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How do you know when you’re in labour?

For a first time mama, knowing the ‘ins and outs’ of pregnancy can be a tricky task. As the 40 weeks progress, you get to know your body and become ‘in tune’ with what is normal for you, and your baby. The third trimester can begin to get a little uncomfortable as your baby grows rapidly, and you prepare to meet your little one earthside. 

At the very beginning, when calculating your due date, the date of your last menstrual period is used to decide on an ‘estimated due date’ which marks 40 completed weeks of pregnancy – this can sometimes be based on an ultrasound as well. Mamas wait eagerly for this date to come… but did you know, from 37 weeks gestation you are considered ‘full term’ and your baby can come at any point between this time and your ‘estimated due date’. Additionally, you may go over that date and become ‘overdue’. Most hospitals have policies around this, and women who are more than 10 days past their ‘estimated due date’, are generally offered an induction of labour. At the end of this (seemingly long) journey, your body goes into labour, and you birth your gorgeous bubba and get to know them in the real world.  

“How do I know I am in labour?”- is one of the top questions we get as midwives. Labour and birth are both such powerful life events that are extremely unforgettable. A mama who has never experienced labour before can find it all a little confusing and daunting. It is important to discuss this with your midwife and sort through any questions or misconceptions that you may have. Your midwife is there to holistically support you through tasks big and small, and this can include talking about the fear associated with labour. Each mama is different and no labour is the same as the next. However, there are a few common symptoms that can let you know that you are ready to labour… keep reading to find out more!

Let’s start with the basics… ‘what is labour?’. Labour can be characterised as strong regular uterine contractions that cause your cervix to dilate, and allow your baby to be born. When your labour begins you may experience some, a few, or all of these symptoms! There is no generalised ‘order’ of the way everything may occur, however, labour can be classified into two main stages: early and established labour. 

Early Labour vs Established Labour

In the early stages of labour, your cervix softens and becomes quite thin. This can go on for hours… days even (especially for first time mamas). During this early stage, you may feel nothing at all for some time. Eventually, you might feel some pain and discomfort but there is no pattern and the contractions are irregular. This often feels like period pain. 

Early labour can often be mistaken for active labour or ‘true’ labour and mama may be niggling for a while before the real action begins. During early labour, other symptoms may also occur which let you know that your body is preparing for birth. If you had an internal examination, early labour can be classified as anything before 4cm dilated. 

When you are in active labour, your contractions will become more intense and rhythmical. 

The top of your uterus tenses up (like your bicep would) in a very tight ‘contracted’ state – this is why you experience ‘contractions’. The contractions begin at the top of your tummy and travel around the sides until your whole belly tenses up. Most importantly, these contractions during active labour are strong and powerful to push your baby down towards the birth canal. This process works in a ‘loop’ with all the labour hormones of oxytocin flowing to keep everything going. The more that the baby’s head presses against your cervix (because of those strong contractions) the more it dilates and therefore more hormones are released. Active labour can be considered from 4-5cm until fully dilated. This is usually when the contractions are occurring in a strong, rhythmic pattern, lasting generally over 45 seconds. 

Signs of contractions

Labour often begins with contractions that may feel like mild ‘period cramps’. These usually don’t come in a pattern, and don’t last very long. The irregularity of them indicates that these are ‘early labour’ contractions and your body is still preparing for everything. Mamas who have experienced Braxton hicks contractions during their pregnancies state that “all of a sudden they become more intense and painful”. If you didn’t know, a Braxton hicks contraction is the tightening of your belly with no pain – these can occur any time during pregnancy and are usually harmless if they are occurring irregularly. I like to call Braxton hicks contractions ‘practice’ contractions for the real thing. 

Your contractions then may begin to intensify and come and go in a more regular fashion. For example, these may begin at every 15 minutes, lasting 20 seconds. As you progress through early labour (which can take some time) the contractions will last longer and become closer and closer together. You will also notice that the pain will be stronger and if you touch your belly, it may feel hard and tense. These are all perfectly normal signs. If you give your midwife a ring during this time they will usually recommend you to stay at home (if both you and bub are well, and bubs movements remain normal.) Staying at home in early labour can help things progress more seamlessly. Having a warm shower, or bath to remain as relaxed as possible are some things that can help. 

Ideally, we want the contractions to be coming as regularly as possible. Usually every 2 minutes and lasting between 40 seconds to a minute. Don’t worry mama, you will slowly and gradually build up to this point. Labour is a gradual process, but it is all worth it when you have your baby in your arms. 

