Emily Oster

8 minute read Emily Oster

Emily Oster

Your Experiences of Going into Labor

Yes, “false” labor is real

Emily Oster

8 minute read

Before I got pregnant, basing my experiences entirely on television, I assumed going into labor would be obvious. Your water breaks — maybe in an elevator? — and you’re immediately in agony.  

As it turns out, this can happen but mostly doesn’t. When I did go into labor with my first child, I spent many hours second-guessing whether it was, in fact, labor. I told my husband to come home, then called him back and said never mind, then called him again and said maybe he should. At some point, it became too obvious to ignore, but as a person who likes to know what is going on at all times, those intermediate hours were frustrating.

Comparatively, I was lucky. Early labor can last for days, and come on and off, so this period of uncertainty can be extended. There’s also something called false labor (or prodromal labor), in which painful but non-productive contractions can extend for days or weeks. 

Sergey Novikov

The fact is: this experience is unpredictable. But that doesn’t mean we can’t look at a little data and paint a bit more of a picture of what to expect. Which is what I’m doing today. I ran a survey about the experience of going into labor, focusing on people who did not plan an induction or C-section. I was focused here on this experience of uncertainty. Did you suspect labor before true labor? What was confusing? How common is it to go to the hospital only to be sent home?

Think of this as What to expect at the end of pregnancy, with the caveat that we’re focusing on a case in which you planned for spontaneous labor. 

Why I ran a survey about labor experiences

My preference is to write about data from published work. Data published in academic journals is more often representative of a broad population. However, there are cases, like this one, where there simply is no data. This is especially true with the experience of false labor — that there is little or no published work at all about it. (Shoutout to Libby Fischer Connell, who wrote a piece on her experience.) 

Given that gap, I came to all of you for answers. I solicited responses on Instagram and in the newsletter, and over 9,000 of you responded. This is not a representative sample. The audience for ParentData is disproportionately more educated (and much more female, for what it’s worth) than the overall population. My hope is that, despite this, it starts to paint a picture.

Some basic information on the births in the sample:

  • About two-thirds of respondents saw an OB for their pregnancy care, with one-third seeing a midwife and a small number seeing a maternal-fetal medicine specialist. 
  • Most people in the sample (57%) gave birth in either week 39 or 40; 13% in week 38, and 15% in week 41. 
  • Although we recruited people who had planned a spontaneous labor, 13% ended up with a C-section.

On the topics of pain relief and pain during labor: 

  • 65% of respondents had an epidural, 26% had no pain relief, and the rest had either nitrous oxide or some other pain relief option. 
  • Respondents also reported their maximum pain during labor — the average was 7.91 out of 10. This doesn’t mean much, but I’ll come back to it later as a comparison. 

How early is too early to go to the hospital?

My primary interest in this survey was in asking people about the experiences they had before they were “in labor.” In a simple view of the world, you start having contractions or your water breaks and you are in labor. But that isn’t how this happens for everyone. Sometimes it seems like labor, but it’s not. That’s what I wanted to explore.

To begin: the question of how common it is for people to show up at the hospital in labor, only to be sent home. 

Of all the respondents, a full 10% went to the hospital at least once for labor, only to be sent home. Most of them only went once, although 2% of respondents said they went to the hospital two or more times before they were admitted for labor. 

Half of these respondents ended up being admitted to the hospital in labor the same day — so, just a few hours at home. Another 25% were within two days. But the tail is long: 6.5% of respondents said it was one to two weeks before they were in true labor, and 4.3% said it was more than two weeks of waiting. 

Nearly everyone was sent home because they were not yet in labor, or not far enough along. But if this reasoning was the same, the experience of patients was wildly different.

For some people, this experience seemed neutral, straightforward: 

  • “My water broke, but labor hadn’t started yet. I was told to come back once contractions were coming regularly or in 36 hours, whichever came first.”
  • “My water broke at home so I went in, but I wasn’t yet very dilated. I think they gave me the option of staying but said it would be a long time, and I didn’t want to do early labor in the hospital. We went shopping and out for lunch before coming back.”

In this last quote, in my mind this person is enjoying a romantic three-course, two-martini lunch with their partner, although I presume it wasn’t quite like that. 

For others, this experience was tough and confusing: 

  • “I had labour start and stop several times and irregular contractions. I was admitted on my third visit after approximately 50 hours of this when I was 5 centimeters dilated.”
  • “I stayed home until I could not talk through contractions anymore. When I was checked at the hospital, they told me I was 1 cm dilated (which I had been for two weeks), told me that my pain wasn’t that bad yet, that it was probably a false alarm. I said I wouldn’t go home. So they told me to go on a walk for two or three hours and if contractions hadn’t stopped by then, I could come back. I tried. Although my walk consisted of little walking and a lot of lying on a bench because I couldn’t walk through the pain, I tried for nearly an hour. Then I went back with the (stupid) plan in my head to beg for some pain relief and then go home because those ‘not even labor’ contractions were unbearable and I could not take it anymore. By then, a new midwife was on shift who checked me again, told me I was fully dilated, ready to push and needed to get to the delivery room really fast.”

I want to pause on this last point for a second to just say: labor is unpredictable, and there is a place here for trusting your instincts. It’s lucky that person didn’t go home, and is a reminder that self-advocacy (or having someone with you who you trust, like a doula or a partner, who can advocate for you) is an important tool in your toolbox. 

What if it feels like you’re in labor but you aren’t?

Prodromal labor — or “false” labor — refers to a situation in which someone has regular, often painful, contractions but the cervix does not dilate. False labor and Braxton Hicks contractions are in the same vein of labor-like contractions that do not move things along, but prodromal labor looks (and feels) more like true labor. Contractions are more consistent, and often more painful.

