Signs that labour has begun

You’re likely to recognise the signs of labour when the time comes, but if you’re in any doubt, don't hesitate to contact your midwife.

The main signs of labour starting are strong, regular contractions and a "show". A show is when the plug of mucus from your cervix comes away.

Other signs that labour is beginning include your waters breaking (rupture of the membranes), backache and an urge to go to the toilet, which is caused by your baby’s head pressing on your bowel.

What are contractions like?

When you have a contraction, your womb (uterus) tightens and then relaxes, like a stronger version of period pains. You may have had contractions throughout your pregnancy, particularly towards the end. During pregnancy, these painless tightenings are called Braxton Hicks contractions.

When you are having regular, painful contractions that feel stronger and last more than 30 seconds, labour may have started. As labour gets going, your contractions tend to become longer, stronger and more frequent.

During a contraction, the muscles in your womb contract and the pain increases. If you put your hand on your abdomen, you will feel it getting harder. When the muscles relax, the pain fades and your hand will feel the hardness ease. The contractions are pushing your baby down and opening your cervix (entrance to the womb), ready for your baby to go through.

Your midwife will probably advise you to stay at home until your contractions become frequent. When your contractions last 30-60 seconds and occur every five minutes, call your midwife for guidance. If you’re planning to have your baby in a maternity ward, phone the hospital.

Here's more information on when to go to hospital

Backache often comes on in labour

You may get backache or the aching, heavy feeling that some women experience with their monthly period.

A "show" signals the start of labour

While you are pregnant, a plug of mucus is present in your cervix. Just before labour starts, or in early labour, the plug comes away and you may pass this out of your vagina. This small amount of sticky, jelly-like pink mucus is called a show.

It may come away in one blob, or in several pieces. It is pink in colour because it’s bloodstained, and it's normal to lose a small amount of blood mixed with mucus. If you’re losing more blood, it may be a sign that something is wrong, so telephone your hospital or midwife straight away.

A show indicates the cervix is starting to open and labour may follow quickly, or it may take a few days. Some women do not have a show.

What happens when your waters break?

Most women’s waters break during labour, but it can also happen before labour starts. Your unborn baby develops and grows inside a bag of fluid called the amniotic sac. When it’s time for your baby to be born, the sac breaks and the amniotic fluid drains out through your vagina. This is your waters breaking.

You may feel a slow trickle, or a sudden gush of water that you cannot control. To prepare for this, you could keep a sanitary towel (but not a tampon) handy if you are going out and put a protective sheet on your bed.

Amniotic fluid is clear and a pale straw colour. Sometimes it's difficult to tell amniotic fluid from urine. When your waters break, the water may be a little blood-stained to begin with. Tell your midwife immediately if the waters are smelly or coloured, or if you're losing blood, as this could mean you and your baby require urgent attention.

If your waters break before labour starts, phone your midwife or the hospital for advice. Without amniotic fluid your baby is no longer protected and there is a risk of infection.

How to cope when labour begins

At the beginning of labour:

  • you can be walking/moving about if you feel like it
  • you can drink fluids and may find isotonic drinks (sports drinks) help keep your energy levels up
  • you can have a snack, although many women don’t feel very hungry and some feel sick
  • as the contractions get stronger and more painful, you can try relaxation and breathing exercises – your birth partner can help by doing these with you
  • your birth partner can rub your back as it can help relieve pain

Premature labour

About one baby in every 13 (8 out of 100) will be born prematurely  in other words, before the 37th week of pregnancy. In most cases labour starts by itself, and the signs will usually be the same as labour that starts at full term. These signs could be:

  • contractions
  • sudden breaking of the waters
  • a "show" (when the plug of mucus that has sealed the cervix during pregnancy comes away and out of the vagina)

Having your baby early

If your baby is likely to be delivered early, you will be admitted to a hospital with specialist facilities for premature babies. This is known as a neonatal unit. 

Find out about premature or ill babies

Not all hospitals have facilities for the care of very premature babies, so it may be necessary to transfer you and your baby to another unit, ideally before delivery (if time permits) or immediately afterwards.

