hey everyone we are kicking off the third trimester talking about that thing we are all
anxiously waiting for labor so what is labor how do you know if you're in labor what should you
expect when should you call your doctor and go to the hospital and we're going
to be covering all of that right after this but just in case you've never met us before
i'm kurt i'm a pediatrician i'm sarah i'm an ob gyn and we are the doctors bjorkman
welcome back everyone as i said i'm an ob gyn and i am also just starting the third trimester
of pregnancy and so we've been going through pregnancy week by week sharing with you guys
all our real life experiences along the way yes we've been counseling patients on these kinds of
topics for years but it has been a real learning experience for us to now be on the patient side of
it and as we're nearing this home stretch that is the third trimester uh we were just sitting
around a couple nights ago as we were getting our hospital bag ready and starting to think about
the big day um i have sarah gosh like what is it actually gonna look like when you're in labor
yeah so you know you literally wait almost 40 weeks for this and then
you're like is this a contraction am i in labor is this braxton hicks what's going on do i call the
doctor do i go to the hospital um so we're going to talk all about that right now a lot of patients
have this misconception that their due date is the day the baby is coming but it's actually rarely
the case yeah only about five percent of women will actually give birth on that due date yeah
so when we look at birth certificate data in the united states it shows us that almost 90 percent
of women are going to give birth and have their baby sometime between 37 and 41 weeks and only a
handful go beyond 41 weeks and as it is about 10 or 1 in 10 babies are actually born pre-term or
before that 37-week mark um if that ends up being the case for you or you have more questions about
pre-term birth and pre-term babies we did a whole episode all about that a couple weeks ago so go
ahead and check that out but basically your due date is kind of just a general idea of when the
baby is going to show up and so that gives you the question of gosh when are you actually in
labor right let's first talk about what labor is and the different stages of labor yeah so
real labor is regular painful contractions that leads to cervical change exactly so remember your
uterus started out as this fist-sized muscular organ that over the course of three trimesters
grew with that growing baby to be the size of a beach ball and so what happens is your body is
going to send signals through hormones and other signaling pathways that are going to start the
involuntary contraction process of that uterus which is then going to lead to cervical change
through both dilation and effacement yes so let's break down dilation and effacement
this i want you to think of the cervix kind of like the door to the uterus and so it has to open
and get a little thinner than it starts out for that baby to pass through so cervical dilation
is you know your uterus is doing those strong muscular contractions and baby's head is pressing
down on your cervix and it starts to dilate okay so it kind of works yep and it starts to open up
the cervix also starts out kind of thick your this door and it has to get paper thin
so that's called a faceman is when the cervix thins out so you end up with a 10 centimeter
cervix that's paper thin so that's where we go back labor equals contractions and cervical change
the whole labor process is divided into three stages that you might likely hear your ob provider
talk about what you're going through the process right so the first stage of labor is where you
go from zero centimeters closed cervix to ten centimeters or completely dilated cervix and
that first stage of labor actually kind of gets broken down into two there is the early labor or
latent labor is what we call it and that's where you're going from zero centimeters
to five centimeters and this is kind of characterized by a slower cervical change
whereas when you hit six centimeters we call that active labor and we expect that cervix to
be changing much more quickly and things are really starting to move along there
gotcha and this is all where all those involuntary contractions are happening correct gotcha okay
which then brings you to the second stage of labor which is the active pushing phase
actually getting the baby from inside the uterus to outside the uterus and into the world yes and
for a first time mom with an epidural this could take up to four hours and so just be ready that
you may have a lot of work to do um they don't definitely don't call it labor for nothing correct
and then the third stage of labor and that is delivering the placenta so
from the time after the baby's born till the placenta or after birth is delivered is usually
about 30 minutes it doesn't have any bones so it's much easier than delivering the baby
so the question you might have and that i actually had this week was how do you know
when this process is actually getting started for real so what i tell my patients is if they start
having contractions at home that they should get out a timer get out your stopwatch on your phone
have download a contraction timer app on your phone something to keep track
and just time those contractions and so um you have a contraction 10 minutes later you
have another contraction maybe 15 minutes after that you have another contraction
15 minutes after that you have another contraction and then those kind of peter
out or you fall asleep or you space out those aren't labor real labor contractions are you
timing those from start of contraction to start of the next one start of one contraction to the
start of the next one yep um so again if those kind of peter out you fall asleep
not labor those are braxton hicks gotcha so braxton hicks aren't real contractions then no no
no braxton hicks are absolutely real contractions it is your uterus contracting but it's kind
of practice contractions that aren't causing cervical change now don't get me wrong they can
be very very painful and uncomfortable but they aren't doing anything to your cervix they tend to
be unpredictable kind of more uncomfortable than painful they aren't regularly timed it's
not like you're having contractions every five minutes you'll have one and then 10 minutes later
you have another and then 15. and so those are braxton hicks they can totally fake women out um
but not that we call it false labor gotcha and so every once in a while i feel like you
mentioned that your uterus is getting harder like a rock is that what a braxton hicks is
that's exactly what it is you kind of feel your uterus contract it becomes really hard really firm
that's braxton tanks so i would say i started noticing
braxton hicks or just uterine contractions around 20 weeks um actually and it just felt
