Am I actually going into labor?

One of the most searched topics during pregnancy? “Am I actually going into labor?”

Although the conventional knowledge says that pregnancy lasts nine months (which would be 36 weeks), most babies are actually born between 38 and 42 weeks. This means that you can think of your due date as more of a “due month” rather than a specific date. In fact, less than 5% of babies are born on their due date. This date range can present a problem, though: how do you know if you are actually ready to meet your baby? Here are four surefire ways to know if you are going into labor.

You’re experiencing certain physical and emotional changes. 

There are specific physical and emotional changes we hear from clients that make your doula double check her birth bag and put her running shoes by the door! We often see a change in emotions and becoming more sensitive. Bursts of nesting energy and new or unusual cravings can also signal your body is getting ready to give birth. Physical changes may also occur.

These may include:

  • feeling “crampy” or having backaches
  • increased vaginal discharge
  • loss of mucus plug (especially blood-tinged mucus)
  • softer, more frequent bowel movements.

Be in tune with your body and emotions, and communicate those changes with your care providers as you get closer to your due month.  

You’re having uterine contractions. 

Uterine contractions are the first sign of going into labor for most people. But how do you know the difference between uterine contractions and Braxton Hicks or false labor contractions? Uterine contractions are regular and consistent; they get steadily closer, stronger, longer and do not lessen with rest, movement, eating or drinking. You may have contractions before you are in labor. But if they are not causing your cervix to change, you are not in labor. See our blog post on latent labor for more on those contractions.

Your water breaks. 

You’ve seen it in movies and on tv shows: water spills on the floor and the character suddenly knows their baby is coming. In reality, only occasionally does your water break ahead of contractions. Typically the other signs we’ve outlined will happen for hours or even days prior to your water breaking. Ir this is your first sign, the vast majority of people will experience contractions that follow within 12-24 hours. 

Your cervix is not a crystal ball and it can’t tell you if labor is imminent.

Cervical exams are not necessarily an indication of when labor will begin. There are a number of cervical changes that have to take place ahead of dilation, the number measured in centimeters that we all associate with how close the baby is to being born.

Your cervix will go through these changes:

  • shift forward to align with the birth canal
  • soften or ripen
  • thin (or efface)
  • The final step is dilation.

These changes may be evaluated by your care provider during a cervical exam once you head to the hospital in order to determine if you are in labor.

To learn more about childbirth and the stages of labor, sign up for our Complete Childbirth Education class or Birth Basics. 

Group B Strep: What is GBS?

If you’re pregnant it’s likely you’ve heard of Group B Strep (GBS), probably as one of the required tests for pregnant individuals. What is it and why does it matter? While GBS is common, (1 in 4 pregnant individuals have it present!) if left untreated it can pose serious health risks. Today we’re taking a look at what GBS is, treatments and testing, and the bottom line so you can make informed and empowered decisions for you and your baby.

What Is Group B Strep (GBS)?

GBS is a common bacterium (Streptococcus agalactiae) that naturally exists and is typically harmless in adults. It resides in the digestive, urinary, and reproductive systems. While the bacteria may be present (colonization) it often doesn’t lead to infection.

If a bacteria has colonized, it simply exists. It’s when it gets out of control that it can cause infection in the body. Even if one is asymptomatic, infection could be present and is very dangerous for newborns which is why testing is so important. An estimated 20-25% of pregnant individuals have GBS present.

Remember: levels can vary over time.

Why Is Group B Strep a Concern During Pregnancy?

Risks to the Pregnant Person:
Those who have GBS present generally are unaffected. Rarely, they can encounter complications such as Urinary Tract Infections (UTIs), infection of the amniotic fluid or infection of the uterus once the baby has arrived. 

Risks to the Baby:
The risks of GBS are generally for the baby. Transmission of the bacteria to the baby during childbirth can lead to early-onset (first week) or late-onset (weeks 1–3) disease. Complications from contracting this bacteria include sepsis, pneumonia, meningitis, long-term disabilities, or even mortality.

Though this can sound scary, please keep in mind that these are rare complications, only affecting 1 or 2 babies out of 100 if the laboring person doesn’t receive antibiotics during labor. Though rare, it’s vital to understand the facts.

