The Early Ones You Need To Look Out For
Your due date’s getting closer, but how will you know the labour signs to look out for? Even the most subtle changes can indicate your baby’s on the way.
We’ve rounded up the clues:
- Your waters break
- Heartburn relief
- You have a ‘show’
- Your nipples leak
- Swollen down below
- Frequent toilet stops
- Sudden burst of energy
- Walking differently
LABOUR SIGNS: YOUR WATERS BREAK
Otherwise known as the moment the sac of amniotic fluid surrounding your baby ruptures. This can happen as an all-in-one gush, or a slow trickle that lasts a few days. Your waters can break any time during labour or birth, or they may be broken by a midwife to help kick-start labour.
If your waters do break, call the maternity unit. Once your waters break, you’re at risk of infection, so the midwives may want you to go in.
They will also ask you about the fluid: it should be a straw-like colour and have a sweet odour. If your waters are green, your baby may have emptied her bowels, a sign of distress, and you’ll need to go to hospital to be checked over.
LABOUR SIGNS: HEARTBURN RELIEF
As your bump grows, your baby will push your stomach upwards. This forces acid in your stomach into your windpipe, causing heartburn.
‘Luckily, in the weeks running up to your due date, you may notice symptoms get slightly better,’ says midwife Helen Taylor. ‘This is because your baby has dropped, which means he’s moved down into your pelvis ready for birth.’
You may also find that you can breathe more easily because your baby isn’t pushing against your lungs and decreasing their capacity
LABOUR SIGNS: YOU HAVE BACKACHE
An ache in your lower back can mean your baby is rotating into the right position for labour.
‘This can take a few days and may be painful,’ says antenatal teacher Philippa Bennett. ‘It could also be the start of your contractions – some women experience them more in their back than their stomach.
Get through the discomfort by taking the recommended dose of paracetamol, then put your feet up, ask your partner for a back rub and have warm a bath.
LABOUR SIGNS: YOU HAVE A ‘SHOW’
A mucus plug covers your cervix in pregnancy and this may come loose up to a few days before labour starts.
A brown, pink or red-tinged stringy or jelly-like discharge, it can come out either in one lump or more gradually over a few days.
Speak to a midwife just to make sure you’re not bleeding,’ says Philippa.
If it’s bright red or the discharge starts to look heavy, head to hospital. If your midwife is happy, just eat, sleep and relax before things really get going.
LABOUR SIGNS: YOUR NIPPLES LEAK
It’s not just during breastfeeding that nipples can leak – it’s all throughout your final trimester.
That said, you’ll probably notice it most in the last few weeks before your baby arrives. The milk you’re leaking is colostrum, a nutrient-rich liquid that will nourish your baby until your proper milk comes in a couple of days after the birth.
If you’re getting wet patches on your clothes, buy some disposable breast pads that you can pop inside your bra
LABOUR SIGNS: DIARRHOEA
The hormones that help your uterus contract can also sometimes cause diarrhoea in the hours before birth.
If this happens, increase the amount of water you’re drinking and hold off on milk or sugary drinks, which can make diarrhoea worse. Try eating bland food such as rice to keep your energy levels up.
LABOUR SIGNS: SWOLLEN DOWN BELOW
Pregnancy has a tendency to leave you feeling swollen in different areas of your body (cankles, anyone?), and that includes your labia at the entrance to your vagina.
‘It can be disconcerting, but it’s very normal,’ says Dr Beckett. ‘It’s caused by the increase in blood volume in your body. When your baby moves down into your pelvis, generally after week 37, it also puts more pressure around your vagina, making it feel swollen.’
Ease any discomfort by placing an ice pack in a clean tea towel and resting it on the area.
LABOUR SIGNS: FREQUENT TOILET STOPS
With a growing baby bump that presses on your bladder, you’ll find you need to pee more regularly during pregnancy. But this could increase even further in the final week before birth, as your baby positions himself in your pelvis.
Carry on drinking water as you don’t want to become dehydrated, but avoid coffee, soft drinks and citrus fruits as these tend to irritate the bladder.
LABOUR SIGNS: SUDDEN BURST OF ENERGY
If getting up off the sofa is about as much activity as you can manage for most of your last trimester, the sudden spurt of energy you get in the days before labour starts (and the urge to clean out your kitchen cupboards) is often a not-unpleasant surprise.
Make the most of it! Sort out the house, organise your baby’s clothes and set up a few change stations ready for her arrival home.
LABOUR SIGNS: WALKING DIFFERENTLY
If your gait has started to resemble a cross between a cowboy and a duck, (attractive!) it could well be a sign your baby will soon be arriving. ‘Your pelvis widens in preparation for birth, which can affect the way you walk,’ says independent midwife Virginia Howes.
