True Versus False Labour
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Direct answer
True versus false labour is distinguished by whether contractions become regular, increasingly frequent and strong, and whether they cause progressive cervical effacement and dilatation. Braxton Hicks contractions and prodromal labour are irregular and do not produce progressive cervical change. Serial cervical examination, rather than pain alone, is the decisive test.
What you must remember
- Braxton Hicks contractions: irregular, usually painless tightening from the second trimester that does not change the cervix.
- Prodromal labour: irregular contractions that may last days, with some cervical softening, and that may or may not progress.
- True labour: regular, increasingly frequent and strong contractions with progressive effacement and dilatation.
- Show: the blood-stained mucus plug, which suggests cervical change but is not diagnostic on its own.
- Pain pattern: true labour pain often starts in the back and spreads to the lower abdomen, although the pattern varies between women.
- Response to rest: false labour pain often eases with rest or sedation, whereas true labour usually continues.
- Membranes: rupture of membranes makes labour likely, but it does not by itself prove that labour has started.
A stepwise method for telling labour apart
No single sign confirms labour, so clinicians combine the contraction pattern, the cervix and the show. The steps below are used together, with serial cervical examination given the most weight.
- Pattern of contractions: record the frequency, duration and regularity over an observed period, since true labour contractions become regular and increasingly frequent.
- Intensity and location: note whether the pain starts in the back and spreads forward, and whether rest or sedation relieves it.
- Baseline cervical examination: assess effacement, dilatation and station as a starting point for comparison.
- Show and membranes: ask about a blood-stained show and any gush of fluid, and check for ruptured membranes where appropriate.
- Reassessment: repeat the cervical examination after a few hours. Progressive change confirms true labour, while no change points to false labour.
- Documentation: record the findings on the partograph and plan admission or discharge according to the trajectory, not the pain alone.
Where the exam tries to catch you
Vignettes often describe a woman in pain who has not yet entered labour, so the exam tests restraint as much as recognition.
- Trap: admitting every woman with irregular contractions Correct: irregular contractions without cervical change are managed with reassurance and reassessment, not as established labour.
- Trap: diagnosing labour from painful tightening alone Correct: Braxton Hicks contractions can be painful but do not cause cervical change, so they do not establish labour.
- Trap: assuming one normal cervical examination excludes labour Correct: labour is confirmed by progressive change on serial examinations, not by a single reading.
Frequently asked questions
What is the difference between Braxton Hicks contractions and true labour?
Braxton Hicks contractions are irregular and do not cause progressive cervical change, whereas true labour produces regular, strengthening contractions with progressive effacement and dilatation. The distinction is made from the pattern of contractions together with serial cervical examination.
Which finding confirms true labour?
Progressive cervical change on serial vaginal examination confirms true labour, together with regular contractions that increase in frequency and strength. A single examination can be misleading, so the change must be seen across repeated assessments.
What is prodromal labour?
Prodromal labour is a preparatory phase of irregular contractions and mild cervical softening that can last for days before established labour. It may progress to true labour, but it often settles without significant cervical dilatation.
What is the significance of a show in pregnancy?
A show is the passage of the blood-stained mucus plug from the cervix, and it suggests that cervical change has begun. It is not diagnostic of labour on its own, so the contraction pattern and serial cervical examination must also be considered.
How is labour progress assessed in the latent phase?
Latent-phase labour is assessed by serial cervical examinations that track effacement and dilatation, together with the contraction pattern. The latent phase is variable in length, so progress is judged over several hours rather than from one examination.