Risk Factors for Transmission:
Your baby may be at a higher risk for contracting GBS if you experience preterm labor, prolonged rupture of membranes (greater than 18 hours), a fever during labor, or a prior GBS-positive baby. Your baby is also at risk if you test positive on your routine GBS testing.

How Is GBS Tested for in the United States?

The United States takes a broad approach to testing using a Universal Testing model that requires a routine vaginal/rectal swab at 36–38 weeks. This will typically be done at your OBGYN or Midwife’s office. This swab is then cultured and evaluated to determine if GBS bacteria are present. If yes, the results will be communicated to you along with options for treating and intervention.

This testing is done between 36-38 weeks to ensure accuracy (remember, this bacteria varies in levels present) and avoid overuse of antibiotics.

Urine testing can also detect GBS earlier in pregnancy. Typically a positive result won’t prompt any action by your care provider but if heavy colonization is indicated, this could require antibiotics during pregnancy.

You might be surprised to find that countries around the world vary in their approaches. Canada, for instance, aligns with the US perspective of Universal Testing whereas Nordic countries such as Sweden and EU countries such as the UK prefer a Risk-Based approach where testing is only done if requested or indicated. Regardless, it’s important to ask questions and follow the recommendations of your trusted healthcare provider.

What Are the Options If I Test Positive for GBS?

Intrapartum Antibiotics:
The gold standard for care is IV penicillin administered during labor at least 4 hours before delivery. This helps ensure efficacy of the antibiotic prior to baby passing through the birth canal. The timing is important!

Special Scenarios:
If labor is rapid it can limit the efficacy of the antibiotics. Antibiotics will still be given but baby will likely be monitored more closely. In the event of a Cesarean section delivery, antibiotics won’t be needed if labor hasn’t begun and your water hasn’t broken.

What Else Should I Know About Group B Strep?

Prevention Strategies: There are no preventative measures that can be taken to eliminate GBS bacteria in the body. This bacteria occurs naturally. Once detected, prompt antibiotic treatment reduces neonatal risk by ~80%.

Newborn Care: It’s important to monitor the baby for fever, lethargy (difficult to wake), or breathing struggles. These can all be signs of infection and should be addressed as soon as possible by a medical provider. The baby’s pediatrician should be the first call. Antibiotics are the standard treatment.

Postpartum Care: Mind the birthing person’s temperature and symptoms alongside baby’s, paying attention to any changes and seeking care if they’re noted.

Emotional Support: Addressing parental anxiety and connecting with support groups.

Future Pregnancies: Retesting will be required for all subsequent pregnancies, however, a positive test isn’t a guarantee. Group B Strep can be a transient bacteria that recedes, eliminating the risk to the birthing person and their baby.

Are There Myths About GBS?

Yes! There are many myths about GBS that can feel scary or leave you feeling confused. The main ones are:

GBS is not a sexually transmitted infection. It is a naturally-occurring bacteria that exists within the body and a common one, at that.

Antibiotics during labor do not harm the baby. While it is true that the antibiotics could have a small impact on baby’s microbiome, these effects have not been studied at length. Preliminary studies with limited data suggest that the impact is short-term and the effects can be mitigated to some degree by choosing to breast or chestfeed.

Positive status doesn’t guarantee infant infection! Even if you do test positive and aren’t able to recieve antibiotics quickly the number of newborns that get sick from GBS are few. While the illness is a very serious one and shouldn’t be taken lightly, it is still rare.

No proven remedies are known to exist besides antibiotics during labor. There are many online suggestions such as Hibiclens or Garlic to change the bacteria levels. There are no scientific studies to prove any of the alternatives work to keep your baby safe.

Wrapping it all up

If you’ve found yourself here because you have tested positive for GBS, don’t panic. Remember, GBS is a bacteria that naturally exists within the body. There is nothing you could do that would change that. If you test positive for GBS at your routine screening, remember that it is manageable with proactive care.

Antibiotics reduce both neonatal and postpartum risks for baby and parent and can be simply administered during labor.

As with everything, remember to ask questions and follow the guidance of your medical care provider. With early intervention, proper treatment, and consistent care you and your baby will not experience any ill effects from GBS.

