Signs of labour - when to go to hospital
The first signs of labour can vary from one person to another, and even from one pregnancy to the next. For many, a first birth takes longer. With a second or especially a third baby, things can move faster, which means there is less time to get organised.
The big question is when to head to hospital, and how to be sure it is truly time rather than just the usual signs that appear in the days before labour. We will also touch on what to do if there is no time to get in and your baby looks set to arrive without a professional present.
Before we list the most common signs, it helps to understand what is happening inside your body during labour. That makes the outward signs easier to recognise.
The hormones that help labour along
During pregnancy progesterone plays a leading role. It protects the pregnancy and inhibits the synthesis of prostaglandins, which would otherwise allow the uterus to contract, helping to stabilise the uterine wall.
When your baby’s adrenal glands are mature enough, they stimulate prostaglandin production. Prostaglandins make the uterus more responsive to contracting and increase oxytocin receptors, so later the uterus can contract more strongly in response to oxytocin. This is how labour gets under way.
Possible signs that labour is starting
Contractions
From 36 to 37 weeks you may notice Braxton Hicks tightenings. These are irregular and usually milder. Weather changes can make them more likely. They differ from true labour contractions.
Some women do not notice Braxton Hicks at all, while others do. These practice tightenings are part of preparation. The cervix softens, moves forward and thins. Your body is getting ready. Most of the time the cervix does not open yet, though it can do.
For some people this shows up as simple bump hardening. For others it feels like period-type cramps. From 37 weeks this is usually not a concern. Before 37 weeks, speak to your midwife or doctor, since it could be a sign of preterm labour.
After 37 weeks, do not rush straight to hospital if there are no clear signs of established labour yet.
Braxton Hicks or true labour?
With Braxton Hicks, tightenings are irregular, or they may keep the same pattern for days without progressing. If you are unsure, try a warm bath (only if your waters are intact). If the sensations settle, it is not yet the main event.
With true labour, contractions intensify, come closer together and last longer. The practice phase can tip over into established labour, and that switch may take time. Tightenings can stop and start again. Then almost without noticing, you are in labour.
During practice tightenings carry on with everyday life if you are well and have not been told to rest. If it is evening, prioritise sleep. Rest now helps you save energy for labour. If you cannot sleep, do not worry. Early on you can still rest between contractions.
What does a labour contraction feel like?
At the start it can feel like period cramps. They are not that strong and last 20 to 30 seconds, with 10 to 15 minutes between them. At this point you do not need to watch the clock anxiously.
Later, as ligaments tense and labour develops, contractions feel stronger and more like deep cramps. You may feel them low in the abdomen, in your back, and sometimes towards the perineum or vagina. Some feel them mostly in the bump, others more in the back.
Breathe in through your nose and out through your mouth, slowly. Do not hold your breath. Breath-holding tenses muscles, can make pain feel worse, and reduces oxygen. Your muscles need oxygen, and so does your baby. Keep breathing through each contraction.
Contractions will strengthen, come more often, and demand more of your focus.
If your contractions have been every 8 to 10 minutes for about an hour, it is sensible to set off. With a first baby, many maternity units are happy to assess you when you reach 6 to 7 minutes apart. A second baby can progress faster, so be quicker to call or go in. If your cervix was already partly open at a recent check, be ready to move sooner.
You may feel a bowel urge because the baby is pressing on your bowels. This is not yet the pushing phase.
Just before pushing, contractions can space out briefly. Pain may ease a little, but the uterus is still working. When your body starts to bear down naturally and the cervix has fully opened, you are ready to push.
A pushing contraction builds from the top of the bump and bears down to help the baby out. Keep breathing, and as you breathe out, allow your body to bear down. Trust your instincts and follow your body’s cues.
Many people find this phase less painful, or the focus takes their attention away from the pain. Others find pushing very intense. Both are normal.
Waters breaking
If your waters break or leak, go to hospital.
If the sac breaks low, a larger amount may gush out at once. If it breaks higher, fluid may trickle.
It can be hard to tell amniotic fluid from urine. You can place a sanitary pad or folded tissue in your underwear and cough. With abdominal pressure, amniotic fluid usually appears again and wets the paper. Some pharmacies sell pads that change colour with amniotic fluid but not urine.
Check the colour. If it is clear or slightly pink, set off to hospital. If it is greenish or brown or you see bits, it may be meconium. Go quickly. If far away, call 999 for an ambulance.
Losing the mucus plug
The mucus plug is a jelly-like, pinkish discharge that helps protect against infection at the cervix. If it comes away, you do not need to rush in. It can appear one to two weeks before labour, or only during labour. On its own, losing the mucus plug is not a reason to go in immediately.
Bleeding
If you see a small pinkish or light red stain on your underwear, do not panic, but phone your midwife or maternity unit. If you cannot get through, go to hospital for a check. If bleeding repeats or you see a larger amount, go urgently. For heavy bleeding, call 999.
Nesting
Many mums-to-be feel an urge to sort and tidy right before labour. Nesting can crop up at any point, but it often ramps up close to the day. You will feel less stressed if the hospital bag and baby things are prepared well in advance.
What if you do not reach hospital in time?
For peace of mind, make a plan in case you do not get to hospital in time. It is rare for a first birth, but a third can be quicker. Know what to do if your baby arrives in the car, in the car park or at home.
Make sure your birth partner knows how to help.
If you feel the urge to push, do not try to drive to hospital. Switch to Plan B.
If you are in the car, your partner should pull over safely and find a proper parking space.
Stay calm. Birth is a natural process. Your body knows what to do.
Use spare clothes or towels as pads. Find a safe position. You do not have to lie on your back. Kneeling is fine. Make sure someone can catch the baby so there is no risk of falling.
If possible, your partner should call 999. Safety comes first. If they need both hands to support the birth, they can call after the baby is born.
When it is time to push, follow your instincts. Your partner should not pull the baby. Their job is to support and prevent a fall. Then pass the baby onto your chest as far as the cord allows. Do not cut or pull on the cord. Leave it for the professionals. Keep the baby skin to skin on your chest.
Cover both of you with a blanket or coats. Your body will warm your baby, with the blanket over your backs.
If your baby’s breathing seems noisy or blocked, gently suction with your mouth from the nose to clear mucus.
If the placenta has not been born when help arrives, that is fine. Have towels ready to absorb blood.
After the birth, how you might feel
Every birth is different. You might experience it as a wonder, or you might have parts you want to process. If you feel your experience was traumatic, please ask for support. You are not alone.
Sources:
NHS — Signs that labour has begun
