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Don’t fear early labour… it can set the tone for the rest of the childbirth experience. Eve Health midwife, Lauren Williams, shares what you need to know about the early stage of labour, so that you can feel more comfortable knowing what to expect and when to transfer to the hospital.

Anyone who has read about labour will know there are three stages:

1) First Stage: Contractions which we break into 3 phases. Latent phase (early labour), Active phase and the Transitional phase

2) Second Stage – Pushing

3) Third Stage – Birth of your placenta

Clinically, early labour is hard to define as it can vary greatly among women, particularly first time mothers, both in clinical symptoms and length of time. The Queensland Maternity and Neonatal Guidelines for normal birth define early labour as “a period of time, not necessarily continuous, that is associated with painful contractions and some cervical change including effacement and cervical dilatation up to 4cm” (Queensland Health, 2012, p. 25). Does this seem confusing?

For many women, recognising the signs of labour and identifying the right time to go to hospital causes significant uncertainty and anxiety. This ultimately leads many to seek validation from professionals at the first sign of labour, rather than having confidence in themselves and their own instincts. There is a large body of evidence supporting the advice to keep women out of the birthing suite until labour has established to avoid unnecessary interventions, however this may result in some women feeling unsupported. Women often find it difficult to accept being at home is best for them as the culture of birth is often reflected negatively through media and birth stories, provoking an increase in childbirth fear. It’s reported up to 20% of women now fear childbirth, regardless of their own personal risk factors. Researchers have attributed the effects of fear in labour and its associated impact on birth outcomes, to the interruption to a woman’s primal sense of safety, altering the natural hormones of labour.

Labour Hormones:
• Prolactin (mothering/nesting hormone)
• Oxytocin (hormone of love)
• Adrenaline/Noradrenaline (fight or flight response)
• Beta-endorphins (feeling of pleasure and reward).

Prolactin has many uses but during pregnancy will drive a mother to seek a safe place to give birth, be it a hospital or at home, and is also said to be the hormone responsible for the nesting behaviour.

Oxytocin, also known as the hormone of love, is responsible for causing uterine contractions during labour as well as helping the uterus reduce in size after the birth to control bleeding. Oxytocin is also responsible for the milk let down during feeding and promoting mother-child bonding. Levels of oxytocin gradually increase throughout the labour, with its peak triggered by the stretching of a woman’s perineum as the baby is born.

Maternal and environmental factors can alter the balance of these rising levels and cause the labour to slow or stop. These changes in labour patterns are a result of the release of adrenaline and noradrenaline, also known as catecholamines. These hormones are responsible for the fight or flight response and are activated when we have feelings of fear and anxiety, interfering with the release of oxytocin. As a result, women often experience a change in their labour patterns (contractions slow or stop) after entering the hospital environment due to the unfamiliar surroundings and the presence of being observed. This is most likely because we are primed as children to see hospitals as a place for sick people and procedures.

Finally, other hormones affected by childbirth fear are a reduction in beta-endorphins, our body’s natural pain-killers, which ultimately leads to an inability to cope with the pain of labour and is said to lead to more use of epidural analgesia.

The majority of women can achieve a normal birth if they feel they can cope and their baby is safe. Attending antenatal education (childbirth classes) for you and your support people during pregnancy will help you form realistic labour expectations and empower you to have confidence to know when the right time is to transfer to hospital.

The signs you may be in early labour:
• Period-like abdominal cramps that come and go at irregular intervals
• Lower back pain
• Heaviness down your thighs
• Nausea (it is common to vomit early and late in labour)
• Loose bowel motions
• Mucous “show or plug” – can appear clear/yellow with old blood or fresh blood through out and may be thick or stringy. (NB: fresh bright bleeding “dripping” not mixed with mucous requires you to seek medical attention)

During this time get as much rest as you can, especially if signs of labour start at night. Try not to get caught up watching the clock until your contractions feel regular and last 60 seconds – that’s what your support person is for. As your labour progresses, your body language will become more primal, you may find yourself rocking, stamping, tapping your hand, heavy breathing or vocalising. This is a good time for your support person to keep an eye on timing contractions and packing the car. Some comfort measures to use during early labour at home include heat packs, baths/showers, movement, and fitballs. TENS machines are also an effective strategy to assist you to feel in control, manage contractions and reduce anxiety before its time to transfer to the hospital. We hire out Labour Tens from 37wks, your midwife can provide you with a tutorial and more education.

Remember – you can’t control your hormones, so trust your instincts!

This post was written by Lauren Williams, a midwife at Eve Health.