First signs of labour: contractions, waters breaking and when to go in

Knowing that labour has begun is a big question for most people, especially in a first pregnancy. A sudden gush of water like in films is actually rare; in many cases labour starts slowly, step by step, and with signs that prepare you. This article explains calmly what different signs may mean and when to act.

The general information here does not replace the instructions your doctor or hospital gives you. If the two differ, their guidance comes first.

Early signs you may notice before labour

Days, sometimes weeks, before true labour begins, your body may start to prepare. These are usually:

• The baby dropping: Your belly sits a little lower and breathing gets easier, but pressure on the bladder grows, so you may need the toilet more often.
• A show (mucus plug): The mucus plug that seals the cervix can come away as a pink, brownish or blood-streaked discharge. Labour may still start days later.
• Back and low back pain: A heavy feeling in the groin and back, or period-like aches, can appear.
• Digestive changes: Some people have softer, diarrhoea-like stools, others feel sick.
• Energy swings: Some people suddenly feel the urge to nest, others feel very tired.
• Irregular tightenings: Your belly goes hard from time to time. This is usually irregular.

You do not have to notice all of these; labour can start without any of them.

True versus practice contractions

Labour contractions become regular over time, grow longer, stronger and closer together. Walking or resting usually does not stop them. Practice contractions (Braxton Hicks) are mostly irregular and ease when you change position or drink water.

For a more detailed comparison, take a look at the Guide article on Braxton Hicks contractions. You can use the contraction timer in the app to measure length and frequency.

When your waters break

When the membranes rupture, some people notice a gush, others a slow, continuous leak. It can mix with urine, so telling them apart can be hard.

• If your waters break, note the time and colour; clear or pale pink-straw colour is usually expected.
• If the colour is green or brown, or the smell is unusual, contact a healthcare facility right away.
• Even without contractions, call the hospital or your doctor if your waters break; they will often ask you to come in for monitoring.

Stay at home or go to the hospital?

In the early stage, resting at home is more comfortable for most people. Even so, the key rule is that the instructions from your doctor or hospital come first.

Here is a commonly used general approach. For a first birth, doctors usually advise calling when contractions come about 5 minutes apart, last about 1 minute each and keep going for an hour; this is similar to the rule found in sources such as the NHS and ACOG. If you have given birth before, doctors usually advise acting earlier because labour may progress faster.

• If you live far from the hospital or have a long journey, talk about leaving earlier.
• Plan the trip in advance for the middle of the night or heavy traffic.
• If you are Rh negative, have a planned caesarean or a high-risk pregnancy, your instructions may differ.

For whom to call and the route to the hospital, see the Guide article on the day-of-birth departure plan.

What happens in the body in early labour?

The cervix slowly softens, thins and opens. In a first birth this stage can be long and sometimes lasts more than a day. In the early stage, contractions are short, spaced out and manageable. As things progress, contractions get longer, the gaps shorten and the intensity builds. At this point many people stop talking or walking and need to focus on each contraction.

The timing varies a great deal. Rather than comparing yourself with someone else’s pace, trust your own body’s tempo.

10 quick tips that help right away

What you can do at home in the early stage:

1. Log contractions with the timer or a clock: length, gap and intensity.
2. Take a warm shower; it can help muscles relax.
3. Sip water often and eat light, easily digested snacks.
4. Rest; nap if you can and save your energy for the birth.
5. Change position: walk, rock on a birth ball, go on all fours or lie on your side.
6. Breathe slowly and deeply; drop your shoulders with each contraction.
7. Ask your partner for a back or lower-back massage.
8. Music, calming sounds or a favourite film may help.
9. Check the hospital bag and papers, and make sure the car seat is in the car.
10. Keep the list of people to call and your plan for getting to the hospital ready.

When to contact your doctor

In the following situations, call the hospital without waiting, or call 112 (in Turkey) or your local emergency number:

• Heavy vaginal bleeding (more than a period)
• Green or brown fluid when your waters break
• A clear reduction in the baby’s movements, or no movements felt
• Regular contractions or waters breaking before 37 weeks
• Severe headache, vision changes or sudden swelling of the face and hands
• Suspected cord prolapse: something hanging from or felt in the vagina (get on your hands and knees and call 112 immediately)
• Fever, foul-smelling discharge or sudden, unbearable abdominal pain
• Constant pain that does not ease even between contractions

If you are unsure in any situation, do not hesitate to call the hospital; asking is always the right choice.

Frequently asked questions

I had a show; has labour started? Not necessarily. A show may mean you are getting closer, but labour can still start days later. If bleeding is heavy or contractions are also present, speak to your doctor.

My waters broke but there are no contractions. What should I do? Call the hospital or your doctor. Most often they will ask you to come in for monitoring. Use a clean pad if you are leaking; do not use a tampon.

My contractions are regular but mild. Should I go to the hospital? Follow your instructions. Mild contractions still further apart than about 5 minutes are often early labour; you can rest at home and keep timing them.

Does diarrhoea mean labour is near? For some people, yes; as the body prepares, the bowels can be affected. On its own, though, it is not a sure sign.

Does labour start right after the baby drops? No. The baby dropping can happen days or even weeks before the birth.

This article is for general information; your doctor’s or midwife’s advice for your own situation always comes first.