If contractions start prematurely, the doctors may be able to use drugs (tocolytics) to stop your contractions temporarily. This hopefully allows time for steroid injections to be given. Steroids will reduce the risk of the baby suffering from the complications of being born very early (particularly breathing difficulties and bleeding). They can take about 24 hours to work.

Many twins and triplets are born prematurely. The average delivery date for twins is 37 weeks and 33 weeks for triplets.

The Royal College of Obstetricians and Gynaecologists has useful information about what to expect in their leaflets, Premature labour and When your waters break early.

If you have any reason to think that your labour may be starting early, contact your hospital straight away.

 

Induction

An induced labour is one that is started artificially. It's fairly common for labour to be induced. Every year, one in five labours are induced in the UK.

Sometimes labour can be induced if your baby is overdue or if there is any sort of risk to you or your baby's health. This risk could be if you have a health condition such as high blood pressure, for example, or if your baby is failing to grow.

Induction will be planned in advance. You'll be able to discuss the advantages and disadvantages with your doctor and midwife, and find out why they think your labour should be induced. It's your choice whether to have your labour induced or not.

Most women go into labour spontaneously by the time they are 42 weeks pregnant. If your pregnancy lasts longer than 42 weeks and you decide not to have your labour induced, you should be offered increased monitoring to check your baby's wellbeing.

Why you might be induced

  • if you are overdue
  • if your waters have broken
  • if you or your baby have a health problem

If you are overdue

Induction is offered to all women who don't go into labour naturally by 42 weeks, as there is a higher risk of stillbirth or problems for the baby if you go over 42 weeks pregnant.

If your waters break early

If your waters break more than 24 hours before delivery, there is an increased risk of infection to you and your baby. You may need a caesarean, and your baby may be vulnerable to problems associated with being premature if your waters break before 37 weeks of pregnancy.

If your waters break before 34 weeks, you will be offered induction only if there are other factors that suggest it's the best thing for you and your baby.

If your waters break between 34 and 37 weeks, your doctor and midwife should discuss your options with you before you come to a decision about having an induction. They should also discuss the neonatal (newborn) special care hospital facilites in your area with you.

If your waters break at 37 weeks or over, you should be given the choice of induction or expectant management. Expectant management is when your healthcare professionals monitor your condition and your baby's wellbeing, and your pregnancy can progress naturally as long as it's safe for both of you.

If you have a health condition or your baby isn't thriving

You may be offered an induction if you have a condition that means it will be safer to have your baby sooner, such as diabetes, high blood pressure, or obstetric cholestasis.

If this is the case, your doctor and midwife will explain your options to you so you can decide whether or not to have your labour induced.

Membrane sweep

Before inducing labour, you will be offered a "membrane sweep", also known as a "cervical sweep", to bring on labour.

During an internal examination, your midwife or doctor sweeps their finger around your cervix. This action should separate the membranes of the amniotic sac surrounding your baby from your cervix. This separation releases hormones (prostaglandins), which may kick-start your labour.

Having a membrane sweep doesn't hurt, but expect some discomfort or bleeding afterwards.

If labour does not start after a membrane sweep, you'll be offered induction of labour. Induction is always carried out in a hospital maternity unit. You will still be looked after by midwives, but doctors will be available if you need their help.

How labour is induced

If you're being induced, you'll go into the hospital maternity unit.

Contractions can be started by inserting a tablet (or pessary) or gel into the vagina. Induction of labour may take a while, particularly if the cervix (the neck of the uterus) needs to be softened with pessaries or gels.  

If you have a vaginal tablet or gel, you may be allowed to go home while you wait for it to work. You should contact your midwife or obstetrician if:

  • your contractions begin
  • you have had no contractions after six hours

If you've had no contractions after six hours, you may be offered another tablet or gel.

If you have a controlled-release pessary inserted into your vagina, it can take 24 hours to work. If you aren't having contractions after 24 hours, you may be offered another dose.

Sometimes a hormone drip is needed to speed up the labour. Once labour starts, it should proceed normally, but it can sometimes take 24 to 48 hours to get you into labour.

What induced labour feels like

Induced labour is usually more painful than labour that starts on its own, and women who are induced are more likely to ask for an epidural.

