Signs of labour

How will I know when I am in labour?

Every woman's experience of labour is different (Tommy's 2019a). You may only be able to work out when labour truly started after you've been through it! But changes that take place in pre-labour and early labour may cause tell-tale signs and symptoms that labour is imminent.

In pre-labour or early labour (the latent phase), you may have:

• Persistent lower back pain or abdominal pain, with cramps that feel like period pain (NCT 2018, NHS 2017a, Tommy's 2019a).
• Painful contractions or tightenings that may be irregular in strength and frequency, and may stop and start (Tommy's 2019a).
• Broken waters (ruptured membranes). Your membranes may rupture with a gush or a trickle of amniotic fluid (NHS 2017a). Although this can happen long before labour starts, you should still call your midwife or maternity unit to let them know (NCT 2018, NHS 2017a, Tommy's 2019).
• A sticky, jelly-like mucus discharge, which may be tinged with blood (bloody show) (NHS 2017a, Tommy's 2019a). This is the mucus plug that blocks your cervix during pregnancy (NHS 2017a, Tommy's 2019a). If it comes out, labour could start soon, or in a few days. It's a sign that things are moving along (NHS 2017a).
• An upset tummy (NHS 2017a, Tommy's 2017a, 2019a) or loose bowels (Tommy's 2017a).

Learn more about what contractions feel like.

Can I tell if labour is about to happen soon?

Maybe. Some of the symptoms you may experience in late pregnancy are good signs that your body is starting to get ready to go into labour.

What should I do early on in labour?

The early phase of the first stage of labour is when your cervix dilates to 5cm (WHO 2018). This can sometimes take up to a few days, and often feels similar to period pain (Tommy's 2019a). The best thing to do will depend on what time of day it is, what you like doing, and how you're feeling.

It's safe for you to take paracetamol if you'd like to (NHS 2017a, Tommy's 2019a). There isn't much evidence that paracetamol can help relieve early labour pain (Othman et al 2012), but some women say they do find it helpful. Ibuprofen and aspirin aren't safe for your baby, so don't take them unless you've been advised to by your midwife or doctor (Tommy's 2017b).

Keeping as calm and relaxed as possible can help you cope with the contractions or tightenings (NCCWCH 2014). It will also help your body release the hormone oxytocin, which you need for your labour to progress (NCT nd).

This could mean watching your favourite movie, going for a walk, pottering around at home, or asking a friend or relative over to keep you company. You could alternate between walking and resting, or try taking a warm bath or shower to ease any aches and pains (NCT 2018, NHS 2017a).

You could also ask your partner for a relaxing massage. Being touched is another great way to get your oxytocin flowing, and may also help you have a faster labour (Bolbol-Haghighi et al 2016).
If early labour symptoms start in the middle of the night, try to get some rest to prepare you for the work ahead (Lowth 2017). If you start noticing the signs during the day though, try to stay up and about as much as you can, because this will help your labour progress (Lowth 2017).

During early labour, you may feel hungry, so eat and drink if you feel like it (Lowth 2017). Nibble on small amounts of high-carb foods to keep you going (Lowth 2017). Toast, sandwiches, cereal and pasta are all good options. If you feel like it, eat little and often (Lowth 2017) to keep your energy up without making you feel too full.

There's some evidence that eating as usual in the day before you give birth may help your labour progress more quickly (Ciardulli et al 2017). But many women feel nauseous when labour starts, so if you don't feel like eating, try not to worry (NHS 2017a). Instead, focus on sipping water or isotonic drinks to keep yourself hydrated (Lowth 2017).

Early labour is a good time to try out different birthing positions, breathing techniques, acupressure and visualisations to see if they help you cope with contractions. If you've been practicing hypnobirthing, now's an excellent time to go over what you've learned.

If you've got a TENS machine, early labour is the time to use it (Tommy's 2019a). It's unlikely to help if you wait until you're in active labour before you start using it (NCCWCH 2014).

How will I know when I've moved into active labour?

