Emily Oster Never Warned Me About Prodromal Labor

Let’s get one thing straight: My well-worn copies of Emily Oster’s books Expecting Better and Cribsheet are dog-eared and underlined, and The Family Firm is currently on my nightstand. I’m a paid subscriber to Oster’s online archive, ParentData, and I read her newsletter about menopause weekly even though I’m only 36. I need you to know that Emily Oster is my Taylor Swift so you understand that it was despite this, or maybe because of it, that when I found myself in the sadistic grip of the hell that is prodromal labor, alternately writhing in pain on the bathroom floor or sadly whimpering in despair from my bed, I was furious with her for not giving me a heads-up.

Also known as “false labor,” prodromal labor is a condition during which a woman suffers extremely painful, labor-like contractions but her cervix doesn’t dilate. If you aren’t familiar with the phrase, don’t feel bad because apparently neither is anyone else.

Of course, OB-GYNs, midwives, and their nurses have heard of this maddening set of symptoms, as they will have observed the devastated shuffle of every pregnant woman who’s just been told she’s not actually in labor, and that she’s going to have to deal with those painful contractions at home by herself with a low-dose muscle relaxer for the pain. They will have observed this not just once in a while but, per one study cited in the Obstetrics & Gynecology journal, an infuriating 26% of the time.

If I sound mad, I am. I’m mad because nobody told me about this extremely painful and emotionally exhausting condition that is more common than preeclampsia. I’m mad because when I brought this up to my midwife during my postpartum checkup, she sheepishly told me, “Yeah, we don’t tell people about it because we don’t want to scare you.” I’m mad because, if I had known, I could have been mentally prepared.

So much of being pregnant, for me, was mentally preparing for the difficulty of childbirth. I was mentally prepared for labor contractions to hurt — that’s why I hired a doula, practiced hypnobirthing techniques, and researched epidurals. I was not mentally prepared for my doula to go home because there were no stretches or breathwork she could think of to help me find relief. I was not mentally prepared for the doctors to say that I couldn’t take painkillers stronger than Tylenol for pain so bad I couldn’t speak. I was not mentally prepared to endure contractions every five minutes for 24 then 48 then 72 then 96 then 120 hours and still not have my baby in my arms.

I was not mentally prepared to lose the will to live while my baby was still inside me.

There are only three scientific studies on prodromal labor in the Obstetrics & Gynecology journal, and all three study its impact on physical outcomes for the baby or mother. The great news is that prodromal labor is not associated with negative impacts to the physical health of the mother or the baby. The bad news is that none of these studies look at how prodromal labor impacts maternal mental health.

Was I the only one whose prodromal labor turned her into a mental and emotional shell of her former self? Given that there is no research on the experience of women’s pain during prodromal labor or its mental and emotional impacts, and because a Google search yields unhelpful articles containing infuriating platitudes like “This is just helping your body prepare for the real thing,” I turned to Reddit. There I found instant validation.

“I had this with my last for 3 weeks. I was so miserable and cried daily,” one user shared.

Another user one-upped her, “I had prodromal labor for literally a month for multiple pregnancies. It was hell[.]”

“Im having this today (37w) my cervix is closed but wtf this hurts so much. I feel like i wont be able to Endure real birth :(.”

“It was way more exhausting than the actual labor.”

After basking in the vindication that I wasn’t making it up — that prodromal labor is as mentally brutal as it is physically painful — I read every comment I could find and noticed a surprising pattern: Regular women who were not medical professionals guiding each other through an extremely painful medical condition because they clearly needed more support than they were getting from their birth teams.

“Were you dilated at all?” Philadelphia-area mom Lindsie Rank asked another user on the thread. Rank was on Week Two of prodromal labor and was preparing to talk with her OB about possibly scheduling an induction. “I wanted to have a low-intervention birth,” she shared, “but at this point, I’m just so exhausted.”

The two compared notes about cervical dilation, effacement percentages (the thinning and stretching of the cervix in preparation for birth), and the positioning of their babies in their respective birth canals. “I got up to 3cm and had multiple [membrane] sweeps, but not really ever past that point,” the other user responded.

A membrane sweep, a non-medical procedure that aims to induce labor by physically sweeping the cervical area to separate the amniotic sac from the cervix itself, is often painful, but by now Rank was used to pain. “I’m going to ask for a sweep tomorrow,” she replied.

In a follow-up interview, I asked Rank why she turned to Reddit. “I was trying to get answers, but in a way that wouldn’t make me feel crazy,” she says. “I was looking for someone who would talk to me like I’m not a stupid person.” I’m not a doctor, but I’m confident that when Reddit is the best place for patients to go for support and advice on a medical condition, we have a problem.

An even more troubling refrain I found was women sharing how their medical teams shrugged off or even downplayed their experiences. One woman, who preferred I use her Reddit name, @Ok_Brain_194, tells me, “I remember expressing [to my OB] that what I was going through was definitely more than Braxton hicks [sic], but it was sort of brushed off because I wasn’t progressing.... So really I didn’t get any insight on managing the pain and discomfort. Certainly no support for the emotional toll.”

