Love’s Labor’s Lost—An Examination of Prodromal Labor
In a two-part series, midwife Emma McNerlin looks at the extremes of the labor experience. This month, she examines prodromal labor, where episodes of painful contractions are experienced for days or sometimes weeks before baby arrives.
By Emma McNerlin
As with many aspects of pregnancy and birth, labor is not a ‘one-size-fits-all’ experience. Experts refer to two extremes of labor: precipitate labor, or extremely fast labor where baby is born within 3 hours of contractions starting, and at the other end of the scale, prodromal labor. Prodromal labor is a phenomenon that affects up to 20% of pregnant women,1 where they experience painful contractions for days or even weeks before labor starts.
Pregnancy, labor and birth can be imagined as a great voyage, with many details remaining unknown or beyond your control when you board the boat. You set out knowing the journey will take roughly nine months, but the experience at sea may vary greatly from your boat to another’s, and the final journey into port relies on calm and skilled sailing in sometimes stormy conditions. Others will share their experience on their boat, but not all of it will resonate with you. In prodromal labor, the boat feels like it is coming into dock, but really it is still a mile from the shore and thrashing in the waves.
The term ‘prodromal labor’ comes from the Latin word prodromus, meaning ‘comes before’, so ‘labor symptoms that come before labor starts’. Medical professionals sometimes refer to prodromal labor as false labor, but for any woman who has experienced it, they will confirm it feels very real out there on those choppy seas! As well as this, some older medical texts do not distinguish prodromal labor from Braxton-Hicks contractions—a painless tightening of the uterus often referred to as practice contractions. Perhaps for this reason, prodromal labor remains a topic largely unexplored by obstetric research.
Typically, in the first stage of labor the cervix softens, shortens and thins (referred to as ripening and effacement) and eventually dilates. There is a latent (early) phase in which the cervix ripens and effaces around 80% and dilates to 5–6 cm. This can take 12 to 18 hours for first births, much of which is experienced as low, dull backache or period style cramps, morphing later into regular contractions occurring up to five minutes apart. These are at least a minute long and are strong enough that you cannot walk, talk or smile through them. This develops further in the active (mid) phase when contractions become stronger and closer together and the cervix completes effacement and dilates to 8 cm. The length of this phase will depend on you being able to move around in labor and the baby’s position. In the transition phase, contractions are at their strongest and closest together, one to two minutes apart. This phase typically lasts one to three hours as the cervix opens the final 2 cm and baby moves deeper in the pelvis.2
In contrast, prodromal labor is observed as episodes of painful contractions that occur in a pattern—typically five minutes apart and lasting just under one minute, for several hours at a time. They eventually subside and, importantly, they do not cause any changes in the cervix. There is no ripening, no effacement and no dilatation, so without an internal examination it can be hard to identify prodromal labor contractions, as they feel very real and painful. It is therefore important to pay attention to the pattern of contraction frequency and duration. The key with prodromal contractions is that they do stop, unlike typical labor. Table 1 is a helpful guide to the differences.
| Braxton-Hicks contractions | Prodromal contractions | Typical labor contractions | |
| Onset | Any time from 2nd trimester | Periodically in the last few weeks of pregnancy | From 37 weeks (more often between 39 and 41 weeks) |
| Pattern | None discernable | Regular and typically up to 10 minutes apart but not growing closer together | Regular and get closer together over time |
| Duration | Short, between 10 and 30 seconds | Typically last just under 1 minute | Increasing in length from 30 seconds |
| Pain | Not painful, may be mildly uncomfortable, felt in the abdomen | Painful, felt in the lower abdomen/pubic region | Painful, typically felt in the lower back, upper legs and lower abdomen |
| Intensity | Low | Consistent, painful, but not strong enough to take your breath away | Increasing in intensity as time passes and contractions become closer together |
| Resolving/waning | Self-resolving, usually with change of position and hydration | Self-stopping eventually, irrespective of maternal behavior | Not stopping, gradually getting longer, stronger and more frequent |
The causes of prodromal labor are not well understood although several contributing factors have been identified, including:
- Breech position baby;
- Imbalance in the ligaments and muscles that support the uterus and pelvis;
- Feeling apprehensive about labor and birth or general anxiety;
- Multiparity—the uterine muscle changes the more pregnancies you have and the more labors you have experienced.
Low impact exercise such as yoga, pilates, or swimming can help to stretch and lubricate the ligaments to avoid imbalance in the pelvis. Also, if you are experiencing anxiety or negative emotions regarding your pregnancy or birth, it is important to talk about them before you reach term. You are not alone; one in five women suffers with anxiety in pregnancy.3 Being in the healthiest possible headspace prior to labor will help to support your body’s natural hormonal process when it comes. Reach out to BAMBI in confidence (bumps@bambiweb.org) to receive guidance on where to get help locally should you need it.
