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The Big Four

Understanding the signs of labor during pregnancy.

It’s not uncommon for pregnant women to be uncertain about when to go to the Labor and Delivery Unit (L&D). The following are the four most common reasons to go to the hospital for assessment:

1. “Baby’s not moving!” It’s alarming if a once-active baby becomes less active. Decreased fetal movement can be a sign of fetal distress, but can also be due to benign conditions such as fetal sleep. As baby gets closer to due date, he or she will become less active as well. If you are ever concerned, the best thing to do is “kick counts.”  To do this, find a quiet environment, lie on your left side and pay attention to your pregnant belly. Count your baby’s movements (jabs, kicks, rolls and flutters). Ten movements in two hours is considered normal and reassuring. If your baby does not meet this criterion, you should go to the L&D for fetal monitoring. I advocate doing kick counts twice a day in the third trimester. It’s a quick and easy way to assure yourself of your baby’s well-being!

2. “I think my water broke!” This doesn’t always happen like it does in the movies. Sometimes it’s a gush of fluid; sometimes it’s a slow constant trickle. If you think your water has broken, proceed to the hospital. When the amniotic sac ruptures, the protective bubble around baby is no longer intact, making baby more prone to infection and to cord prolapse (where the umbilical cord falls through the cervix into the vagina), which is a surgical emergency. Your doctor will want to examine you to confirm that your water has indeed broken and provide you with additional care accordingly.

3. “I’m bleeding!” It is not uncommon for women to experience light spotting during pregnancy after vaginal exams or intercourse. In these cases, the spotting can vary from pinkish to bright red to dark brown discharge and is usually no cause for alarm. However, should you ever experience bleeding “like a period” or bleeding associated with abdominal pain and/or tightness, you should proceed to the hospital for assessment. This can be a sign of labor or problems with the placenta that can lead to fetal distress. Furthermore, if your blood type is rhesus factor negative, you may also need additional medication to protect your unborn baby.

4. “I’m not sure if I’m in labor!”
True labor is uterine contractions causing cervical change. Many women are confused about when this occurs versus false labor. False labor contractions, also known as Braxton Hicks contractions, will be irregular in timing, do not get closer together or increase in strength, may stop with change of position or movement, and are usually felt only in the abdomen.

Conversely, true labor contractions start in the back and proceed forward; increase in intensity; come with regular frequency and last 30 to 70 seconds; and are not affected by position, rest or movement. I advise women to proceed to the hospital when the contractions last one minute, occur every five minutes and are painful! When this happens, there is a good chance that the cervix is changing. If a patient is less than 37 weeks’ gestation and has four painful contractions lasting one minute each in one hour, she should proceed to the hospital to rule out preterm labor.

Is There a Baby in Your Future?

If there is, you will need a doctor for yourself and your baby. ValleyCare Medical Foundation continues to grow.

This collaborative network of well-established and respected physicians in the Tri-Valley offers personalized care for your entire family, right in your community.

Scott Eaton, MD
Nicole Jeffrey-Starr, MD
William Phillips, MD
Jennifer Salata, MD
Sonia Santana, MD
Gabrielle Schaefer, MD
Laura Silverstein, MD
Rebecca Stone, MD

Christi Klimisch Lombre, MD
Yatin Shah, MD

To learn more about ValleyCare Medical Foundation physicians, visit

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