“But, how will I know?”

hospital bag timing contractions third trimester birth

This post follows up our discussion around the frustrating response “Oh, you’ll know” in a previous post.

You can probably see this circular argument playing out:

Q: “How will I know if I’m in labor?”

A: “Oh, you’ll know.”

Q: “Sure. But HOW?”

A: “Well, you’ll know.”

Q: “You’re useless to me.”

There are solutions for answering this question but getting to them can be a bit tricky to navigate for the novice. (And aren’t all expecting parents novices?)


“Is this a contraction?”

The first way into answering this question tends to comes in the form of a description by a doctor, birth educator, friend, family member, random stranger (you get the picture). You’ll hear, “it starts like this” or “it feels like that” and then it is your job, as the one who is actually feeling the feeling, to link the sensation to the description. The strangest matching game you’ve ever played. This is the highlighted description when you google “What does a contraction feel like”:

“Early contractions may feel like period pain. You may have cramps or backache, or both. Or you may just have aching or heaviness in the lower part of your tummy. You may feel the need to poo or just feel uncomfortable, and not be able to pin down why.”— BabyCenter.com

So you can either wait to feel something that you might “not be able to pin down” or look into another way to get a more straightforward answer: monitor external changes.

Healthcare professionals accomplish this by either putting their hand on the stomach and sensing the tensing of the muscles or by hooking up the tocodynamometer. The tocodynamometer (affectionately called “toco” for short) measures the pressure changes at the level of the skin.

This measurement technique can be a problem, as patent dating back to 1974 explains [1]:

“This invention relates to measurement of uterine contractions or other biological phenomena involving displacement of an external body surface.” — 1974 Patent for tocodynamometer

Basically, other things going on in the body, like gastrointestinal activity, might register as a contraction.

Plus — yes, you read that right — this patent dates back to 1974. The same equipment that our mothers used when they birthed us are used to birth our babies today. What other field of medicine still relies on technology that dates back over 40 years?

On top of this, the toco is only available at the hospital. Not a problem if you don’t mind heading to the hospital for a few hours and have a good insurance plan that covers this visit. BUT can be especially troubling for women living in rural parts of the United States. A 2014 policy brief pointed out that only 20% of rural counties had OB/GYN services [2].

Bloomlife has the only true yes or no answer that you can get at home. You feel something, you see something in the app. True real-time feedback linking the very personal sensation felt to the empirical data displayed.

More important, Bloomlife measures the electrical activity of the uterine muscle flexing rather than the changes at the surface of the skin that happen to occur when the muscle flexes. Where the toco measures the effect of a contraction, Bloomlife measures the cause. Those intestinal gas bubbles look a whole lot different from that angle. And a whole lot more accurate.


“Am I in labor?”

While the only true definition of labor is cervical change, women don’t exactly have the luxury (or skill set) to check the status of their cervix at home. Most women then rely on information about contractions. Over 60% of women in a survey of 600+ describe contractions as the first sign of labor [3].

Furthermore, labor onset is often defined at when contractions started that led to labor. In an analysis of 62 research surveys that relied on defining the onset of labor — that transition between non-labor and early labor — most of the studies used information about contractions in their definition, even more so than cervical dilation [4]

So what do women learn from contractions? (Assuming they can feel them…see the first point.) Well, as the American College of Obstetricians and Gynecologists points out, contractions that come in a regular pattern and gradually become closer together typically indicate labor contractions over false labor contractions. Understanding these patterns requires diligent note-taking with a stopwatch to record the start and stop of each contraction. Or couples can download one of the 84 “contraction tracking” apps or apps with contraction trackers included. All of these apps are glorified stopwatches and they all require the women feeling the contractions to guess the start and stop of each contraction.

Bloomlife offers something different: an easier way to see the contraction pattern as it unfolds, completely automatically. The Bloomlife sensor does the heavy lifting of detecting the start and stop of contractions proactively and then the Bloomlife app displays the contraction pattern as a simple, scrollable bar reflecting an hour at a time. This allows expecting parents to see what is going on from a glance. No more guesswork.


