Signs of labour

The journey of pregnancy culminates in the much-anticipated event of childbirth. As the due date approaches, an expectant mother often finds herself eagerly scanning for signs that herald the arrival of her little one. Nature, in its wisdom, provides a set of cues to signal the body's readiness to bring new life into the world. Let's delve into the varied signs that indicate the onset of labour, unravelling the intricate dance between the mother's body and her unborn child.

Mucous Plug

The cervix, which is the lower part of the uterus, remains closed during pregnancy, safeguarded by a thick gelatinous seal known as the mucous plug. This plug acts as a protective barrier, keeping bacteria and other foreign elements out of the uterus. As the cervix begins to soften, thin out, and dilate in preparation for labour, this mucous plug may be dislodged. It can appear as a thick or stringy discharge, which can be clear, pink, or slightly blood-streaked. The loss of the mucous plug, often referred to as 'losing the plug', is a sign that the body is gearing up for labour, although it may still be days or even weeks away.

Bloody show

The "bloody show" refers to a slight increase in blood or pinkish discharge that follows the loss of the mucous plug. It's caused by the rupture of tiny blood vessels in the cervix as it begins to efface (thin out) and dilate (open). The appearance of the bloody show indicates that the cervix is undergoing changes in readiness for birth and usually means that labour will commence within a few days.

Baby 'dropping' - station of baby

The term "baby dropping" refers to a stage late in pregnancy known as "lightening." This is when the baby moves into the pelvis in preparation for birth. Here's a breakdown of what this means:

Timing: Lightening usually occurs a few weeks before labour begins, though it can happen earlier or just before labour in some cases. It's more common for first-time pregnancies to experience this earlier.

Physical Changes:

Baby's Position: The baby descends lower into the pelvis. This change in position is often noticeable.
Altered Shape of the Abdomen: Many women notice that their belly looks lower and feel a sensation of heaviness or pressure in the pelvis.

Symptoms and Sensations:

Eased Breathing: With the baby moving down, there's less pressure on the diaphragm, making it easier to breathe.
Increased Pelvic Pressure: This can feel like heaviness or aching in the pelvis.
Frequent Urination: The baby's head pressing against the bladder can cause a need to urinate more often.
Increased Back Pain: The change in the baby's position can affect the mother's centre of gravity, potentially causing back pain.

Not a Predictor of Labour: While lightening is a sign that the body is preparing for labor, it doesn't necessarily indicate when labour will start. It can occur weeks, days, or just hours before labor begins.

Stations: The concept of "stations" in obstetrics refers to a measurement system used to describe the position of a baby's head (or presenting part) relative to the ischial spines in the mother's pelvis during childbirth. The ischial spines are bony prominences in the pelvis and serve as a reference point. The station is measured from -5 to +5:

Negative Stations (-5 to 0): This indicates that the baby's head is above the ischial spines. The higher the negative number, the higher the baby's head is in the pelvis. For example:
- -5 Station: The baby's head is floating above the pelvis.
- -3 Station: The head is lower but still above the ischial spines.
- 0 Station: The baby's head is at the level of the ischial spines, also known as "engaged."
Positive Stations (+1 to +5): This indicates that the baby's head is below the ischial spines. The higher the positive number, the closer the baby is to being born. For example:
- +1 Station: The baby's head is just below the ischial spines.
- +3 Station: The head is deeper in the pelvis, moving closer to the vaginal opening.
- +5 Station: The baby's head is crowning, which means it is visible at the vaginal opening during a contraction.

Waters Breaking

Rupture of membranes (ROM) is a significant event in pregnancy, typically signalling the onset of labour. It refers to the breaking of the amniotic sac, a fluid-filled membrane that surrounds and protects the baby in the uterus.

Why It Happens

Natural Rupture: In most cases, ROM occurs naturally as a part of the labor process. When the baby is ready for birth, the amniotic sac breaks, releasing its contents, often referred to as the "waters."
Induced Rupture: Sometimes, medical intervention is required to induce labor. In such cases, a healthcare provider might artificially rupture the membranes, a procedure known as amniotomy.

Composition of Amniotic Fluid

Amniotic fluid, or "waters," serves several crucial functions:

Protection: Cushions the fetus, absorbing shocks and protecting it from injury.
Development: Allows free movement, essential for musculoskeletal development.
Temperature Regulation: Helps maintain a constant temperature around the baby.
Infection Barrier: Acts as a barrier to infection.

This fluid is primarily composed of water, but it also contains electrolytes, fetal urine, and lung secretions. Its composition changes as pregnancy progresses.

Fun facts!

Intact Membranes During Delivery

Rarely, a baby might be born with the amniotic sac still intact, a situation known as "en caul" birth.

Membrane Replenishment

Interestingly, amniotic fluid can replenish itself. The baby continually swallows the fluid, processes it, and then releases it back into the sac via urination. This cycle helps maintain the volume and composition of the fluid, essential for fetal development.

Lesson 1 – Signs of labour

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