True versus False Labor and Different Birthing Positions

Topics to Cover: True vs False Labor & Birthing Positions

Labor is the physiologic process during which the products of conception are expelled outside of the uterus
fetus, membranes, umbilical cord and placenta

It lasts
-between 8 and 18 hours for primgravida
-between 1 and 14 hours for multigravida

Stages of Labor
I. True Labor versus False Labor
Preliminary signs of Labor contd.:

A. Lightening (Fetal descent into the pelvis) 

-increased urinary frequency d/t pressure on bladder
-easier breathing d/t decreased pressure on diaphragm
-pressure on sciatic nerve leading to leg pain d/t increased abdominal pressure from shifting of fetus and uterus
-occurs 2 weeks in primips and on the day labor begins in multips
True Labor versus False Labor
Preliminary signs of Labor contd.:

B. Braxton Hicks Contraction
-Painless usually – only tightening of the abdomen in the first and second trimester
-mild irregular contractions occurring throughout the pregnancy – patternless
-doesn’t cause contraction and dilation – no softening or stretching of the cervix – no effacement.
-can be diminished with activity, eating or changing positions

True Labor versus False Labor
Preliminary signs of Labor contd.:
C. Burst of energy
-before onset d/t having
experienced increased
fatigue during most of
3rd trimesters.
-Nesting instinct
D. Weigh loss
-may lose 1 to 3 lbs up to
3 days before labor
-may accompanied by flu
like symptoms –
-diarrhea and frequent voiding
True Labor versus False Labor S & Sx Comparison
Cervical Changes
-Cervix shortens, softens and dilates progressively in True labor
-No dilation or effacement in False labor

True Labor versus False Labor S & Sx Comparison
B. Level of Discomfort
-Intense in true labor and doesn’t go away with activities
-back discomfort that spreads to the abdomen as a result of contractions

-Mild in false labor and sometimes may go away with varying activities
-discomfort is localized in the abdomen or groin as a result of preliminary contractions
True Labor versus False Labor S & Sx Comparison
C. Contractions
-Regular with increasing frequency and duration in True Labor. Positioning or activity doesn’t affect.

-Irregular pattern in False Labor. May change with positioning and activity.

Short Clip of True vs False Labor
Short clip of True labor vs False labor
True Labor versus False Labor S & Sx Comparison
D. Uterine Palpation
– Hard as a board and can’t be indented in True Labor
– Easily indented with a finger in False Labor

E. Ruptured membranes
-AKA water break –  a big gush of fluid that soaks through your clothes. Subtle manner is mistaken for vaginal discharge or urine leakage.
-In true labor, there is a possibility. Labor is imminent.
-In false labor, no ruptured membranes.
True Labor versus False Labor S & Sx Comparison
F. Fibronectin (fFN) test
-an important protein during pregnancy
-acts like glue, anchoring the placenta and fetal membranes to the uterine wall early in pregnancy
-during onset delivery, fFN gets slippery (allowing the fetus and placenta to detach cleanly from the uterus), and can be found in a woman’s cervix or vaginal mucus secretions.
-If no fFN is found, a woman has a less than 5 percent risk of delivering her baby within the next two weeks.

II. Birthing Positions

Characteristics of good birthing position:
Makes mom feel more comfortable
d/t distraction
Speed up the labor process
Provide maternal-fetal circulation
Decrease length of labor
Enhanced sense of control
-relieve the sense of being
overwhelmed and out of control
Decrease perineal traumas and fewer episiotomies

Birthing Positions
Importance of birthing positions:
Lying flat is the least efficient and risks compressing nerve endings and major blood vessels
mother’s position influences the relationship between her pelvis and baby
Changing positions during labor
can change the shape and size of the pelvis – help the baby’s head move to the optimal position – first stage labor
helps the baby with rotation and descent – second stage 
put pressure on different parts of the body, so changing positions as the muscles get tired can help the mother to relax during contractions

Birthing Positions
A. Walking
-uses gravity – encourages descent
-encourages uterine contractility
-helps widen pelvic opening
-prevent pressure being concentrated
-contractions often less painful

-mother can’t use if she has HTN

Birthing Positions
B. Standing
-excellent for oxygenation of fetus
-helps create pushing urge
-better alignment in pelvis
-may speed up labor
-reduces backache
-poor control of delivery
-visualization very hard for birth
Birthing Positions
C. Sitting
-good for resting while using gravity
-can be used with continuous electronic monitoring
-may ease the pain of birthing
-amniotic fluid dripping or constant trip
-moms can see more of a birth in this position
-mother’s weight might put too much pressure on the perineum

Birthing Positions
Birthing Positions
D. Kneeling – on knees and hands
-with persistent posterior presentation baby, gives the greatest opportunity to turn or rotate to an anterior position
-how: kneeling moves baby away from spine into abdominal cavity, where there is more space
-heaviest part of the baby’s body (head and spine) encourages by gravity to fall forward to the lowest point
-too much pressure on the knees
-harder to get up
Birthing Positions
E. Squatting
-may increase rotation of baby
-enhances rapid descent
-increasing hip girdle pelvis diameter -up to 2 cm
-using gravity
-diaphragm muscle from upper trunk rib cage to press to fundus
-allows shift of weight for comfort
-curve of the pelvis become almost vertical

-often tiring to mother
-sometimes hard to hear FHTs
-may be hard for mother to assist in delivery
Birthing Positions
F. Side Lying
-easier to relax between pushing efforts due
to less muscles being used
-takes pressure off of perineum and
other internal organs
-keeps weight of your uterus off
of blood vessel (vena cava) ensuring blood flow to uterus and baby
-helpful during fetal distress (bradycardia) or blood pressure issues
-appropriate for lengthy labor; promoting body wide relaxation -helps support weight of the baby
-gravity neutral
-slows down labor
Facts and Research Studies
-Lithotomy is the most commonly used position in hospital. Most uncomfortable is lying on the back and hold still by stirrups
-The best gravity maximizing and most comfortable childbirth position is the squatting position
-Upright positions can be difficult if you have an epidural, because your legs may be too numb to support you or balance in an upright position

Images Credits:
Pregnance picture:
Stages of birth diagram:
Dilation and effacement:
Birthing positions:
Labor positions:

Harding, A. (2004). Labor: true or false?. Baby Talk, 69(7), 70. Retrieved from Health Source – Consumer Edition database.
Jonge, A. D., & Janssen, A. L. (2004, January). Birthing positions. A qualitative study into the views of women about various birthing positions. Journal of Psychosomatic Obstetrics & Gynecology , 25(1), 45-75. doi:10.1080/0167482041000173743.
Murkoff, H., & Mazel, S. (April 10, 2008). What to Expect When You’re Expecting (4th ed., pp.376-382 ). New York, NY: Workman Publishing Compan.
Rosdahl, C. B., & Kowalski, M. T. (2008). Textbook of Basic Nursing (9th ed., pp. 1083-1084). Philadelphia, PA: Lippincott Williams & Wilkins.
MayoClinic. (May 2, 2006). Mayo Clinic Guide to Healthy Pregnancy (1sted., pp. 177-179). New York, NY: HarperCollins.


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