The Changes Your Body Experiences After Birth

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We spend nine months getting ready for baby to arrive–both physically and emotionally. But the actual birth experience portion of your journey is relatively short. After birth, your body continues to change for many months. Here are some of the changes you can expect in the moments, weeks, and months after birth. 

What will I experience immediately after birth?

Immediately after birth, a care provider may place baby directly on your chest. This skin-to-skin contact helps regulate baby’s body temperature and calms baby. But it can also help your uterus contract to reduce bleeding. Bleeding may still be taking place from where the placenta was attached to the uterus or from any tears. A care provider might provide medication to slow or stop that bleeding, perform a uterine massage, or stitch the perineum. You might also shake, have contractions, feel weak, or be sore (you did just work very hard). 

How long does it take to recover from childbirth?

How long it takes to physically recover from childbirth depends on what happened during birth as well as the birthing person’s activity level. If you had tearing, an episiotomy, excessive blood loss, or a cesarean birth, it may take you longer to recover. In the days and weeks following birth, your body will feel different. You may be exhausted, bloated, and sore. The change in hormones can cause mood swings, sweating or hair loss. Pregnancy and childbirth also stretches ligaments and muscles, so your abdominal and pelvic floor muscles take time to tighten back up. If you had a c-section, remember that it is major surgery. You shouldn’t lift or over-exert yourself. Take the time you need to recover, listen to your body and be gentle with yourself

What are the emotional changes I’ll experience after birth?

Our brains are a part of our bodies, and the physical changes to our brains can alter our emotions. The change in hormones that happens in the postpartum period can make you feel happy, excited, positive, overwhelmed, sad, possessive, or disappointed. These are all normal. Making a plan for how family and friends (link to last blow) can help reduce stress. Prolonged and severe depression can also happen after childbirth, and if you (or your support network) are worried about a Postpartum Mood Disorder (PMDD) or Post-traumatic Stress Disorder (PTSD), talk to your care provider. 

What physical changes are not normal?

If you have any physical or emotional changes that concern you, talk to your care provider. They can help you determine what is normal and what isn’t. You should also talk to your care provider if you have vomiting, flu-like symptoms, fever, heavy bleeding, difficulty urinating, leg pain, vaginal itching, dizziness, shortness of breath, or racing heart. 

Can I recover more quickly after childbirth? 

The most important thing to do after giving birth is listen to your care provider. They can help you understand what you went through and how long it will take to recover. Make sure you prioritize your needs for rest, nutrition, and mental health. Many women feel physically recovered from childbirth around 6 weeks, but for most, it may take longer. 

A postpartum doula can provide education and support, and assist with newborn care, breastfeeding support, or anything else that can help ease the transition when a new baby arrives. 

Early Labor | What Should I Do?

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Early labor can often leave us with the question of, “When do I head to the hospital?”. Clever reminders like “511” remind us that contractions should be 5 minutes apart and 1 minute long for 1 full hour before you head in. As doulas, we are huge advocates for distraction through early labor. Often, when you focus on distractions you’re able to discern when you can’t ignore labor anymore.

When your pregnancy is healthy and labor is going normally, we love to encourage clients to try to make their contractions go away. True labor won’t stop just because you put your feet up! In addition to staying hydrated, eating nourishing food that feels good to you, and laying down for a bit, here are a few of our favorite ways to enjoy a distraction during early labor.

Schedule an Appointment

An excellent way to relax and distract yourself is to get yourself to a self-care appointment. Book a pedicure, a prenatal massage, or find a salon near you that does blow outs. These appointments are wonderful for distraction but they also help create a flow of oxytocin in your body. Oxytocin is a wonderful pain relief and also calming hormone and it can be stimulated by skin-to-skin contact. Be sure you’re in contact with your birth team and consider having someone else drive (just in case!)

Warm Shower or Bath

The warmth of a shower or bath can ease tension and relax your muscles, helping you stay comfortable as early labor progresses. Water has a calming effect and can provide gentle relief, especially for back pain or cramps. Sitting or standing under a warm shower allows the heat to target your back and abdomen, while a bath can create a more immersive, weightless experience that helps you relax between contractions.

