The first symptoms of labor tend to occur much earlier than at the time of delivery. Usually, therefore, the woman has plenty of time to evaluate these symptoms together with the medical staff and to understand whether or not it is a false alarm.
The most important signs that herald the beginning of labor (prodromal phase) are:
the issue of the cervical cap;
the beginning of regular and worsening contractions over time;
spontaneous rupture of membranes (water breaking).
Cervical cap emission
During pregnancy, the cervix is occupied by an accumulation of mucous material, which prevents the ascent of pathogenic microorganisms into the uterus, protecting it from the aggressions of the outside world. At the beginning of labor, when the cervix begins to dilate in preparation for childbirth, this cap slips away and is expelled. On this occasion, the expectant mother feels the release of a white, dense, odorless and mucilaginous substance, streaked with blood and sometimes followed by a small blood loss.
Water breakage
The "water bag" is the "sack" that contains the fetus and the amniotic fluid in which it is immersed.
In its classic presentation, the breaking of the water leads to the descent into the vagina of a large quantity of hot liquid, normally odorless and colorless. These characteristics help to differentiate it from urine and common vaginal discharge, more viscous, not continuous and sometimes mixed with blood. The amount of amniotic fluid that comes out of the vagina is however variable; if, for example, the bag is punctured at one point rather than completely breaking, the loss is modest and not constant; nevertheless, it repeats itself throughout the day and is generally associated with the mother's movements.
The membranes can break at the beginning of labor or without the contractions having started; in most cases the waters break during labor and if uterine contractions do not occur in the next 24 hours, they are generally medically stimulated.
Uterine contractions
In the last period of pregnancy uterine contractions are a fairly faithful company. False labor pains, or more technically contractions of Braxton-Hicks, tend to increase in intensity and frequency. Unlike these contractions, typical of previous weeks, the actual preparatory contractions for childbirth are characterized by a stable and continuous rhythm, and do not disappear by walking, lying down or changing position. On the contrary, they become more and more frequent and painful, so much so that when they arrive the woman needs to stop and lean on someone or something. During this event, the expectant mother feels an internal compression of the belly, which in true contractions is often associated with a painful sensation in the upper part of the abdomen or in the loins (at the level of the kidneys) and at the hips.
Sometimes accompanied by the loss of amniotic fluid, at first the true uterine contractions follow one another every 15-30 minutes, with a duration that can range from 15 to 20 seconds. Once the labor has begun, the contractions become more and more close, more intense and longer, appearing 3-5 times every 10 minutes, for a duration of 40-60 seconds each. Given the importance of the intensity and frequency of this symptom, pregnant women generally receive precise instructions from health professionals to note the frequency and duration of contractions. The important fact, however, is not so much the distance between one contraction and the next, but the regularity with which they follow one another.
Another symptom that can announce the imminent arrival of labor is diarrhea, sustained by the release of endocrine and paracrine hormones that prepare the mother's body for the happy event.
Generally, the only subjective symptoms are not enough to diagnose labor. In order for the health personnel to confirm that the long-awaited and planned time is almost upon us, it is necessary to carry out a vaginal examination. If with the passage of time the uterine cervix dilates and thins the labor is now begun: active or dilating phase, also called I stage).
