As long as we're on the subject of false labor, I have to point out that even though we do all we can to thoroughly examine you, and ensure your safety and your understanding of when to return; on occasion, an unexpected precipitous labor can occur. Understand that we have no crystal balls to indicate when true active labor will begin, and how fast it will go. Unfortunately, we, too, are human just like you. Here is a story that will show that quite well:
When I was first training as a nurse in OB, I had one of the best teachers of the field, in my opinion, of all time. We'll call her Adrienne. Adrienne tried to show me at length the ins and outs of recognizing the difference between the "feel" of a woman in true labor and the "feel" of one who wasn't.
One night a fairly flighty hispanic 16-year-old came into the unit reporting that she thought she was in labor. She walked in with an array of followers including her fellow capricious teenage friends and an assortment of extended family members. But it wasn't the crowd of people that struck me. It was the fact that she sauntered into the exam room munching on a large bag of Cheetoes. Even after she was changed into a hospital gown and we were interviewing her for her health history, she never ceased to chomp on her obnoxious orange snack.
After a reasonable amount of time, it was determined that her cervix was not changing, and we prepared to discharge her home. We started to explain that she wasn't in labor.
"But the contractions are strong (chomp, chomp)," she was saying between Cheetoes. We gave her an exented education of what to expect in labor and when to call her doctor. As we were explaining things to her, her Spanish-speaking-only grandmother kept interrupting and gibbered off angrily in Spanish to which the girl jabbered back. The grandmother was clearly upset at us. We continued our exhaustive explanation of things to expect and when to return. The girl never stopped eating her Cheetoes.
"Is there a question we can answer that your grandma might have?" Adrienne asked politely.
"She just thinks that I'm in labor and you shouldn't send me home, (chomp, chomp)" the girl answered. "So how do I know when to come back? (chomp, chomp)" she asked, after we had just been through a long discussion of the answer.
Defeated, Adrienne answered, "Honey, when you can't eat Cheetoes anymore, come back."
So they left, the grandmother shooting us devil eyes all the way down the hallway and out the door.
Two hours later, we received a call from the ER that an ambulance was coming with a 16-year-old who delivered at home. OMGsh, it was our girl... Just as Adrienne hung up the phone with the ER, the elevators opened with the EMTs delivering our patient. And out in front darted the vengeful grandmother with fire in her eyes. Adrienne dove under the desk and avoided the hell-hath-no-fury grandmother's gaze.
And there was our patient, being wheeled by on the gurney, with her baby in one arm and a bag of Cheetoes in the other! (Chomp! Chomp!)
Thursday, September 10, 2009
Monday, September 7, 2009
False Labor on Labor Day
Its the weekend. Not just any weekend...Labor Day weekend. And yet, I find myself laboring on this Labor Day...in a labor ward...how ironic. A couple of ladies came in tonight, and otherwise we were quite peaceful. But I have to mention some things about one of these particular patients because, like so many others like her who make the same mistake, she was very disappointed to find that she wasn't in labor and was sent home.
First of all, when you are frolicking down the hallway toward the labor nurse's desk to happily announce, "Hi! I'm here to have a baby!" with a big smile on your face-- that might be the first thing that lets your labor nurse suspect false labor. Let me explain: labor hurts. Sorry, I can't lie about that. In real labor, most likely you will have to stop walking during a contraction. You will not be able to talk through it. It will make your breathing change or you may be tempted to hold your breath. Real labor contractions change your mood and your ability to socialize with others. Now I am NOT saying that you won't be able to cope with it, but it will be intense enough to command control of you.
This same patient, after calling in all of her kin folk to take part in the blessed event, introduced her sister as "a doctor without a degree." I don't know what that means. But when the RN examined her cervix finding it to be one centimeter dilated and thick (50% effaced) with the baby not even in the pelvis yet, that sister exclaimed, "Well that doesn't mean anything! We're going to have a BABY!" So, the RN with two degrees explained to the patient and the doctor-without-a-degree that with a first baby, this MAY indicate that labor hasn't begun yet. The plan of care was to observe her over a period of a couple of hours, have her walk awhile, and re-examine her cervix before concluding anything. After all, labor is defined as "active cervical change."