Not knowing when prodromal labor will end will be as maddening as the pain, but it will end. I think just knowing this would have helped me enormously.

Rank felt similarly dismissed. “I was sent home and told to come back when I feel like dying.” Not only did the lack of empathy from her medical team make her feel isolated, this “advice” made it difficult to know when was the right time to go to the hospital. Most pregnant women are educated on the 5-1-1 rule: Go to the hospital when contractions are five minutes apart, lasting one full minute, for at least one hour. However, prodromal labor renders the 5-1-1 guidance useless.

Over the three-week period of her prodromal labor, Rank visited or called her OB’s office multiple times seeking guidance on when to come to the hospital; each time, she was met with doubt. “Are you sure you’re having contractions?” she says one OB asked before hooking her up to a monitor that confirmed she was, indeed, having contractions. On the 24-hour call line a few days later, Rank says a nurse questioned her: “I see that you’ve already been in… Are you sure?”

“No,” Rank wanted to shout. “I’m not sure! That’s why I’m calling you!”

On top of managing her pain, Rank found it difficult to balance the desire to make the best decision for herself and her baby against the pushback she kept receiving at the hospital. “Am I going to get to the hospital and they’ll think I’m crazy? Or is this critical to protect the safety of my kid?” she asked herself over and over. “I got less cautious as the three weeks went on because I had gone twice and they shrugged me off.”

When Rank’s son finally arrived, he was born with shoulder dystocia (an obstetric emergency) and the umbilical cord wrapped around his neck. He required immediate, life-saving care. “I do worry when I think back on it,” she says. “The 15 people who rushed into the room when he was born [not breathing] to resuscitate him were necessary. What if I hadn’t gone to the hospital because I thought it was just more prodromal labor?”

Dr. Rosa Cui, OB-GYN at the Katz Institute for Women’s Health at Northwell Health, acknowledges that because prodromal labor acts so much like true labor, “It’s really hard to predict what the outcome is going to be.” However, she is adamant that it is the job of the provider to do the work to figure out if it’s true labor or not, no matter how many times a patient comes in. “I tell all my patients ‘If you have 5-1-1 and do the right thing and come to the hospital, we will do the assessments.’”

Cui offers additional signs to look for when determining if you should go to the hospital when the 5-1-1 rule doesn’t apply: “The obvious signs are if the water breaks, there’s vaginal bleeding, or if the baby is less active. Beyond that, if the contractions go away and then come back again, or if they are getting even closer,” a return to the hospital is warranted. She adds a final sign that was music to my ears: “Or if we get to the point where someone is so uncomfortable, if they can’t breathe, walk, or talk during these contractions, and they need additional pain management.”

When I tell her that every woman I interviewed for this piece felt like her pain was dismissed, Cui is not surprised. “There’s data out there to show that the way women’s pain is appreciated by physicians is not quite adequate,” she acknowledges. “It’s tough because pain is not a blood marker, where we can see the number and interpret the intensity that way. But with pain management, we can always improve with how we communicate about that.”

As validating as Cui’s words are, changing the mindsets and practices around women’s pain at every hospital across the country won’t happen overnight. In the meantime, I have a simpler solution: Tell pregnant women about prodromal labor before they’re in the middle of it.

When ask what she wished she would have known about prodromal labor, @OK_Brain_193, says, “I wish I would have known about it, period. I knew all about Braxton Hicks and of course true labor, but I never knew my body could act like it was going into labor over and over without anything actually happening.”

Rank tells me she did an online birth course and hired a doula to come to her house to give her a customized birth class, and neither mentioned prodromal labor. “I think it’s reflective of pregnancy education in general, which is primarily focused on the baby,” she says. “There is not enough focus on the mental health and well-being of the mother.” When I ask her what she would want explained in a hypothetical prodromal labor section of a birthing class, she gets right to the point: “It’s not that complicated. You just need to tell people 1, this is a thing that can happen; 2, the 5-1-1 metric won’t apply to you, so here is another metric you can use to determine when to go to the hospital; and 3, it’s really painful, and it’s OK to be really upset about how much the pain is impacting your life.”

I’m going to add another: 4, Not knowing when prodromal labor will end will be as maddening as the pain, but it will end. I think just knowing this would have helped me enormously.

On Day Five of my prodromal labor, the pain of a contraction was so bad, I projectile vomited onto my bedroom wall. As I hobbled to the bathroom, my water broke. Everything changed in that moment. The mental anguish lifted. I was still having contractions, but they seemed manageable for the first time since they began. I high-fived my husband over the giant puddle of amniotic fluid in our hallway. I was finally in true labor, and nobody at the hospital could send me back home without a baby.

Libby Fischer Connell is an essayist living in Pittsburgh, Pennsylvania. She has been a barista, a teacher, a grocery store clerk, a corn detasseler, and a tech CEO. Originally from Nebraska, the Mississippi River shaped her adulthood as she followed it from St. Louis, to Mississippi, to New Orleans, and then back up to Pittsburgh (via the Ohio), where she now lives with her husband, their magical daughter, and their very beautiful and very anxious dog, Sylvie. Read about Libby's misadventures with Sylvie in her substack, Outfoxed.