Your pain relief options are not restricted by being induced. You should have access to all the pain relief options usually available in the maternity unit.

Women who are induced are also more likely to have an assisted delivery, where forceps or ventouse suction are used to help the baby out.

If induction of labour doesn't work

Induction isn't always successful, and labour may not start. Your obstetrician and midwife will assess your condition and your baby's wellbeing, and you may be offered another induction or a caesarean section. Your midwife and doctor will discuss all your options with you.

Side effects of induction of labour

One in every five births in the UK in 2004-05 were induced, according to NICE. Among these induced births, when labour was started using drugs:

  • less than two-thirds of these women gave birth without further intervention
  • about 15% had instrumental (assisted) births (such as forceps or ventouse)
  • 22% had emergency caesarean sections

Natural ways to start labour

There are no proven ways of starting your labour yourself at home.

You may have heard that certain things can trigger labour, such as herbal supplements and having sex, but there is no evidence that these work.

Other methods that are not supported by scientific evidence include acupuncture, homeopathy, hot baths, castor oil, and enemas.

Having sex won't cause harm, but you should avoid having sex if your waters have broken as there is an increased risk of infection.

For more information on induction, you can read the National Institute for Health and Care Excellence (NICE) guidelines on induction of labour. NICE also has information for the public on induction of labour.

When to go to the hospital or birth centre

If it's your first pregnancy, you may feel unsure about when you should go into hospital or a midwifery unit. The best thing to do is to call your hospital or unit for advice.

If your waters have broken, you'll probably be told to go in to be checked.

If it is your first baby and you are having contractions but your waters have not broken, you may be told to wait. You'll probably be told to come in when your contractions are:

  • regular
  • strong
  • about five minutes apart
  • lasting about 45-60 seconds

If you don't live near your hospital, you may need to come in before you get to this stage. Make sure you know the signs of labour and what happens.

Second babies often arrive more quickly than the first, so you may need to contact the hospital, midwifery unit or your midwife sooner.

Don't forget to phone the hospital or unit before leaving home, and remember to take your notes.

If you are planning a home birth, follow the procedure you have agreed with your midwife during your discussions about the onset of labour. Make sure you know the signs of labour.

What to expect at the maternity unit

Maternity units vary, whether they are in hospitals or midwifery units, so the following is just a guide to what is likely to happen.

You can talk to your midwife about the way things are done at your local hospital or midwifery unit, and what you would like for your birth. If your wishes can't be met, it's important to understand why.

Your arrival

If you carry your own notes, take them to the maternity unit's admissions desk. You will be taken to the labour ward or your room, where you can change into a hospital gown or other clothes of your own.

Choose something that is loose and ideally made of cotton, because you'll feel hot during labour and won't want to wear anything tight.

Examination by the midwife

The midwife will ask you about what has been happening so far and will examine you. If you are having a home birth, this examination will take place at home. The midwife will: 

  • take your pulse, temperature and blood pressure, and check your urine
  • feel your abdomen to check the baby's position and record or listen to your baby's heart 
  • probably do an internal examination to find out how much your cervix has opened, so they can then tell how far your labour has progressed (tell your midwife if a contraction is coming before they perform this examination, so that she or he can wait until it has passed) 

These checks will be repeated at intervals throughout your labour. Always ask about anything you want to know. If you and your partner have made a birth plan, show your midwife so they know what kind of labour you want and can help you to achieve it.

Delivery rooms

Delivery rooms have become more homely in recent years. Most have easy chairs, bean bags and mats, so you can move about in labour and change position. Some have baths, showers or birthing pools. You should feel comfortable in the room where you are giving birth.

Some maternity units may offer you a bath or shower. A warm bath can be soothing in the early stages of labour. Some women like to spend much of their labour in the bath as a way of easing the pain.

Water births

Some maternity units have birthing pools so that you can labour in water. Many women find that this helps them to relax. If labour progresses normally, it may be possible to deliver the baby in the pool. Speak to your midwife about the advantages and disadvantages of a water birth. If you want one, you'll need to make arrangements well in advance.