Maternity - L&D, part 1: Physiologic Changes before Labor, True vs. False Labor

Hi, I'm Meris, and in this video, I'm going to be talking to you about the physiologic changes that happen for patients before labor, and we're also going to be talking about the difference between true labor and false labor. I'm going to be following along using our maternity flashcards. These are available on our website, LevelUpRN.com, if you want to get a set for yourself. If you already have a set for yourself, I would invite you to follow along with me. All right, let's get started.

So first up, we're talking about physiologic changes that occur before labor. And when we say this I want to make it really clear that it doesn't mean that these are changes that happen immediately before going into labor, but these are the changes that will be happening in the weeks leading up to labor.

So, for instance, backache--well, yes, this may happen immediately before labor, but also, as the muscles and ligaments relax in that area in your pelvis preparing for labor, that can cause a backache.

Another thing we have on here is the bloody show. And now, a bloody show is what it sounds like. It's a show of bloody mess, and this is something that not all patients will experience but it's a brown or bloody or blood-tinged vaginal discharge. You may also hear this called a mucus plug. But essentially, we're passing things through the vagina that previously were being held by the cervix, in preparation for labor--doesn't mean I need to go to the hospital right this second, but it does mean that we're getting closer to delivery.

A burst of energy which is sometimes called nesting--so I know that for me, personally, I felt very much like I had to get the house ready. I had a scheduled C-section with my daughter, but I still had that nesting experience where I needed to clean everything, and I couldn't sleep because I had to wash all of her clothes and that sort of thing.

Now contractions--and we're going to talk about this in the next card, too, but contractions are going to start coming more frequently and getting close together. And obviously, if I'm having true contractions that are increasing in strength and duration and intensity and all of that, then yes, that means I probably am in labor right now. But you will still have an increase in even Braxton Hicks contractions as you get closer to labor.

Now, GI upset--very common, but again common in all of pregnancy, so not a huge sign there.

But lightening--lightening is the the point in time in which the baby drops lower into the pelvis, and so this may be something where your provider might say, "Wow, really looks like that baby has dropped." That could mean that labor is oncoming.

And then, of course, rupture of membranes, again doesn't always mean--you see in the TV, movie world, "My water broke," and then they're like, "I got to go to the hospital right now." Not necessarily the case, but probably very soon. So just because the membranes have ruptured does not mean it's time to have the baby right this second, but probably pretty soon, and you should still seek medical attention if you believe that your water has broken or your membranes have ruptured.

Now let's talk about true versus false labor, and I want to show you that there's a really, really nice chart here on the back. We put this in a table for you, to show you some of the compare-and-contrast between true labor and false labor.

So let's talk about what false labor is. This is usually just the body practicing. We talk about practice contractions and things like that. Literally, the body does practice. And also, as the baby gets bigger and puts pressure on things, you can have these irritations and these symptoms.

So when we talk about contractions, we have true contractions which affect the length and the dilation of the cervix. That is what a true contraction is. It is actually changing the cervix itself versus a Braxton Hicks or a practice contraction. This is just a weak contraction and it's going to be not really time-able. It's not something where it's getting stronger. It's coming at a regular interval. It's happening more frequently. All of those things are usually associated with true contractions--doesn't mean that it's not painful. It's just not labor.

Now, with contractions, if I have actual labor contractions and I'm walking, it's going to increase the intensity of my contraction. Whereas being active, walking, changing position--that may actually help to decrease the pain of Braxton Hicks contractions. Now, again, we're talking about practice versus real. A real contraction is because of a positive feedback loop. I'm getting that oxytocin, which is causing the contractions, and the contractions are causing more oxytocin to be released, causing stronger contractions, etc. No matter what I do - drinking water, laying down, rolling on my left side, any of those things - it's not going to stop that positive feedback loop. But with a Braxton Hicks practice contraction, if I drink water, if I lay down, if I put my feet up and relax, all of those things may help to make the contractions go away. So that's an important distinction, as well.

We've already said cervical changes only happen with actual contractions. And then this one is just a little bit of a thing, but the presenting part of the fetus - meaning the part that is presenting at the cervix - is going to be engaged in the pelvis with true labor, but will not be in false labor. But really, I would focus more on the contraction side of things.

Okay, so I hope that review was helpful. Let's go ahead and test your knowledge right now, so I want you to think about this patient that I'm going to be telling you about. We have a patient who calls the OB clinic where you work and says, "Hey, I'm 32 weeks pregnant and I've been having these contractions all day long. They come and go and I'm really concerned, and I think I might be in labor." And you talk to the patient on the phone for a little bit and get some information and you decide to bring the patient into the clinic. And the provider does a cervical check and says that the cervix is closed, high, and thick. What do you think? Is this true labor or is this false labor? Let me know.

I hope that review was helpful. If it was, go ahead and like this video so that I can know, and I do hope I see you in the next one. Thanks so much, and happy studying.