Interestingly, there is no evidence that prodromal labor causes any distress to baby at all. In fact, women who experience prodromal labor are more likely to have shorter established labor when it does finally progress.4 As for any pregnancy, if you experience painful contractions before 37 weeks or have bright red vaginal bleeding, waters breaking or reduced fetal movements, contact your OB-GYN.
Prolonged prodromal contractions are exhausting and disheartening, sapping much needed energy in the last weeks of pregnancy and leading you to enter labor with no reserves. It is therefore important to get into a headspace where once you recognize it, you ignore it as much as possible. Try to remain upright and walk, and dance or sway when the contractions are there. Eat slow-release energy foods often and keep yourself hydrated. Don’t be afraid to use analgesia like paracetamol—always following dosage instructions on the label—which is effective when taken regularly. When the contractions stop, rest and sleep, even if this means you are up at night and sleeping in the day; grab all the rest you can, while you can.5
Prodromal labor is often mistaken as early (latent phase) labor because all the books say when the contractions are five minutes apart, go to hospital, right? WRONG! Remember, prodromal contractions are persistently the same, not gradually increasing in length, strength and frequency. Arriving at hospital expecting to be well advanced, or at least halfway, only to find that your cervix is unchanged, can be devastating. At this point, it is important to know that you are not broken. If you are beyond 37 weeks, baby is moving well, you have no bleeding or fluid leaks, and you are coping well, then the best place for you to wait is at home.6 There is no need to hurry Mother Nature; remember, prodromal labor feels very real, but it does not change the cervix. Women in prodromal labor can behave like they are in established labor, which can result in doctors offering to speed up labor. Staying in hospital means risking interventions that are unnecessary in prodromal labor, such as breaking of waters or use of Pitocin to speed up contractions, which can result in a much different labor experience than you had planned. Being at home and given time in a safe, calm, familiar environment can help support your natural hormones to regulate the contractions and get them underway.7 As always, the golden rule is if you are OK and baby is OK, there is no need to intervene. Keep in mind that your baby is steering the ship; your job is to try to calm the seas and make sure you have enough steam left to get you into port.
It seems that there is so much to learn and know about labor and birth. There are many decisions and choices, circumstances can change, and plans can often go awry. There is no right or wrong way to birth; each labor is unique. Being well-supported by your birthing team, as well as getting as prepared and informed as possible, will help you to navigate your decisions.8 No labor lasts forever, but pacing yourself during episodes of prodromal labor will help you to stay on track for the birth you planned.
Photos from Canva.
References
1 Belly Belly (2021) 7 Reasons Why Pre-labor Sucks. bellybelly.com.au/birth/7-reasons-why-pre-labor-sucks/
2 NHS (2020) The stages of labour and birth. nhs.uk/pregnancy/labour-and-birth/what-happens/the-stages-of-labour-and-birth/
3 Fawcett, E.J. et al. (2019) The Prevalence of Anxiety Disorders During Pregnancy and the Postpartum Period: A Multivariate Bayesian Meta-Analysis. J Clin Psychiatry. Jul 23; 80(4):18r12527. Available online at: pubmed.ncbi.nlm.nih.gov/31347796/
4 American Pregnancy Association (2022) Prodromal Labor. americanpregnancy.org/healthy-pregnancy/labor-and-birth/prodromal-labor/
5 Maykim, M. et al. (2021) Impact of therapeutic rest in early labor on perinatal outcomes: a prospective study. American Journal of Obstetrics and Gynaecology. 3(3):100325. Available online at: pubmed.ncbi.nlm.nih.gov/33545440/
6 Nelson, D. et al. (2017) False Labor at Term in Singleton Pregnancies: Discharge After a Standardized Assessment and Perinatal Outcomes. Obstetrics & Gynecology. 2017 Jul;130(1):139-145.
7 Gharoro, E (2006) Labor management: An appraisal of the role of false labor and latent phase on the delivery mode. Journal of Obstetrics and Gynaecology. 26(6):534-7. Available online at: pubmed.ncbi.nlm.nih.gov/17000500/
8 Ferguson, S. et al (2013) Does antenatal education affect labor and birth? A structured review of the literature. Women and Birth, Vol. 26, Issue 1. sciencedirect.com/journal/women-and-birth/vol/26/issue/1
About the Author
Emma McNerlin is a UK trained and registered midwife, first aid instructor, and owner of Bumpsy Daisy Café and Community; a cafe and parenting community centre for new and expecting parents offering birthing classes, hypnobirthing, first aid workshops, and baby classes.
The views expressed in the articles in this magazine are not necessarily those of BAMBI committee members and we assume no responsibility for them or their effects. BAMBI Magazine welcomes volunteer contributors to our magazine. Please contact editor@bambiweb.org.