How do I know when I am in labour?

If you're pregnant, you’ll find yourself wondering what labour feels like and what contractions feel like throughout your pregnancy, but even more so as your baby’s due date nears. Even if you’ve been through it before, the signs of labour approaching aren’t always clear. Symptoms can be subtle. Read on to learn the signs labour could be coming, how to cope with labour pain symptoms, and when to contact your doctor or midwife.

How do I know when I am in labour?

Every pregnant person's labour is different, and pinpointing when it begins is hard. It's more of a process than a single event, when a number of changes in your body work together to help you give birth (Winter and Cameron 2006).

Early signs of labour

In the early stage of labour, also called the latent phase, you may feel the following:

• Persistent lower back or abdominal pain, often accompanied by a crampy premenstrual feeling.
• An urge to use the toilet. This is because baby’s head is pressing on your bowel.
• A bloody show (a brownish or blood-tinged mucus discharge) is a sign that things are moving along; it’s directly related to changes in the cervix caused by dilation.
• Contractions that occur at regular and increasingly shorter intervals and become longer and stronger in intensity (NCCWCH 2007: 139). Keep in mind that labour pain symptoms vary from person to person.
• Broken waters, but you're in labour only if it's accompanied by contractions that are dilating your cervix (Walsh 2004: 438-9).

How you will feel in early labour depends on whether you've had a baby before, how you perceive and respond to pain, and how prepared you are for what labour may be like (Walsh 2004: 438; Cheyne et al 2006).

When should I contact my doctor or midwife?

You, your doctor and midwife will have talked about what to do when you think you're in labour. Don't be embarrassed to call. Doctors and midwives are used to getting calls from people who are uncertain if they're in labour; it's part of their job.

And your doctor or midwife can tell a lot by the tone and tenor of your voice, so talking helps them too. Your provider will want to know how close together your contractions are, whether you can talk through a contraction, and any other impending birth signs you may have.

If you're planning to have your baby in hospital or a birth centre, your provider may ask you to come in so that they can make an assessment. Or your midwife may opt to come to your home to assesss you, regardless of your choice of birth place.

If they think you're still in early labour, they may ask you to go home until you’re in active labour, and they may make plans to come back to assess you again. Their decision will depend on how you're coping and whether you've got a birth partner to support you. Generally, though, you’ll be admitted when you’re in active labour – having regular contractions, and at least 4cm dilated.

You should contact your midwife or doctor if:

• your waters break, or you think you're leaking amniotic fluid (NCCWCH 2007: 206;)
• your baby is moving less than usual (NCCWCH 2008: 276)
• you have vaginal bleeding (unless it's just a small amount of blood-tinged mucus) (NCCWCH 2008: 251; Lindsay 2004a: 772; Lindsay 2004b: 856)
• you have fever, severe headaches, changes in your vision, or belly pain (NCCWCH 2008: 228)

What should I do early on in labour?

It depends on what time of day it is, and how you're feeling. It also depends on whether you have had a baby vaginally before. (If so, labour may go much quicker. You might skip early labour altogether!) Keeping calm will help labour to progress (McNabb 2007: 415) and help you cope with the contractions (NCCWCH 2007: 93-4).

Do whatever will help you to relax. This could mean watching a film, or asking someone 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. If you can, try to rest to prepare for what’s ahead. If this is your first labour, try to ignore it as much as you can, especially during the night. It’s important you get some sleep.

During early labour, you may feel hungry, so eat and drink if you feel like it (McNabb 2004: 415). This will help to comfort you and make it easier to rest.

Early labour is a good time to try out positions and breathing techniques to see if they help you cope with the contractions, now that you're having them for real! If you've rented a TENS machine, early labour is the time to use it (NCCWCH 2007: 93; 100).

Can I have contractions and not be in labour?

Yes. When you are in labour, your cervix becomes gradually thinner (this is called effacement) and dilates. Some people are sensitive to contractions before the cervix has started to dilate (NCCWCH 2007: 145; Winter and Cameron 2006: 455-6). A labour and delivery nurse, or your doctor or midwife, can confirm whether cervical changes have started by doing an examination.

If your baby is in a posterior position (with their head down but their back to your back) it can take longer for their head to engage and for labour to get started properly (Lewis 2004: 890). Your contractions may be erratic and low in intensity, and you may have a lot of backache.

Your doctor or midwife will advise you on ways to cope at home until labour becomes stronger (NCCWCH 2007: 145). You could try a warm bath or massage to relieve the pain.

Can I tell if I’m going into labour?

Maybe. Signs labour is coming include:

• Lightening (when the baby's head begins to drop into position in your pelvis). You may notice that you can breathe more deeply and eat more, but you'll also need to pee more often. This can happen weeks ahead of labour in a first-time mom.
• Your vaginal discharge becomes heavier and contains more mucus. (Again, this can happen days or weeks ahead of labour.)
• You'll have more frequent and more intense Braxton Hicks contractions.
• You may have loose bowels (McCormick 2003: 435-6; 446).

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