While the nurse was explaining this, she noted contractions being traced on the monitor.
"Have you had some contractions since we've been talking?" the nurse asked to assess the patient's perception of the contractions.
"I think so!" she answered with wide eyes. "They got to 5 minutes apart at home!" However, the nurse noted no change in her behavior during these contractions...the second sign to us that might indicate false labor.
You see, typically, real labor requires painful contractions that are persistent. And if you're not sure if you're contracting, chances are that its not time to come to the hospital yet. Also, we like to see you when your contractions are painful AND about 2 or 3 minutes apart. Surprising? Well, with your first baby this is typically what we will tell you. If you've had a previous vaginal delivery, you may want to come on in when the contractions are painful regardless of the timing. Either way, PAIN is the key here.
So to tell you the end of the story, the woman and all her family followers were sent home. But, fortunately for her, she returned the next day presenting in active labor and had a beautiful birth. But sometimes these types of false contractions can continue for days or even weeks before true labor begins. If this happens to you and you are wondering if you'll know when the right time is to come in...let me tell you this: the contractions that weren't changing your cervix will change into contractions that will. You are going to feel different. You will know the difference, I promise you.
In any case, always report contractions to your doctor. Make sure they know what is going on with you and please don't go by my words alone. If you are contracting, you need to be evaluated either by phone or in person by your provider. And as always, if in doubt, come in to the hospital to be evaluated. It's better to be sent home than to find yourself in a situation you don't want to be in. Be safe.
First of all, when you are frolicking down the hallway toward the labor nurse's desk to happily announce, "Hi! I'm here to have a baby!" with a big smile on your face-- that might be the first thing that lets your labor nurse suspect false labor. Let me explain: labor hurts. Sorry, I can't lie about that. In real labor, most likely you will have to stop walking during a contraction. You will not be able to talk through it. It will make your breathing change or you may be tempted to hold your breath. Real labor contractions change your mood and your ability to socialize with others. Now I am NOT saying that you won't be able to cope with it, but it will be intense enough to command control of you.
This same patient, after calling in all of her kin folk to take part in the blessed event, introduced her sister as "a doctor without a degree." I don't know what that means. But when the RN examined her cervix finding it to be one centimeter dilated and thick (50% effaced) with the baby not even in the pelvis yet, that sister exclaimed, "Well that doesn't mean anything! We're going to have a BABY!" So, the RN with two degrees explained to the patient and the doctor-without-a-degree that with a first baby, this MAY indicate that labor hasn't begun yet. The plan of care was to observe her over a period of a couple of hours, have her walk awhile, and re-examine her cervix before concluding anything. After all, labor is defined as "active cervical change."
While the nurse was explaining this, she noted contractions being traced on the monitor.
"Have you had some contractions since we've been talking?" the nurse asked to assess the patient's perception of the contractions.
"I think so!" she answered with wide eyes. "They got to 5 minutes apart at home!" However, the nurse noted no change in her behavior during these contractions...the second sign to us that might indicate false labor.
You see, typically, real labor requires painful contractions that are persistent. And if you're not sure if you're contracting, chances are that its not time to come to the hospital yet. Also, we like to see you when your contractions are painful AND about 2 or 3 minutes apart. Surprising? Well, with your first baby this is typically what we will tell you. If you've had a previous vaginal delivery, you may want to come on in when the contractions are painful regardless of the timing. Either way, PAIN is the key here.
So to tell you the end of the story, the woman and all her family followers were sent home. But, fortunately for her, she returned the next day presenting in active labor and had a beautiful birth. But sometimes these types of false contractions can continue for days or even weeks before true labor begins. If this happens to you and you are wondering if you'll know when the right time is to come in...let me tell you this: the contractions that weren't changing your cervix will change into contractions that will. You are going to feel different. You will know the difference, I promise you.
In any case, always report contractions to your doctor. Make sure they know what is going on with you and please don't go by my words alone. If you are contracting, you need to be evaluated either by phone or in person by your provider. And as always, if in doubt, come in to the hospital to be evaluated. It's better to be sent home than to find yourself in a situation you don't want to be in. Be safe.
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