If your walk has changed and you’re also experiencing discomfort, it could be a sign of pelvic girdle pain (PGP). ‘Talk to your GP who may refer you to a physiotherapist. They can teach you exercises or provide a special belt to help support your pelvis,’ says Virginia.
LABOUR SIGNS: CONTRACTIONS
Firstly, are you sure these aren’t Braxton Hicks? ‘These short, painless, tightening sensations mean your uterus is gearing up for labour,’ says Erika. Real contractions tend to start weak, perhaps feeling like period pain, then grow in frequency and intensity.
‘Don’t rush to hospital, but do let the unit know what’s happening,’ says Philippa. Instead, take the recommended dose of paracetamol and try to chill out. Established labour is usually when you have three, one-minute contractions in the space of 10 minutes. When the contractions become so intense, you struggle to talk, you’ll know it’s definitely time to head to hospital.
PREMATURE LABOUR AND BIRTH
WHAT DOES PREMATURE BIRTH MEAN?
A premature birth is when a baby arrives before 37 completed weeks of pregnancy. Generally, the further on in your pregnancy you are, the more likely it is that your baby will do well.
This is because his organs will be more mature, his lungs will be better prepared for breathing and he’ll have more strength for sucking and feeding.
In the last few decades, intensive care for extremely early babies has improved dramatically, and survival rates are much better than they used to be.
However, there can sometimes be long-lasting effects for babies arriving very early, including cerebral palsy and learning difficulties.
At 35 weeks
A baby who arrives at 35 weeks is unlikely to have any problems, although he may be a bit small and may possibly have some breathing difficulties.
Between 28 and 34 weeks
Premature babies born at less than 34 weeks of being in the womb still have a lot of growing to do and their internal organs need to mature. They may be quite weak and may find sucking and breathing difficult. They are best cared for at a neonatal intensive care unit (NICU).
Babies born as young as 28 weeks also have fair chances of survival at good healthcare facilities.
Less than 28 weeks
Unfortunately, babies younger than 28 weeks may find it difficult to survive and those who do may have mild to severe disabilities.
How common is premature birth?
It is estimated that 13 per cent of all births in a year in India are premature.
The premature birth rate seems to be on the rise in our country. India has the largest number of premature births compared to any other country. Premature births in India account for nearly a quarter (23.6 per cent) of the world’s premature birth count.
WHY DO PREMATURE BIRTHS HAPPEN?
There’s no explanation for why premature births happen. Healthy women are most likely to complete their term. However, even doctors cannot tell for sure which babies will arrive early.
There are a number of risk factors, both medical and social that increase the chances of premature labour and birth.
Medical reasons that make you prone to premature labour are:
- a bacterial infection in your vagina
- expecting twins or more
- heavy bleeding during pregnancy
- an abnormality of the uterus
- cervical weakness
- previous terminations of pregnancy (abortion)
- previous miscarriages, especially between 16 and 24 weeks
- previous premature birth, though it’s only a slightly higher risk, and many mums go on to have a baby at term
- waters breaking early
Certain social and lifestyle factors have also been found to play a role in premature labour. These factors include:
- Living in poverty.
- Being the victim of domestic violence.
- Smoking and taking drugs.
- If your job involves long hours and hard physical work it can triple the risk. That’s especially the case if you bend over for more than an hour a day in later pregnancy.
Being underweight may increase your risk, so looking after yourself is important. Being overweight can also increase your risk of complications which may lead to premature birth.
If you have unusual vaginal discharge at any stage, see your doctor.
Are there health reasons why a baby might need to be born early?
Yes. Premature births sometimes happen because doctors decide that a baby needs to be born early for medical reasons. The doctor may decide to induce labour or to perform an early caesarean section.
Doctors might decide that a baby needs to be born early if:
- he is not growing properly in the uterus
- he has an abnormality
Or if the mother has:
- a medical condition which means it is safer for the baby to be born early
- chronic diseases like hypertension, diabetes, severe anaemia, and nephritis
- had some trauma to her abdomen, such as a blow to the belly
WHAT SHOULD I DO IF I THINK I’M IN PREMATURE LABOUR?
If your waters break, or you start having contractions before 37 weeks of pregnancy, contact your doctor or hospital immediately. Even if it’s the middle of the night, don’t wait until morning, get on the phone straightaway!
You will almost certainly be asked to go to the hospital immediately. Don’t drive yourself. If you have nobody to give you a lift, call an ambulance.
WHAT WILL HAPPEN AT THE HOSPITAL?
