don’t happen more often than every five minutes, and they stop for long periods or stop altogether. If the contractions are actual labor, they will come at regular intervals and will continue to get closer together and stronger in intensity.
How strong are the contractions? Of course, this will be subjective and different for everyone, but in general, with Braxton Hicks, they are usually weak and don’t get much stronger. Or they can start strong at first and then get weaker. Prodromal labor can come with more intense contractions than Braxton Hicks. Again, prodromal labor will stop and start or stop altogether.
When you are really in labor, contractions will get steadily stronger and closer together as time goes on. Monitoring the frequency and intensity of your contractions over time is the key to knowing if you are in true labor.
Will Interventions Relieve Contractions?
There are a few things you can do that will usually help to resolve Braxton Hicks contractions. If you are experiencing what you think could be Braxton hicks, drink some water, and make sure you are hydrated. A full bladder may trigger Braxton Hicks contractions. Make sure you don’t put off going to the bathroom, and you can try that to alleviate the contractions.
Braxton Hicks contractions will often stop when you change position or get up and move around. If you have been sitting or lying down for a while, try taking a walk. If you have been moving around a lot, take a break and sit or try lying down on your left side, which may help ease some of the discomforts. It can also be helpful to take a warm bath or listen to some soothing music, or anything else you would do to try and relax. These interventions may not have any effect on prodromal labor. Also, if you are going into labor, these interventions will not stop contractions.
Where is the Pain or Discomfort?
The last question you want to ask yourself is, where do you feel the pain or discomfort? Usually, with Braxton Hicks, you feel it only in the front of your abdomen or pelvis. With prodromal labor or true labor, contractions are more intense and can start in your lower back and move to the front of your abdomen or start in your abdomen and move to your back, rather than localized in one spot.
Braxton Hicks contractions do not cause any changes to your cervix. Since prodromal labor usually occurs within the last month of pregnancy and proceeds labor and birth, it may come with changes to your cervix. The only way to know whether your cervix has started to dilate and efface is with a vaginal exam. It is not uncommon for the cervix to be dilated a centimeter or two weeks before going into labor. Cervical dilation and effacement are also not linear. Meaning that how quickly you progress from one centimeter to the next does not happen consistently over time. Even if you knew you were one centimeter dilated, you would not know whether you would be going into labor in a few days or a few weeks.
I was unable to find evidence on whether prodromal labor causes the cervix to prepare for labor. Since the timing of prodromal labor is within the last month of pregnancy, it is likely there would be some changes to the cervix. While it would make sense that these are related, it was a challenge to find studies to support a causal relationship. Anecdotally, there is a lot of speculation that prodromal labor often leads to a shorter birth, but again, I did not find a study to show that.
The American College of Obstetricians and Gynecologists define preterm labor as regular contractions of the uterus resulting in changes in the cervix that start before 37 weeks of pregnancy. Some signs of preterm labor may include vaginal bleeding or spotting, an increase in vaginal discharge, or a change in the type of discharge. Discharge that becomes watery, has a lot of mucus, or blood, even if it’s only pink or blood-tinged could be a sign of preterm labor. Keep in mind that discharge does tend to increase as your pregnancy progresses. You are looking for a sudden significant difference in consistency or color. Another sign of preterm labor is a lot more pressure in the pelvic area, which is a feeling that your baby’s pushing down. And lastly, low back pain, especially if it’s dull or rhythmic, and you didn’t previously have back pain.
When should you Call Your Doctor or Midwife?
The short answer to when you should call your doctor or midwife is to trust your gut. If you haven’t reached 37 weeks, you should call your care provider right away if your contractions are becoming more frequent, rhythmic, or painful, or if you have any possible signs of preterm labor.
Generally, if you’re past 37 weeks, there isn’t a need to call your care provider just for contractions until they are about 1 minute long, are five minutes apart, and continue for one hour. If your doctor or midwife has given you different guidelines, then obviously go by those. Ask your care provider when you should call or come in with contractions. Remember, there are three measurements you will want to keep track of the length of a single contraction, the length of time between contractions, and how long they have been going on. There are a ton of simple apps for your phone that makes it super easy to time and keep track of them.
If you ever have any doubt, call your care provider. They can probably tell how your labor is progressing, if you are just having Braxton Hicks or are in prodromal labor, by talking to you on the phone. If you have contractions that you cannot walk or talk through, it may be time to head to your hospital or birth center, or if you have a home birth, tell your midwife to come on over. The downside is that you could be sent home and told that you are not ready to go into labor. While that may be a disappointment, you are always safer, erring on the side of caution.
Coping with Prodromal Labor
If you are having symptoms of prodromal labor, please let your care provider know, so they are aware of it. There are some theories as to why some expecting mothers experience prodromal labor. One theory is that your body is practicing contractions to prepare you for labor. If your baby is not head down and is breech or transverse, your body may have some of these contractions to try and help your baby to move in a head-down position. There is also some speculation that prodromal labor can be brought on by stress or anxiety. Since we do not know what causes prodromal labor, it is challenging to give you tips to relieve it. By looking into each of these theories, we can come up with things to try that may be helpful.
The Positives of Prodromal Labor
There is a positive side to experiencing Braxton Hicks or prodromal labor, and that is that it allows you to practice some techniques to manage contractions. These “practice contractions” are thought to be a preparation for labor. If you experience these, try out some of the techniques you plan to use during labor. Methods could include tools like breathing exercises, visualization, movement, or meditation.
Your Baby’s Position
Ideally, your baby is head down before birth, but not all babies get into this position before you go into labor. If your baby is breech or transverse prodromal labor could be your body’s way of trying to get your baby head down. Now is an excellent opportunity to learn about your baby’s position and talk to your care provider about your options if you are nearing your due date and your baby is not head down.
A Sign that You Should Relax
Looking at the theory that stress or anxiety can cause prodromal labor, the best thing may be to relax. Relaxation is different for everyone, and you know what helps you to unwind. If you are having prodromal contractions that disrupt your sleep, try to get in a nap during the day. There are a lot of things you are doing to prepare for your baby. Keep in mind, the last few weeks of pregnancy are going to be some of the quietest for your foreseeable future. In a perfect world, you go into labor very well rested and ready for the marathon of birth. If you can rest, relax, or sleep early on, you should. Once you are in active labor, you will hit a point when you can no longer sleep through or ignore your contractions.
If you are experiencing prodromal labor for days or weeks before your birth, relaxing can help you preserve energy for when you need it in labor. You will be better prepared for your labor if you go into it rested, rather than exhausted.
Stay Hydrated and Eat Well
One of the common causes of Braxton Hicks contractions is dehydration, and sometimes making sure you are drinking enough water can make those uncomfortable contractions go away. While drinking more water may not affect prodromal labor, it is still crucial for you to stay hydrated and energized with healthy whole foods. Your body is working hard, and you need fuel and nutrition.
Hang in There
It can be frustrating to feel like you are starting and stopping labor for days or weeks before you get to meet your baby. Keep your eyes on the prize and know that there is a light at the end of this tunnel. Communicate with your doctor or midwife about your symptoms or any concerns. Ask your partner or friends or family for help so you can focus on taking care of yourself.
Also, remember that you are not in this by yourself. Your baby is in this with you. The two of you will be working together to get to and through birth. I promise, when you hold your baby and look at that sweet face, the last thing that will cross your mind is prodromal labor. All of your discomforts will be 100% worth it.
Thank you to Zahler for their support of this episode.
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