Safety Note: Be sure to keep the water at a comfortable, warm temperature (not hot) and stay hydrated if you’re soaking for a while.

A pregnant individual does a yoga and meditation routine.

Movement and Gentle Exercise

Moving around can be surprisingly effective in early labor. Gentle stretches, walking, a prenatal yoga video, or using a yoga ball can help release muscle tension, encourage a more optimal baby position, and may even help labor progress. Slow dancing with a partner or swaying your hips in a figure-eight motion can bring comfort and connection, grounding you through each contraction.

Tip: If you have a yoga or birth ball, sit and gently rock your hips, move them in a figure 8 motion, or bounce lightly to ease any pressure in your lower back or hips.

Create a Calming Environment

A soothing environment can make a big difference in how you feel. Dim the lights, play calming music or sounds, and use soft, cozy blankets or a favorite pillow. Try lighting a candle that has a soothing scent to create a spa-like atmosphere if you’re interested in aromatherapy. Choose things that bring you comfort and help you feel safe.

Tip: Make a playlist with a mix of calming and upbeat songs. The calming ones can help you relax, while the upbeat tracks can lift your mood if you’re feeling restless.

A pregnant woman in early labor reads a book sitting on a couch.

Mindful Distractions

Early labor is the perfect time to engage in activities that keep your mind occupied without draining your energy. Simple activities like reading a favorite book, watching a comforting movie, or doing a craft project can keep your focus off contractions while still allowing you to relax. Some people enjoy adult coloring books, knitting, or easy puzzles that bring a sense of calm.

Tip: Make a list of short, enjoyable tasks you can do easily and stop anytime, so you’re prepared with options if labor progresses quickly or you start needing to focus more on your contractions.

These techniques can help you stay comfortable and relaxed at home as labor begins. Remember, there’s no right or wrong way to experience early labor; do what feels best for you. Take things one contraction at a time, stay connected to your body, and know that each step brings you closer to meeting your baby.

Unsure if it’s really labor? Check out our blog “Am I actually in labor?”

Hypertension in Pregnancy | Preeclampsia and HELLP

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Hypertension in pregnancy and its related complications, such as Preeclampsia, can have significant implications in the health and safety of birthing individuals and their babies. Prior to 2007, these conditions were more rare in otherwise healthy pregnancies. Studies have shown, though, that Chronic Hypertension in Pregnancy doubled between 2007-2021 (source). 

Understanding what these conditions are, how they are diagnosed, and what symptoms to watch for is key to early detection and effective treatment. With early intervention and treatment, pregnancy outcomes have a high probability to be positive even after diagnosis. In this post, we will explore hypertension in pregnancy and preeclampsia including symptoms, how these conditions are diagnosed, and variations or other related diagnoses.

A doctor takes the blood pressure of a pregnant patient in their office.

Hypertension in Pregnancy

What is Chronic Hypertension in Pregnancy?

Chronic hypertension in pregnancy is defined as high blood pressure that either exists prior to pregnancy, is diagnosed within the first 20 weeks of pregnancy, or does not resolve by the 12-week postpartum checkup. According to this article, Chronic Hypertension affects at estimated 5% of pregnancies.

What is Gestational Hypertension in Pregnancy?

The main difference between Chronic Hypertension and Gestational Hypertension in pregnancy is that Gestational Hypertension (formerly known as Pregnancy-Induced Hypertension or PIH) is new Hypertension that is diagnosed after 20 weeks of pregnancy. This condition is unique in that it is diagnosed after birth if you don’t develop preeclampsia and your blood pressure returns to normal after 12 weeks postpartum.

While this makes it sound less severe than Preeclampsia, it’s of note that if this condition progresses from mild to severe Gestational Hypertension the treatment is very similar to severe Preeclampsia. Both conditions are important to monitor and intervene if necessary.

Unlike Preeclampsia, Chronic and Gestational Hypertension may not always present with symptoms. However, regular monitoring of blood pressure is essential to ensure early detection. 

What Symptoms Should You Watch for?

Pregnant individuals who experience high blood pressure readings (140/90 mmHg or higher), headaches, visual disturbances, or swelling of the face, hands, or feet should discuss with their healthcare provider if further testing is needed.