If you're planning to have your baby in a hospital or birth centre, the active phase of the first stage of labour is the time to go (NHS 2017b, Robinson 2019). This starts when your cervix is about 5cm dilated, and lasts until it's about 10cm dilated (Robinson 2019, WHO 2018). It's also called established labour (NCT 2018, Tommy's 2019a).


While you're in active labour, listen to your body and watch out for how you're feeling. As labour intensifies, you're likely to talk less. You'll find holding a conversation during a contraction more difficult (Nightingale 2013). You may notice that you have to pause as each surge builds, leaning forward and rocking your pelvis to help you through it (Nightingale 2013).

As your labour progresses, you may start to turn your awareness inward, focusing on each contraction and using your breath to help you cope (Nightingale 2013). You may start "sighing" out from the start of each contraction, or even making little moaning or humming noises (Nightingale 2013).

As your labour gets stronger, you may start to feel less inhibited and care less about what you're doing. This may help you demand exactly what you need to help you cope (Nightingale 2013)!

When should I call my maternity unit or midwife?

You've probably talked with your doctor or midwife about what to do when you think you're in active labour. But if you're not sure whether the time has come, don't be embarrassed to call your midwife or maternity unit. Midwives are used to getting calls from women who are uncertain if they're in early labour or active labour, and who need guidance (Nightingale 2013). It's part of their job.


The midwife will want to hear about what you've been experiencing, particularly how close together your contractions are (Tommy's 2019a). She'll be able to tell a lot by the tone of your voice, and how you respond to a contraction, so talking helps (NCT 2018).

It's not always possible for a midwife to accurately judge over the phone whether active labour has started (Janssen et al 2009). If you're using hypnobirthing or deep relaxation you may sound as though you're in an earlier stage than you are (Finlayson et al 2015). So it's important to trust what your body is telling you as well as being guided by your midwife.

If you're planning to have your baby in hospital or a birth centre, you may not need to go in straight away. Instead, your midwife may give you some coping tips and advise you to stay home until your contractions become more frequent and stronger (NHS 2017a). Or she may ask you to come in so she can assess your labour (NCCWCH 2014).

Trust your instincts on when you think it's the right time to leave the house or call in the midwife. This may mean ignoring pressure from your partner, mum, or whoever else is with you, until you feel it's the right time to go (Nolan 2011).

If you're going to hospital or a birth centre, always phone before setting off (NHS 2017a), as your chosen unit may be busy. If that's the case, the staff may direct you to another unit if there's another one nearby. It's a good idea to prepare for this possibility so that it's not such a big disappointment if it happens to you.

Once your midwife sees you, she'll offer you some extra checks to see how far along you are (NHS 2017a). If you're in active labour, she'll admit you to the labour ward (NHS 2017a), or stay with you if you're having a homebirth. If she thinks you're still in early labour, she's likely to encourage you to go home until you're in active labour. If you stay at home until your labour is more established, you're likely to have a more straightforward birth experience (Tommy's 2019a).

Can I have contractions and not be in labour?

If you're having true contractions, which get progressively stronger, longer and more frequent, chances are you're in labour (Lowth 2017). But you may experience Braxton Hicks contractions (sometimes called "practice contractions") long before the big day (Tommy's 2019b).

It can sometimes be easy to mistake Braxton Hicks contractions for the real thing (Tommy's 2019b), especially if you haven't had a baby before. One way to tell the difference is that Braxton Hicks contractions often go away if you change position (Tommy's 2019b). So if you're sitting, try getting up and walking around, or vice-versa.

If you're not sure whether you're having true contractions or Braxton Hicks, call your midwife or maternity unit (Tommy's 2019b). The midwife may be able to tell just by asking you some questions, and listening to your tone of voice and breathing (NCT 2018). Or she may offer you an assessment – either at the hospital or birth centre, or at home (if you're having a homebirth) – to check whether labour has started (NCCWCH 2014).

At the end of the day, you know your body best. If you have an uncomplicated pregnancy, staying at home until labour is well established may help you have a better birth experience (Tommy's 2019a). But if you're feeling concerned or distressed, don't hesitate to call your midwife or maternity unit and ask for an assessment (NCCWCH 2014, Tommy's 2019a).