The doctor will take your history to know the details of your present pregnancy. She would also want to know if anything similar had happened in your previous pregnancies or if you had any miscarriages in the past.
You will be asked about the sequence of events that had happened before you reached the hospital. Then you will be admitted to the antenatal ward for observation and a number of tests may be carried out to check for infection, such as:
- urine test
- vaginal swab
- blood test
Your doctor will do a vaginal examination to see whether your cervix is shortening and opening. At some hospitals, you may be offered a vaginal ultrasound scan to see how long your cervix is. A short cervix may indicate that labour has started.
Doctors can’t stop labour if it is really underway and resting won’t help either. However, if you are less than 34 weeks pregnant, your doctors may give you a drug to delay the birth for a short while, if you need to be shifted to another hospital with a specialised neonatal intensive care unit.
You will also be given steroid drugs to help your baby’s lungs mature. A baby’s lungs are not ready to breathe air until about 36 weeks of pregnancy, so, if he is born before then, he may have breathing difficulties. Steroid injections help his lungs to mature more quickly, though our expert gynaecologist, Dr AshwiniNabar, feels this won’t help if the labour is already advanced and your baby is coming out soon.
If you are more than 34 weeks pregnant, your doctor will probably allow labour to continue at its own pace. Your baby will be small when he is born but is likely to do very well even if your hospital has basic but not highly specialised neonatal care facilities.
WHAT IS PREMATURE LABOUR LIKE?
It is probably hard to describe the shock of finding that you are going to give birth several weeks or a couple of months earlier than you had anticipated. You will naturally feel very worried, and perhaps out of control because of all the medical attention that you may be receiving. Ask your doctor if she can explain things to you.
Your baby’s heartbeat will be monitored throughout labour. If you need some pain relief you will probably be given an epidural as it does not have side effects for the baby.
You will most likely be able to deliver vaginally, however, a caesarean section might be necessary if you have gone into labour following a haemorrhage or your baby seems to be in severe distress.
HOW CAN I HELP MYSELF AT HOME?
Before you are fully established in labour your cervix (the neck of your womb) has many changes to make. It changes position, thins out and dilates. While these changes are occurring pains are mainly felt in your back or may be described as ‘period like’ cramps. These pains tend to remain irregular and have no real pattern.
During this pre-labour period there are many things you can do at home to help yourself to have a normal birth. Firstly avoid using comfort techniques too soon. If your contractions are mild enough to ignore them do so. Go about your daily routine, when it is time to pay attention your body will alert you.
- Try to stay as relaxed as possible- it is normal to be anxious.
- Listen to relaxing music.
- Take a walk with your birthing partner.
- Take a warm bath or shower at regular intervals (baths are only allowed if the waters are not broken).
- Ask your birthing partner to give you a back massage- this helps with the backache and relaxes you.
- Eat small light meals and drink plenty.
- Empty your bladder every 1-2 hours. (a full bladder can block baby’s descent)
- Sleep – if the contractions are mild or stop, sleep or nap between contractions (being tired reduces a body’s ability to handle stress).
- Breathing – keep your breathing deep, steady and slow during a contraction. Once the contraction is wearing off close your eyes and allow your body to rest before the next contraction.
- Try to remain upright once the contractions become strong. Gravity will help your baby to be born. Being upright doesn’t have to mean standing- you may also try squatting, kneeling or leaning/sitting on a birthing ball. You may try rocking your pelvis gently, swaying your hips, walking up and down stairs.
- It is safe to take a painkiller such as PLAIN Paracetamol (if you are not allergic). You can take two (500mgs) tablets every 4-6hrs. Do not take more than 8 tablets within a 24hour period. This helps with mild pains, allowing you to have some rest.
WHAT COULD PREMATURE BIRTH MEAN FOR MY BABY?
Having a baby born early can be worrying and distressing for parents. Your doctor and/or midwife will be happy to talk to you about this and give you information about support groups that you might find helpful.
Premature babies have an increased risk of health problems, particularly with breathing, feeding and infection. The earlier your baby is born, the more likely he or she is to have these problems and your baby may need to be looked after in a neonatal unit. However, more than eight out of ten premature babies born after 28 weeks survive and only a small number will have serious long-term disability. Many survivors (as children) who have long-term health problems still rate their quality of life as being good.
If you give birth before 24 weeks of pregnancy, it is sadly much less likely that your baby will survive. Babies who do survive after such a premature birth often have serious health problems. The possible treatment and outcomes for your baby in your individual situation will be discussed with you.
You will be supported to spend as much time as you can with your baby. Breast milk is very important for premature babies: the doctors and nurses will talk to you about this and provide any support you need.