Losing your mucus plug

Another sign of labour beginning is losing your mucus plug. A mucus plug is a protective collection of thick mucus in the cervix – which is the opening to the womb. During pregnancy, the cervix releases a thick, jelly-like fluid to keep the area moist and protected. This fluid eventually accumulates and seals the cervical canal, which makes a thick ‘plug’. Mama, this mucus plug is quite spectacular as it acts as a barrier or perhaps a ‘gate-keeper’ to your cervix. It keeps unwanted bacteria and other sources of infection from travelling into your uterus. Imagine it like a ‘cork’ that seals everything up, but also begins the party (the party of labour and birth). Losing your mucus plug may mean that labour and birth are coming soon! This could be during that same day, or in the few days following. It is when the cervix begins to soften and dilate so that ‘plug’ may come away. 

Many women experience vaginal discharge throughout pregnancy, so it can be at times difficult to determine when the mucus plug has been released. It most likely is to appear stringy or thick and jelly-like, unlike typical vaginal discharge. 

If your mucous smells funky or is strange in colour, give your midwife or medical professional a ring as they may want to assess you.

Bloody show

With all of the mucous, there can be some blood mixed in with it. This can either be a small amount of red blood, or old dark brown blood. It occurs for the same reason as losing your mucus plug – the cervix changing and softening. Your cervix and vagina contain thousands of vessels that are increased during pregnancy so bleeding can be common. If labour is near, and is paired with some of these other symptoms, this is a normal sign and usually nothing to worry about. A bloody show has a thick, gelatinous, and sometimes stringy texture. It can also appear translucent with very little blood. If the bleeding you experience is not similar to this or if you are worried, always give your midwife or healthcare professional a call to clarify. Any fresh red ongoing bleeding is not normal, so please call your midwife if you experience this. 

A bloody show can occur prior to labour beginning but it can also happen when you transition to fully dilated during labour. Various cultures can display bloody shows more frequently and this symptom is a great tool of estimating aspects of labour and birth. 

Waters breaking 

Some mamas may have a big gush. Others may have a slight trickle and think they are urinating and can’t stop! The sensation of wetting yourself is really common when your waters break. The amniotic fluid that is surrounding your bubba is warm and when it ‘breaks’ the amniotic sac ruptures and fluid leaks out of your cervix. 

In early labour, your cervix may not be dilated very much, so it may not actually be that ‘gush’ that the movies show. In some cases, when your waters break, it may only be a trickle or a very small ‘leak’. If you think this is happening to you mama, put a pad on and give your midwife a call. This allows you to have a good look at things like the colour, smell, and texture.

When your waters break, they should be clear or pink in colour, with a watery or mucousy consistency, and with an inoffensive smell. Don’t worry, your midwife will ask you some of these questions over the phone and let you know whether you should come in for an assessment. If you come into the hospital there are a few tests that can be done to check if your waters have definitely broken or not. Pop a pad on, to monitor the colour of the water, for once you call your midwife as well. 

Sometimes your waters may not break at all until the very moment your babe is born. Every mama is different.

 

Backache 

Similar to the contractions that you experience in early labour, you may feel these pains in your lower back. Back pain in labour can indicate that your baby is possibly posterior facing which means their back is resting up against your back. This can be quite painful and may cause a longer labour. A pesky backache can actually be one of the first signs that mamas experience when going into labour. It is usually more than the typical discomfort of the third trimester and you may need to use some forms of pain relief. Try using a heat pack on your back or get your support person to do some massage on your lower back. Additionally, regular and ‘cyclic’ back pain whilst pregnant can be of concern and may be a symptom of premature labour. If this occurs, and is persistent, urgently give your midwife or medical professional a call. 

Urge to go to the toilet

Mamas say they know labour is near if they suddenly have an urge to go to the toilet to open their bowels. This is caused by your baby’s low head pressing on your bowel and increasing the activity down there. Just as the muscles in your uterus are relaxing in preparation for birth, so too are the muscles in your bowel and rectum. This is completely normal and a physiological part of birth!

Like I said, you may experience, some, all, or none of these common symptoms leading up to your labour. This can be a very exciting time as things begin to ramp up and the ‘party’ begins. If you experience any of these symptoms before 37 weeks gestation (full term) seek medical care immediately.

Good luck lovely mamas, you are going to do amazing!

*As midwives, we normalise labour and birth as typical and beautiful life events – most of the time they are. Please note that this is generalised advice for mamas, however this is not an individualised diagnosis. If you are ever concerned about whether or not you are in labour please ring your care provider for an assessment and further advice*


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Expert Author: Aliza Carr

Aliza Carr is a midwife and perinatal mental health specialist. You can read her blog at bumpnbub.com.

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