Childbirth usually begins spontaneously, but it may be started by artificial means if the pregnancy continues past 41 weeks gestation. There are three signs that labor may be starting: rhythmical contractions of the uterus; leaking of the bag of waters (amniotic sac); and bloody show. The importance of the sign of contractions is in the rhythm and not the contractions. True labor contractions may start once every ten or 15 minutes or even at longer intervals, but gradually the interval decreases until they come every three to four minutes. The most important thing a woman can do at this phase is to remain relaxed. The bag of waters may leak slowly or may suddenly burst, and there is a gush of fluid. There is no pain when the water breaks, although it may be startling. If contractions are not ongoing prior to this, they are likely to start soon after. If they do not, it may be necessary to stimulate labor as the womb is now open to possible infection. The bloody show is a slight discharge of blood and mucus. It usually occurs after the cervix has started to dilate slightly and the mucus plug that keeps the cervix sealed from potential pathogens becomes dislodged.
Linda K. Bennington MSN, CNS, Thomson Gale, Gale, Detroit,