Signs labour has begun

It’s the moment you’ve been waiting for for months – or is it? How do you know whether labour has begun?

By 37 weeks you’re on tenterhooks. You could be meeting your baby any day now, and only one thing stands between you and that wonderful moment – the small matter of the birth. We give you the low-down on when to   sit back and rest up, and when to call the hospital – quick!

Reading the signs

Signs that labour is imminent usually start appearing anytime from 37 weeks. Gail Johnson, midwife and Education and Professional Development Advisor at the Royal College of Midwives, says you might notice mild clues.

‘Before the baby ‘engages’ (when his head moves down into your pelvis) you’ll probably feel out of breath and get heartburn,’ she says. ‘But when he moves down, you’ll feel lighter and more comfortable (known as ‘lightening’), although he’ll put more pressure on your bladder.’

But don’t start filling the birth pool just yet. Lightening usually happens around 36 weeks in a first pregnancy, and doesn’t mean labour is kicking off. In subsequent pregnancies it can happen the day labour starts, and you might not notice it at all.

Putting on a show

Before labour, you may notice a ‘show’: a mucous, bloody discharge. ‘As your cervix starts to soften and stretch in preparation for birth, the plug of mucus that has been sealing your cervix comes away,’ says Gail.

‘Midwives don’t take this show as a sign that labour is starting, as it can happen several days beforehand, but it’s encouraging.’ Having sex can also trigger a slight show.

And as labour approaches, Braxton Hicks ‘practice’ contractions may become more frequent, but not necessarily more painful.

Feeling contractions

Usually the first sign of labour, it can be easy to mistake early contractions for backache or niggles. In fact, it’s your womb muscles gradually tightening and relaxing in order to start opening your cervix.

Women feel contractions in different ways. ‘Some say they get contractions in a similar place to where they feel period pains,’ explains Gail. ‘If you usually get backache, pelvic pain or pain down your thighs, you might feel this in early labour.’

‘At the onset of labour, contractions tend to be spaced out, up to an hour apart,’ says Gail. ‘You might feel something, but not enough to stop and think. As labour progresses, they’ll become more frequent, closer together, stronger and longer.’

False start

It doesn’t seem fair, but you can have contractions without actually being in labour. Your cervix needs to be dilating too, which is why, when you get to hospital or see a midwife when you think you’re in labour, the first thing they do is examine your cervix to see if it has started opening.

If this doesn’t seem to be happening, you will not be classed as in ‘established labour’ and may be sent home again. This is frustrating – especially if you are in pain!

But don’t worry, it’s very common, and it’s just a matter of time before your contractions become regular and gradually more intense and your cervix begins to dilate. In the meantime, head home and try to relax.

(nb. Urinary tract infections can also cause contraction-like pain – this isn’t labour, and antibiotics will easily sort an infection out.)

Lower back pressure

Depending on the way your baby is lying, the pressure felt will be different. If he is lying in the occipital posterior position (with his back to the mum’s back) there tends to be more pressure on your back.’ It’s perfectly possible to have a vaginal delivery if the baby is this way around.

The sound of gushing water

Don’t worry - it’s unlikely this will happen while you’re queuing for the cashpoint. Your waters will probably break not long before delivery, when the sterile amniotic fluid can act as a kind of lubricant during birth – but there are exceptions.

Around 2–8 per cent of women will experience their membranes rupturing before labour, and in around five per cent of labours it doesn’t happen until delivery.

If your waters break before the onset of contractions, you’ll probably go into labour within 24–48 hours. You must tell your midwife if they break prior to labour as there is a risk of infection.

Action stations

Once you’re sure you’re in labour, try not to panic. Remember you’re not alone. ‘If at any time you feel worried, call your midwife for reassurance,’ says Gail. ‘That’s what we’re here for.’

If you’re not worried, you don’t need to call your midwife until your contractions are regular and painful, and about 10 minutes apart. The midwife will want to know:

• what your contractions feel like

• how far apart they are

• how long they’re lasting

• whether your waters have broken, and if so, what colour they are (greeny black can indicate the baby has passed meconium – his first poo, which can be a sign of fetal distress)

• whether it’s your first baby

• whether you feel well and the baby has been moving normally.

It’s a good idea to keep a note of all these things during early labour. Your midwife needs to know of any potential risks, too. It’s important to mention anything abnormal, such as headache, fever, bleeding or abdominal pain. And mention any known risks, lack of baby movements and any illnesses or conditions you have. 

Can the midwife tell how far along you are by the tone of your voice?

‘This is difficult because all women deal with pain differently,’ says Gail. ‘A vague rule is that if you can talk through a contraction then you’re in early labour. They take your breath away later on, so if I’m talking to a woman and she suddenly goes quiet, I know she is probably having an intense contraction.’

What should I do in early labour?

‘If it’s during the night, go to bed and get as much sleep as you can,’ advises Gail. ‘If it’s daytime, do normal bits and pieces around the house, be active, rest when you need to and eat and drink as you feel like it.’

If you’re not planning a home birth, it’s still good to stay at home for as long as possible – you want labour to become established before you leave the house. ‘If you move to hospital too soon, you may become anxious and this can slow contractions,’ says Gail.

If you’re sent home again because labour hasn’t progressed, don’t despair. ‘Look on being sent back home as a positive thing,’ advises Gail. ‘At home, you can eat and drink what you like, and you’ll feel more relaxed and in control.’

A comfortable environment will help you feel in control and cope with the increasing discomfort. Research shows that the more relaxed you are in labour, the better the outcome.

Stop/start…

Sally Kent, 38, is mum to Thomas, 17, Daniel, 16, Laura, 13, and Max, nine weeks.

‘I had so many false starts to labour that I lose count! I started contractions at 39 and when I went to hospital I was 3–4cm dilated, but disappointingly my contractions stopped and I was sent home.

The next week I had backache and contractions, more painful than the week before. I went to hospital, but after three hours the contractions faded again. I felt daft. At 11 days overdue I had contractions again. I went to hospital when they were three minutes apart, but I was only 3cm dilated.

I was sent home and told to come back in the morning to be induced! The contractions were more painful after the induction next morning. My baby’s heart rate dropped, and they started considering a caesarean, but on one last try I had Max with a ventouse delivery.’