Prodromal Labor: A Survival Guide

Does this story sound familiar? 

You go to your childbirth education classes, and hear that labor usually lasts 12-24 hours for a first birth. "Ok," you think. "I can handle that."

A few weeks later, you begin to feel steady contractions, and having never been in labor before, you think they feel fairly strong. Over the course of the day, they keep going, but don't ever get much stronger, longer, or closer together. Sometimes you feel a little tired and start to get relaxed and try to rest, and your contractions ease up a little. So you resolve not to rest, not to relax; you are going to stay active and upright and get this baby out! After 18 hours of walking around your neighborhood, rocking on your birth ball, and having your partner press on your sacrum, you figure you must be getting close to having your baby. So you go to the hospital and have your cervix checked, only to find that you are only 1-2 cm dilated and they want to put you on some pitocin or send you home.

So what's going on here? 

When we talk about how long labor lasts and the phases of labor, you usually learn about three phases in the first stage of labor: Early labor, Active Labor and Transition. But there's another phase that doesn't happen in every labor, but does happen in many births, especially first ones.

This phase is called PRODROMAL LABOR, and wow, does it cause a lot of confusion.

In medicine, the "prodrome" or "prodromal phase" refers to an early symptom or set of symptoms indicating the onset of a condition. So in general, the prodromal phase of labor refers to the earliest signs that labor is beginning. For some pregnancies, the prodromal phase is just a vague set of symptoms, like loose stool, loss of the mucous plug and a strong nesting instinct. Contractions might follow in a few hours or days and progress normally, so you only realize that those things were signaling the start of labor in hindsight.

For others, the prodromal phase starts with contractions. These contractions can be quite regular, but usually they do not progress, or become longer, stronger and closer together for some time.  The prodromal phase can typically last anywhere from 24-72 hours, although it can also come and go throughout the day. If you are laboring with your second, third, or later baby, you may be susceptible to prodromal labor that comes on at night and fades by morning. The contractions may produce some cervical change, such as softening the cervix or bringing it from a posterior to more anterior position, but won't result in much cervical dilation. 

See why this can be so confusing for folks?

My advice to everyone preparing for labor is to ignore your labor until you can not ignore it any more. In the words of my doula trainer, Therese Hak-Kuhn, "Do Life."

  • If you would be sleeping normally at that time of day, sleep (or at least lay in bed and rest).
  • If you would be working, do some work.
  • Eat well, stay hydrated, empty your bladder regularly, and keep yourself focused on anything other than the contractions you're feeling.
  • My clients have enjoyed baking baby a birthday cake, preparing food to put in the freezer for postpartum, or even baking cookies to bring for the nurses when they eventually go to the hospital.
  • You could watch your favorite funny or romantic movies - anything to get those good hormones going. 
  • I've even had clients come in for a nice relaxation massage at this point in labor.
  • And if it helps you ignore your contractions longer, you might use a hot pack on your lower back or right above your pubic bone for a while, or rest in a nice warm bath.

At some point, it will not possible to ignore your contractions any longer. Your contractions will be noticeably longer AND stronger AND closer together. This is the point where it makes sense to start your labor coping techniques - like having your partner massage your back or shoulders, changing positions, getting in the shower, rocking on your birth ball, etc.

Because you've been ignoring the early contractions, you've conserved more of your energy for the part of labor where you will need to focus and work your labor coping skills. Plus, you will be less likely to be obsessing over how long you've been in labor, and less likely to let your mind and the clock race ahead of where your body is in the labor process. 

But what if you experience prodromal labor for, like, a really long time?

First, the good news:  For many women who experience a long prodromal phase, once active labor kicks in, things tend to happen fairly quickly! 

However, if you are experiencing prodromal labor for so long (and so consistently) that you have been unable to get any sleep or even real rest for a day or two, and you are concerned that you won't have the stamina to get through active labor when it begins, have a talk with your care provider about how to get some rest. Rest is paramount! Can they prescribe you something to help you get some sleep? Are they comfortable with you drinking a glass of wine to get some shut eye? And while you're at it, have a talk with your doula. After you are able to get some rest, if you are still in a similar labor pattern, it might be time to consider trying some techniques to see if you can help your baby and your body with getting baby into the best possible position for a smooth labor. Options could include the Miles Circuit, Spinning Babies' Three Sisters (Forward Leaning Inversion, Side-lying Release, and Rebozo Sifting) or other ideas your doula may have. Having additional emotional support from your doula can be priceless, too.

The very best thing you can do is pace yourself - rest, stay hydrated and well fed, and know that your labor will resolve into a more regular pattern with time and patience. Don't wear yourself out trying to do things to get labor to progress! It's very common with prodromal labor for contractions to slow or stop when you lay down, change positions, or start to relax. If these things cause your contractions to stop, all that means is that it's not time for your baby to be born yet. But have heart; your baby will be born!

Did you experience prodromal labor in one or more pregnancies? Share with us below about your experience, and how you coped with it! Would you do anything differently if you experienced prodromal labor again?