How are Chronic and Gestational Hypertension Diagnosed?

Both Chronic and Gestational Hypertension are diagnosed via blood pressure measurement, urine analysis, and blood tests. Blood pressure tests are always the first line of defense as they’re taken at each routine visit. Urine analysis is also routine however they’ll do a more intensive analysis to rule out Preeclampsia. Blood tests may also be taken to check on organ function.

How Common is Hypertension in Pregnancy?

Hypertension occurs in about 10% of pregnancies in the United States. Chronic Hypertension affects about 1-5% of pregnancies, while Gestational Hypertension affects approximately 6-8%.

Pregnant individual takes their own blood pressure at home to monitor for hypertension, preeclampsia, and hellp in pregnancy

Preeclampsia

What is Preeclampsia?

Preeclampsia is a serious condition that typically develops after the 20th week of pregnancy. It is characterized by high blood pressure and damage to organs, most commonly the liver and kidneys. This condition can progress rapidly and pose significant risks to both the pregnant person and the baby. It can potentially lead to complications like preterm birth or placental abruption and can even be fatal if left untreated.

What Symptoms Should You Watch for?

The symptoms of Preeclampsia can range from mild to severe. It’s important that individuals share their symptoms with their healthcare provider no matter the level of intensity. It is possible, however, to have Preeclampsia without these symptoms which is why routine prenatal appointments are important! Just like with Hypertension in Pregnancy, persistent high blood pressure (140/90 mmHg or higher), headaches, visual disturbances, and swelling of face, feet, or hands are common. 

Other things to watch for include:

  • Excess protein in the urine (proteinuria)
  • Upper abdominal pain, particularly under the ribs on the right side
  • Nausea or vomiting
  • Sudden weight gain
  • Shortness of breath

How is Preeclampsia Diagnosed?

If Preeclampsia is suspected, the first step will typically be to get a reading on blood pressure followed by a urine analysis. When readings are consistently at 140/90 mmHg or higher and there is protein present in the urine, healthcare providers will typically move forward with a blood test to check on liver and kidney function and platelet counts as well as an ultrasound and non-stress test (NST) to monitor the baby’s growth as restricted fetal development can be common in Preeclampsia.

How Common is Preeclampsia?

Preeclampsia affects about 5-8% of pregnancies in the U.S. It is most common in first-time pregnancies, but risk factors include being pregnant with multiples (twins or more) and a history of hypertension or kidney disease.

How Common is Postpartum Preeclampsia?

Postpartum Preeclampsia is rare, occurring in about 0.3-0.7% of pregnancies. It can occur in individuals who had Preeclampsia during pregnancy, but it may also develop in individuals with no prior related history. The symptoms remain the same during pregnancy and after delivery. Postpartum Preeclampsia can develop after a baby has been delivered. The highest risk is 48 hours after delivery but it’s important to pay attention to symptoms that develop once you’ve arrived home and seek care immediately if something appears to be off.

Are There Other Conditions I Need to be Aware of?

The other main hypertension-related condition to be aware of is HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome. HELLP previously was thought to be its own classification. It is now thought to fall under the hypertension umbrella as a variation of Preeclampsia. This condition can be more difficult to diagnose because the early symptoms present just like Preeclampsia symptoms. This is why it’s important to know the symptoms, attend your routine prenatal appointments, and intervene early. Preeclampsia.org estimates that of the 5-8% of pregnancies that develop Preeclampsia, 15% of these people develop HELLP (source).

Hypertension and its related conditions are significant health concerns for pregnant and postpartum individuals. These conditions, while statistically more rare, are still important to pay attention to and know the symptoms of.

During pregnancy it is important to attend routine appointments for a whole host of reasons! Early detection of conditions like Hypertension is just one. Remember, even if a pregnant individual develops one of the conditions we’ve noted here, treatment is possible! Outcomes are greatly impacted by early intervention.

Struggling with one or more of the symptoms above? We want to encourage you to reach out to your doula and healthcare provider immediately. Chances are you’re okay (statistically speaking!) but the peace of mind from double checking is invaluable.