How do I know labour is starting? Signs of labour and when to come to hospital

Every labour is different. Some women notice changes for several days before labour becomes established, while for others labour can begin more suddenly.

Knowing what to look out for can help you feel more prepared and understand when it is time to contact your maternity team or come to hospital.

If you are unsure about what you are experiencing, you don't have to work it out on your own. A midwife is available 24 hours a day at your St John of God Health Care (SJGHC) hospital to provide advice and reassurance.

Signs that labour may be approaching

In the hours or days before labour begins, you may notice some changes as your body prepares for birth.

These can include:

• Your baby’s head moving down into your pelvis, sometimes called engagement or lightening
• Backache or an aching sensation in your lower back
• Braxton Hicks contractions becoming stronger or more noticeable
• Increasing pelvic pressure
• Increased vaginal discharge
• A 'show' - mucus that may be pink or blood-stained as the cervix begins to change
• Period-like cramping
• An upset stomach or increased need to open your bowels
• A feeling of increased energy or 'nesting'

These signs can indicate that your body is preparing for labour, but they do not necessarily mean that active or established labour has started.

How do I know if I am having real contractions?

Throughout pregnancy, you may experience Braxton Hicks contractions. These are sometimes called practice contractions.

Braxton Hicks contractions are often irregular and may stop and start. They may become uncomfortable but usually do not continue to build in strength and frequency in the same way as labour contractions.

As labour progresses, contractions generally:

• Become stronger
• Become more regular
• Last longer
• Become closer together
• Require more of your concentration and focus

You may also experience lower back pain or pressure with contractions.

There is no single contraction pattern that tells every woman exactly when she should come to hospital. Your maternity team may give you specific advice based on your pregnancy, your previous births and your individual circumstances.

If your contractions are becoming regular and stronger, or you are finding it difficult to manage at home, contact your Birth Suite or maternity unit for advice.

What happens if my waters break?

Your waters may break before labour begins or during labour. They do not always break with the dramatic gush you may see in the movies. You may experience:

• A sudden gush of fluid
• A slow trickle
• A sensation of continued wetness

Amniotic fluid is usually clear, pale or slightly pink. If you think your waters have broken, put on a clean sanitary pad and contact your Birth Suite or maternity team for advice, even if you are not having contractions.

Your midwife will ask you questions about the fluid, including its colour and smell, when it started and how much fluid you have noticed.

How will I know if my waters have actually broken?

It can sometimes be difficult to tell the difference between amniotic fluid, urine and normal vaginal discharge.

If you are unsure, use a clean sanitary pad and contact your maternity unit.

Your maternity team can assess your symptoms and, if necessary, perform an examination or test to determine whether your membranes have ruptured.

What does the colour of the fluid mean?

Amniotic fluid is usually clear, pale or slightly pink. If the fluid is green or brown, it may contain meconium - your baby’s first bowel movement. Meconium can occur for a number of reasons and may require closer monitoring of your baby's wellbeing during labour.

If your waters are green, brown or blood-stained, or if the fluid has a strong or unpleasant smell, contact your maternity team or hospital promptly for advice.

What if my waters break before 37 weeks?

If you think your waters have broken before 37 weeks, contact your delivering hospital immediately.

Waters breaking before 37 weeks can increase the risk of infection and premature birth and requires prompt assessment.

If you notice fluid leaking from your vagina before 37 weeks, use a clean pad and contact your maternity team rather than waiting to see whether contractions begin.

What about Group B Streptococcus (GBS)?

If you have been advised that you are GBS positive, tell your maternity team when your waters break or when labour begins.

Your maternity team will advise you about the appropriate management and whether antibiotics during labour are recommended based on your individual circumstances and hospital guidelines.

When should I call the hospital?

Your maternity team can give you personalised advice about when to come to hospital.

As a general guide, contact your SJGHC Birth Suite or maternity unit if:

• Your waters break or you think they may have broken
• You have vaginal bleeding that is more than a small amount of blood-stained mucus or 'show'
• Your baby's movements have changed, or you are concerned about your baby's movements
• You have regular contractions that are becoming stronger and closer together
• You are having contractions before 37 weeks
• You have abdominal pain that does not feel like normal labour contractions
• You develop a fever or feel unwell
• You are concerned that something is not right
• You need pain relief, support or reassurance
• You are unsure whether labour has started

You should also follow any specific instructions your maternity team has given you, as these may differ depending on your pregnancy and individual circumstances.

When should I seek urgent help?

Call 000 for an ambulance if you have heavy vaginal bleeding, severe or unusual pain, feel seriously unwell, or think your baby may be about to be born, and you are unlikely to reach your planned place of birth in time.

If you experience a severe headache or significant visual changes, these can be warning signs of pre-eclampsia and require urgent medical assessment.

Trust your instincts

There is no single way for labour to begin. Your waters may break first, contractions may gradually become stronger and more regular, or you may notice backache, pelvic pressure or increased discharge before labour becomes established.

The important thing is to pay attention to the changes happening in your body and contact your maternity team if you are unsure. You don't have to wait until you are certain that you are in labour before calling. Your midwives are there to support you, answer your questions and help you decide what to do next.

References

• Pregnancy, Birth and Baby: Early signs of labour
• Pregnancy, Birth and Baby: Giving birth: contractions
• Pregnancy, Birth and Baby: Waters breaking
• Pregnancy, Birth and Baby: Waters breaking early (PPROM)
• Healthdirect: Giving birth: contractions