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Will my second labor and delivery be like my first?
Q: I’m 33 weeks pregnant with my second child. My first was born 13 days early without clear signs of labor, such as contractions or fluid leakage. At 37 weeks I was more than 3 centimeters dilated; at 38 weeks I was more than 5. My obstetrician broke my bag of water and I went into labor, delivering the next day. What are the chances the same thing will happen again? I know every pregnancy is different, but is every labor and delivery different as well?
A: While every labor and delivery is unique, some women have a similar experience from one birth to the next. From the description of your first birth, it seems that your cervix began dilating before you were in labor. Some women have cervical incompetence, which means the cervix spontaneously stretches open as pregnancy progresses and does not require uterine contractions to dilate. Cervical incompetence increases your risk of pre-term birth.

The maximum dilation of the cervix during labor is 10 centimeters. If the cervix is already dilated at the onset of labor, less work is needed to achieve delivery; the result is a faster labor. Because you were more than 5 centimeters dilated with your first child before labor began your body had already done half the work of the first stage of labor!

In my experience, most first-time mums are well aware of the signs of true labor. I have only occasionally seen someone reach 5 centimeters dilation without much discomfort or awareness. Common signs of labor include:
  • Uterine contractions. The uterine muscle tightens, making your abdomen feel firm and hard to indent. Initially contractions may feel mild and irregular; over time they increase in frequency and intensity.

  • Leakage of amniotic fluid. The membrane that surrounds the baby tears, allowing amniotic fluid to leak out. Fluid is clear with a smell similar to freshly baked bread. However, when small amounts of amniotic fluid mixes with other vaginal secretions, the colour and smell may change. If a baby produces meconium (its first bowel movement) before labor begins, the amniotic fluid may look yellow or green, or contain green particles.

  • Bleeding. As the cervix dilates, the small blood vessels of the cervix may begin to bleed. The blood may be mixed with cervical mucus, known as a bloody show.
With your history of fast labor and early dilation, it’s quite possible that you could have another early baby. Your doctor should examine your cervix regularly during the second half of pregnancy to see if you are dilating early. After 37 weeks gestation, if your doctor finds you are well dilated, you can discuss whether to induce labor by breaking the water bag in the hospital. This will assure you of delivering there rather than at home or en route!

Laura E. Stachel M.D. Obstetrician & Gynecologist