“I don’t want to get it wrong”

“I often say that dilation doesn’t generally start until they’re having contractions every five minutes and they’re lasting at least a minute, and then I mean a full minute in relation to what they’re feeling. So that they understand, because it’s so specific to relate to.” Eri et al., 2011

This is pretty standard advice, called the 5–1–1 rule (or sometimes it becomes 4–1–1) that relates to contractions that are 5 minutes apart, lasting for 1 minute, with a regular pattern for 1 hour. The rule is based on the idea that when contractions get within this range, the woman has likely transitioned from latent to active labor.

Through all of this, the laboring woman, and likely her birth partner, are back to timing and tracking contractions. (See note above about the 84 contraction tracking apps) This becomes more complicated when you factor in that she is in the midst of labor.

Bloomlife’s automatic counting provides the metrics of average frequency and duration of contractions at your fingertips. No stopwatch required.


“Stay at home for as long as possible”

While the advice for when to head to the hospital tends to follow the 5–1–1 rule, the best way to keep moms at home longer is by allowing them to feel confident listening to the signals of their body. This comes from reassurance, knowledge and support.

When the Norwegian midwives at a hospital call center encourage moms to successfully stay at home in the cases of false labor or early labor, these calls start with midwives asking about contraction patterns and then continue with midwives actively reassuring the moms over the phone [5].

A more in-depth birth education combined with easier ways of communicating with their birth team can also help reassure women to stay home. A study of Swedish women who were successful at remaining at home until they were in active labor reports that several educational tools — including private birth classes — enabled them to feel in control and “maintain power.” These women also reported that they shared the experience with others (e.g., calling birth team early in labor) in order to have a second opinion on “what is normal.” [6]

Bloomlife offers an additional educational tool for the expecting mom to learn more about her body and find the confidence and reassurance she needs. Bloomlife also promotes better support by helping expecting couples connect more easily around what is going on in her body and facilitate the communication with their birth team.


“Is this normal?”

This is perhaps the trickiest question:

“Normal” is a complicated word because the physiological data needed to fully understand a “normal” pregnancy, labor and birth simply does not exist.

“Our inability to reduce the cesarean rate may be attributable in part to the incomplete understanding of a normal labor process.” [7]

Here at Bloomlife, we are dedicated to our larger mission of better understanding and preventing pregnancy complications; in order to understand pregnancy complications, we first must understand what a normal pregnancy looks like. To this end, we are currently taking part in a study with partners at top research institutions to investigate exactly this question: What are the physiological parameters of a healthy pregnancy? We are excited to share the information with the research community, the medical community and our community of parents as the data become available.

Before we get there, the Bloomlife pregnancy wearable helps individual expecting moms learn “Is this normal for me?” By guiding her to learn about her own contractions, contraction patterns and baseline uterine activity, Bloomlife curates a truly personalized view into the pregnant body to honor the uniqueness of each pregnancy. No other prenatal tool can currently provide this depth of information.

Pregnancy is categorized as a disease by the medical world and a disability by the workforce. This is not how it should be — pregnancy symbolizes the journey into parenthood and the welcoming of a new child, a truly life-changing moment. Pregnancy should be an empowering time of life for women as they transition to motherhood. Women — and their partners — should be encouraged and praised for taking an active role in their prenatal care and deserve to have every tool available to strive for their ideal birth story.

Bloomlife is one such tool for expecting parents taking this journey. Read more about how Bloomlife works in this next post.


REFERENCES

[1] http://patents.justia.com/patent/3945373

[2] Kozhimannil, K., et al. (2014)

[3] Gross MM, et al. (2006)

[4] Hanley GE, et al. (2014)

[5] Eri TS, et al. (2011)

[6] Carlsson, et al. (2012)

[7] Zhang J, et al. (2010)

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