Teaching About Signs of Labor

One of the most important topics of a childbirth preparation class is guiding your students in how to recognize the onset of labor, and how to differentiate between pre-labor and true labor. Here are some methods for teaching this topic:

Lecture. The quickest and easiest would be to just tell your students the signs. This is not adequate, especially for your students who are not auditory learners. They will not take in the information, nor remember it, nor be able to apply it later on.

Lecture while writing key symptoms on board. Adding the visual element will aid your visual learners take in the information, and just watching you write will help your kinesthetic learners remember. It’s especially helpful if you sort things into categories of possible, pre-labor, and positive signs while you write. (See examples below of what the board might look like at the end of your lecture.

Sorted brainstorm. Write three columns on the board, labeled possible, pre-labor, and positive. Ask your students to brainstorm some signs of labor that they know of. When they say them, write them on the board under the right category. When you’re writing them down, you can add more details and/or vocabulary. For example, if they say “discharge”, you can write it up as bloody show/mucus plug, since those are common terms for that. If they say “water breaks”, you can separate that into “trickle of fluid” and “gush of fluid”.

Once they’ve come up with a good collection of symptoms, add in any that are missing. Here’s what my board may look like at the end:

Possible “nesting urge” Soft BM’s / diarrhea Nausea Restless backache	Pre-Labor Bloody show / mucus plug Leaking fluid	Positive Dilation of cervix > 4 cm Gush of fluid
Braxton-Hicks contractions                                     cramps		True labor contractions

Review: Then go back over them in more detail. For example, differentiate between pregnancy backache and labor backache, give some examples of nesting urge, tell what characteristics to notice about the amniotic fluid. Especially spend time on contractions, and how they would differentiate between Braxton Hicks, prelabor, and true labor contractions. The key point they need to get is that true labor contractions are progressing – with time, they get Longer, Stronger, and Closer Together.  I also tell them that if they’re not sure if it’s labor or not, they can “test” it by drinking lots of water, and changing their activity (if they were active, lay down and rest; if they were resting, get up and move around.) If after an hour, contractions stop, slow, or remain the same, it’s nothing or it’s pre-labor, if contractions continue to progress, it’s true labor.

Here’s what my board may look like at the end of this:

Possible “nesting urge” Soft BM’s / diarrhea Nausea Restless backache	Pre-Labor Bloody show / mucus plug Leaking fluid	Positive Dilation of cervix > 4 cm Gush of fluid Color Odor Amount Timing
- - - - - - - - - - - - -  Contractions - - - - - - - - - - - Braxton Hicks or Pre-Labor- - - - - - - - - - - - True Labor
Cramps                                     Feel in belly only                                     Neutral or uncomfortable                                     Irregular contractions                                     Non-progressing		Back or Back & Belly Uncomfortable to painful Regular contractions Progressing – LONGER, STRONGER, CLOSER TOGETHER
To test: drink water, change activity             If things stop, or don’t progress, it’s nothing or pre-labor             If contractions progress, it’s true labor

Card sort.

Preparation: Make up index cards (or large post-it notes) in advance, with symptoms listed on them, in layman’s terms of what the mother may experience (see below).

In class introduction: Write on the board three categories: possible, pre-labor, and positive / definite. Explain that there are several symptoms that may indicate that labor is starting, but that some are less certain than others. Some are possible signs, because they may be just normal parts of pregnancy, or may indicate labor. Some are pre-labor symptoms that can go on for several days before labor begins, and some are positive signs that show you’re definitely in labor.

In-class activity: Then, hand out the cards to your students, and ask them to come to the board and tape cards up in the category they think they belong in. Tell them they can discuss it amongst themselves, and if they think someone else has mis-placed a card, they’re welcome to move it to what they think is the right category. Let them work for a while, till they seem to have come to a consensus.

In-class review: Have students go back to their seats, and then review the symptoms in more detail (see notes above about what to touch on during review.

Variation 1: Partners only: Try having just the dads/support people sort out the cards while the moms sit and watch. I have found the partners always do a good job, and the moms are always impressed/reassured, because they were worried that their partner didn’t know anything about labor.

Variation 2: Red herrings. You could also add a fourth category of Not Labor before the possible signs, and give them some symptoms that are standard aspects of late pregnancy to throw them off.

Sample wording for cards for card sort:

Not Labor: Tired of being pregnant. 41 weeks pregnant. Low backache at the end of the day – feels better with massage or heating pad. Desire to get things done before baby is born. After vaginal exame, care provider reports  cervix is 1 cm dilated. Brownish discharge a day or so after sex or after a prenatal exam.

Possible: Irritable backache, can’t sit still, feels better when lean forward. Cramps, like menstrual cramps. Frequent soft bowel movements / diarrhea. Nausea or vomiting. “Nesting urge” – sudden irrational desire to get something done.

Pre-Labor: Vaginal discharge: mucus-y, may be streaked with a little blood. Trickle of fluid wets her underwear. Contractions felt in belly – two in one hour, then nothing for a while, then 3 little ones, then nothing.

Positive: Gush of fluid from vagina. Contractions felt in back and belly, getting painful. Contractions that are getting longer, stronger, and closer together. After vaginal exam, care provider reports cervix is more than 4 cm dilated.