Maternity - L&D, part 1: Physiologic Changes before Labor, True vs. False Labor
by Meris Shuwarger BSN, RN, CEN, TCRN September 18, 2021 Updated: December 07, 2022 3 min read 1 Comment
This article covers the physiologic changes that happen in a pregnant patient before labor, as well as the differences between true labor and false labor.
The Maternity Nursing series follows along with our Maternity Nursing Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
Expected physiologic changes before labor
The physiologic changes that occur before labor are the changes that occur in the weeks leading up to labor. They are not a sign that labor is imminent.
The following physiologic changes may occur before labor (note that these are organized in alphabetical order, not in the order they may occur as labor approaches):
- Backache: though this does occur immediately before labor, backache may also be caused well before labor as the muscles and ligaments relax in that area in the pelvis in preparation for labor.
- Bloody show: this is a brown or bloody or blood-tinged vaginal discharge. Sometimes it is called a mucus plug. Essentially, things that were previously held by the cervix are passing through the vagina. Again, this does not mean labor is imminent, but it does mean that the delivery is getting closer.
- Burst of energy: also called “nesting,” this is an overwhelming need to organize the home in preparation for the new baby. A pregnant person might feel compelled to clean everything in the house (surfaces, clothes, dishes, etc.), or rearrange the contents of all the drawers and closets.
- Contractions: even if labor is still a ways off, contractions may become stronger and occur more frequently.
- GI upset: it is common for a pregnant person to experience nausea and vomiting or heartburn, which, of course, may occur throughout a person's pregnancy.
- Lightening: This is when the baby drops lower into the pelvis. A provider might say that the baby has “dropped,” which could mean that labor is going to start soon.
- Rupture of membranes: This is another indication that a pregnant person is about to give birth, though, again, possibly not imminently. They may say their water has broken,” but that does not mean they are about to give birth or have to rush to the hospital.
- Weight loss: It is possible that a pregnant person loses from 1 to 3 pounds as labor approaches. This is the body shedding water weight and often occurs in the days before giving birth.
What are Braxton Hicks contractions?
Braxton Hicks contractions are mild, irregular contractions during pregnancy. They feel like tightness in the abdomen. Think of Braxton Hicks contractions as practice for giving birth, helping the muscles of the uterus to get ready for labor and the birthing process.
True versus false labor
There are several key differences between true and false labor.
True labor is when the baby is really on its way. False labor is the body’s way of practicing for giving birth. As the baby gets bigger and puts pressure on things, a pregnant person may experience irritations and symptoms of labor, but that may still be days or weeks away. Below are some of the differences between true and false labor.
True labor involves regular contractions, which become stronger and closer together over time. These contractions affect the length and the dilation of the cervix. Contractions in false labor are weak and irregular.
In true labor, walking increases contraction intensity. In false labor, walking or a change of position decreases the intensity of contractions.
Comfort measures and contractions
A real contraction is due to a positive feedback loop: the pregnant person is feeling the release of oxytocin, a hormone that stimulates the uterine muscles and causes contractions that begin the process of labor. The contractions cause oxytocin to be released, which causes stronger contractions, etc. No matter what the pregnant person does by way of comfort measure — drinking water, laying down, rolling on their left side — it won’t stop the positive feedback loop.
With a Braxton Hicks (practice) contraction, if the pregnant person takes comfort measures (drinks water, lays down, puts their feet up and relaxes), these may help to make the contractions go away, indicating it’s probably not time yet for true labor.
Remember that no matter the contractions, whether the person is experiencing real or false labor, it does not mean that it’s not painful.
Cervical changes only happen with actual contractions (not with Braxton Hicks contractions). The pregnant person’s cervix undergoes dilation and effacement in true labor.
In true labor, the presenting part of the fetus — the part that is presenting at the cervix — is going to be engaged in the pelvis. This does not occur in 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.
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September 29, 2021
Answer: False labor. Braxton Hicks.