False labor tends to happen late in pregnancy, but it can last for days or weeks. Generally you wouldn’t be admitted to the hospital with false labor, because hospitals typically do not want to keep people in the hospital for extended periods (for many reasons).

There is really not a lot of research on this. Prodromal labor isn’t a precisely defined thing; you could think of it as a prolonged first stage of true labor, or a worse set of Braxton Hicks contractions. Perhaps for that reason, or maybe just because research on women’s experiences is lacking, we’ve got very little in the published literature.

I asked survey respondents both if they had Braxton Hicks contractions and if they had been diagnosed with “false labor.” Fifty percent of respondents reported Braxton Hicks contractions, and 8% of them reported a diagnosis of false labor. 

Perhaps the most important thing to note from the survey is that these “false” contractions were, actually, very painful. In the graph below, I show the average “maximum pain” level for labor — overall, and with or without pain relief — and then the average maximum pain for Braxton Hicks contractions and false labor. 

The maximum pain levels in labor are the highest — slightly higher for those who report not using any pain relief — but the pain level in false labor is also significant. Respondents reported an average of 5 out of 10 for these false contractions. That is significant — and it’s also often dismissed.  

When respondents talked about this experience, the overwhelming impression is one of confusion and frustration: 

  • I wasn’t given much information about prodromal labor and told to continue to go home to progress into labor. Not until I was crying and without sleep for three days after consistently asking what was going on did I get admitted.”
  • “Some said it was prodromal labor, some said it was ‘real’ labor. Everyone agreed that when you stuck me on the monitor, I was measuring real contractions! Just not progressing enough to keep me in the hospital. Multiple times I was sent home with contractions every 5 minutes apart lasting 1 minute at a time. At one point they were speeding up to every 3 to 4 minutes, but after an IV they slowed down again. It was … annoying.”
  • “The mental and emotional challenge of prodromal labor was as bad as the pain. When I actually went into labor, my body was already so exhausted from days of limited sleep, pain, and stress.”

Here is my takeaway from this: False labor is real. Not real in the cervical sense — by definition, these are contractions that do not move cervical dilation — but real in the sense that it happens to a good share of people and the pain is real. I have a feeling that, for many people, just hearing a version of Yes, this pain is real, and you’re not alone or crazy would be extremely helpful.  

Okay, but how did you know you were in labor?

How did people finally know they were in labor, whether they had false labor or not?  

About half of respondents had contractions, 41% had their water break, and the remainder learned from their doctor or in another way. 

Of course, this raises the question: How do I know if the contractions are “real,” if it is the final labor push? The short and sometimes frustrating answer to this is that you wait. If they get stronger, and closer together, they’re real. If they go away, then you wait. One piece of advice for early labor is to try not to think about it if you can. If the pain is bad enough that ignoring it is impossible, it’s time to go in. 

The bottom line

  • There is very little published research about experiences in labor, and even less about false labor specifically. 
  • False, or prodromal, labor and Braxton Hicks contractions are in the same vein of labor-like contractions that do not move things along, but prodromal labor looks (and feels) more like true labor. Contractions are more consistent and often more painful.
  • Fifty percent of respondents to our survey reported Braxton Hicks contractions, and 8% of them reported a diagnosis of false labor. Respondents reported an average of 5 out of 10 on the pain scale for these false contractions. This pain is significant but is too often dismissed.
  • If you are toward the end of your pregnancy and begin experiencing contractions, pay attention to whether they get stronger and closer together. If so, you’re in “true” labor.
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RLee
RLee
10 days ago

I had intense prodromal labor after having an ECV (successful!) in 2023 and am happy to see this article come to existence as I ran many unhelpful Google searches those sleepless nights!

Commenting, however, on a secondary topic, which is water breaking prior to contractions starting. I was told in all my pre birth classes that “it doesn’t actually happen”. Long story short, it happened to me, my contractions did not start naturally, and I essentially ended up with a failed induction and a borderline emergent C-section 46 hours later. I was surprised to see in this article that not only that 2 other people raised water breaks before contractions but also that they were sent home! I was told to come straight to the hospital as I was now prone to infection and that I had no more than 48 hrs to deliver. I would love to see more data and information around this (I’m told it’s PROM, premature rupture of membranes).

Esmeralda
Esmeralda
11 days ago

Such a good article! I had prodromal labour in all three of my pregnancies — with contractions that became frequent, regular, and intense, and then stopped, only to start up again some time later. You might think I would have known the difference by the third pregnancy, but that was the one where I went to the hospital three times, over a period of a month, with the third finally leading to a baby being born.

I’m a doula now, and from the comments I get from my clients, obstetricians are completely out to lunch on this topic.

Ariana
11 days ago

I think it could also be VERY useful for there to be studies relating false labor to problem birth scenarios (including stillbirth). My son’s heart rate slowed down precipitously while I was in the hospital, but not yet admitted to the hospital, at 40 weeks. Luckily I was hooked up to the monitor and an emergency c-section saved his life. But I went in “false” labor (so helpful to have the term prodromal labor, false labor is such a bad name) two weeks earlier and once two nights previously, and I always wondered if that was maybe a moment when body was trying to start labor and when the baby needed, for whatever reason, to be born. I don’t think this is common at all (thank goodness) but the fact that this subject hasn’t been studied much at all is such a telling sign of how much we fail pregnant women and unborn children with the lack of extensive research. Based on Emily’s limited research here, it doesn’t seem like there is a strong correlation, but also it would require much more research to rule out the possibility that prodromal labor might indicate a need for greater monitoring.

Dana F
Dana F
11 days ago

I am a Plus subscriber and an avid IG follower, bummed I missed the call to respond on this topic (just had my first in June 2024 and read the PregnantData newsletter weekly) — Are you continuing to collect data in the study at this time? If so I’d love to be a respondent!

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