At a prenatal visit, a primigravida asks the nurse how she will know her labor has started. The nurse knows that what indicates the beginning of true labor?

Choice A rationale Contractions that are relieved by walking are typically Braxton Hicks contractions, often termed "false labor.”. True labor contractions, driven by oxytocin release causing myometrial shortening, generally increase in intensity and frequency with ambulation, unlike false labor which represents intermittent, irregular uterine tightening that does not effect cervical change. Choice B rationale During the onset of labor, there is often an increase in vaginal discharge, particularly the bloody show, which is the release of the mucous plug and small amount of blood from cervical capillaries as the cervix begins to efface and dilate. A decrease is not indicative of true labor beginning. Choice C rationale Discomfort associated with true labor primarily originates in the lower back and radiates to the abdomen, due to uterine muscle contractions and pressure on sacral nerves. False labor discomfort is often centered in the abdomen and groin, lacking the true labor pattern. Choice D rationale True labor is characterized by uterine contractions that exhibit a positive feedback loop: they become progressively stronger (more intense), closer together (more frequent), and longer in duration, leading to effacement and dilation of the cervix, which is the definitive clinical sign of labor progression.