like my uterus was a rock i'd feel my belly or i'd have curt feel my belly and i'd say
feel this it's so hard it feels like a rock and that's all a contraction is like a menstrual cramp
um your uterus just contracts and you feel it and it's not really painful it's kind of uncomfortable
and it just starts doing that um till the end of pregnancy and it's not until there are those
regular painful contractions every five minutes or so that we're talking about labor
um but that's the braxton hicks so these racks and hicks contractions that don't lead to real labor
can be triggered by multiple different things things like exercise activity dehydration a full
bladder or even sexual intercourse yep and so if you are noticing contractions and you're kind of
not sure which way it's going i often tell my patients to kind of change up what you're doing
if you were exercising or being really active then go sit down take a warm bath take a shower
drink a full glass of water or if you are kind of just relaxing and you're noticing it get up go for
a walk and see are these contractions getting stronger over time or do they kind of peter out
and go away but if none of those things work for you and you're still having continuous regular
painful contractions you might be in real labor so that brings us back to timing those contractions
so you're writing it down they're every seven minutes they're every seven minutes now they're
every six minutes you're really feeling it you're breathing through those contractions you can't
sleep through these it's a little tough to walk around you're squeezing your partner's hand that
is sounding like labor so i usually advise my patients to call when they get to the 5-1-1 point
and that means that you are having contractions every five minutes they last about a minute long
and that's been going on for an hour and these are just getting more and more intense so at that
point call your provider yeah and the timing of when you should call your ob provider may vary a
little bit based on how far away from the hospital you live and how many babies you've had before um
so if you lived a far ways away or if you've had multiple babies before it may mean that you need a
little bit extra time you need to mobilize to get to the hospital sooner it's a great thing to sit
down and chat with your ob provider at one of your visits during the early third trimester to say
how soon do you want me to call you when i start having regular contractions exactly and they're
going to have an answer of what they are really comfortable with the other thing i want to point
out here is that if you are less than 37 weeks and you are having regular painful contractions
no matter how long they've been going on for you should absolutely call your ob provider
because that makes us concerned for preterm labor and we don't want you to stay at home for that
so as we were editing this video we realized that we wanted to make sure we talked about a couple
more reasons to call your ob gyn so in addition to the 5-1-1 rule we talked about which was
you're having contractions every five minutes they last about one minute and it's been going
on for at least an hour other reasons to call your ob are going to be you're having regular
contractions and you're less than 37 weeks if you think you're water broke or you have
a big gush of fluid from your vagina if you are having vaginal bleeding definitely call your ob
right away and then some other important things to call your ob for or if you have a headache
you develop a severe headache that doesn't get better with tylenol if you have vision changes new
changes in your vision if you have some pain right here kind of on your right side of your abdomen
that won't go away or if you notice that you have this unexplained new onset shortness of breath
call your ob and the final thing always call your ob if you feel like your baby is not moving
like normal for you when the time comes that you do call your ob provider they're likely going
to want to walk through some of the symptoms that you've been going through over the past
hour or so to see kind of what they think about what you've been feeling and if it sounds like
true labor and then with you you guys will have that joint decision about is it time to come in
or do we want to wait another hour and check back in before calling you in exactly and so
either way by the time you make that decision to come to the hospital or wherever you're going to
go deliver baby at uh one of the first steps is to check and see how often the contraction is coming
and what's happening with baby's heart rate and they'll often do this with some sort of external
monitoring that they're able to measure these with exactly and the other thing they're going to do
when you get there and have been having these painful contractions is to check your cervix
because as we learned labor equals painful regular contractions and cervical change
so we want a baseline when you get there of what your cervix is doing and then usually depending on
how dilated your cervix is they will say hey let's watch these contractions over the next hour or two
and recheck your cervix to see if it's changed if your cervix hasn't changed they might say hey
you know what this is early labor your cervix is changing really slowly why don't you go walk
around for a while or if you live close to the hospital maybe go home take a hot shower or bath
bounce on your ball and check back in in a couple hours and see where your cervix is at now your
cervix may be four or five centimeters dilated or you may change a centimeter or two over that time
and your ob is going to say hey it is time to get admitted this is labor let's get this show on the
road and have a baby and they will talk to you about your different options for what you want
to do for pain control and all these different things um but it's showtime yeah and so with that
we can of course not predict when that day's going to come and so we've been doing lots to get ready
for that and we're going to be sharing that all with you guys in the upcoming week so please make
sure you're subscribed we're going to be going through things like what's in sarah's hospital
bag what we're doing with our nursery to get ready as well as covering some educational topics about
epidurals and pain control options for your delivery you know what should i
expect if i end up needing a c-section and all these different things so that you know
what to expect when you get to that hospital and actively we're ready to have that baby
so we can't wait to see you guys next week make sure you're subscribed bye guys
we're doctors but not your doctors anything we've said in this video
is for education or entertainment purposes only it is not medical advice
any specific medical questions you have should be directed to your provider