SIGNS OF LABOR
A common concern of women as they near the end
Labor is the series of events by which uterine
contractions and abdominal pressure expel a fetus
and placenta from a woman’s body.
Regular contractions cause progressive dilatation
(enlargement or widening of the cervical canal) and
create sufficient muscular force to allow a baby to
be pushed from the birth canal (or vagina). It is a
time of change, both an ending and a beginning,
for a woman, a fetus, and her family.
THEORIES OF LABOR ONSET
Labor normally begins when a fetus is sufficiently
mature to cope with extra uterine life yet not too
large to cause mechanical difficulty with birth.
In some instances, labor begins before a fetus is
mature (preterm birth).
In others, labor is delayed until the fetus and the
placenta have both passed beyond the optimal
point for birth (post term birth).
Progesterone withdrawal begins:
• Uterine muscle stretching, which results in
release of prostaglandins
• Pressure on the cervix, which stimulates the
release of oxytocin from the posterior
pituitary
• Oxytocin stimulation, which works together
with prostaglandins to initiate contractions
• Change in the ratio of estrogen to
progesterone (increasing estrogen in
relation to progesterone, which is
interpreted as progesterone withdrawal)
• Placental age, which triggers contractions at
a set point
• Rising fetal cortisol levels, which reduces
progesterone formation and increases
prostaglandin formation
• Fetal membrane production of
prostaglandin, which stimulates
contractions
of pregnancy is how they will know if they are
beginning labor.
Preliminary Signs of Labor
Before labor, a woman often experiences subtle
signs that signal labor is imminent.
Lightening
In primiparas, lightening, or descent of the fetal
presenting part into the pelvis,
 occurs approximately 10 to 14 days before
labor begins.
 This fetal descent changes a woman’s
abdominal contour.
 Lightening gives a woman relief from the
diaphragmatic pressure and shortness of
breath that she has been experiencing and
in this way “lightens” her load.
 Lightening probably occurs early in
primiparas because of tight abdominal
muscles.
Increase in Level of Activity
 A woman may awaken on the morning of
labor full of energy, in contrast to the
feeling of chronic fatigue she felt during the
previous month.
 This increase in activity is related to an
increase in epinephrine release initiated by
a decrease in progesterone produced by the
placenta. This additional epinephrine
prepares a woman’s body for the work of
labor ahead.
Slight Loss of Weight
 As progesterone level falls, body fluid is
more easily excreted from the body. This
increase in urine production can lead to a
weight loss between 1 and 3 pounds.
Braxton Hicks Contractions

 In the last week or days before labor begins,

a woman usually notices extremely strong
Braxton Hicks contractions.
 Women having their first child may have
great difficulty distinguishing between
these and true contractions.

Ripening of the Cervix

 Ripening of the cervix is an internal sign

seen only on pelvic examination.
Throughout pregnancy, the cervix feels

softer than normal to palpation, similar to

the consistency of an earlobe (Goodell’s
sign).
 At term, the cervix becomes still softer
(described as “butter-soft”), and it tips
forward. Cervical ripening this way is an
internal announcement that labor is very
close at hand.