Recognizing the signs of labor

In late pregnancy, it's easy to wonder whether every symptom you're having is an early signs of labor. Are you having Braxton Hicks or "real" contractions? Is that your mucus plug or normal vaginal discharge?

While every woman's experience is different, learning the typical signs of labor can help you feel more prepared when it does happen. While in the movies women have two contractions and deliver a baby, in the real world labor is typically a longer and unmistakable process.

What is labor?

Labor is the process of delivering your baby – and your placenta – from your uterus through your vagina and into the world. Labor usually occurs sometime between 38 and 41 weeks of pregnancy.

Your body will go through different stages of labor during childbirth, and you'll experience a number of telltale signs of each stage.

The first stage, cervical dilation and effacement, is when your cervix thins and opens. This stage has two phases, the latent phase, when your cervix is slowly dilating from 0 to 6 cm, and the active phase, when stronger contractions dilate the cervix more rapidly from 6 cm to full dilation at 10 cm.

Once you're fully dilated, the second stage starts as your baby descends into the vaginal canal and is birthed. (You'll be pushing during this stage.)  The third stage starts with your baby's birth and ends with the delivery of the placenta.

Early signs of labor

In the final days or weeks before your due date, you may notice one or more signs that labor is near. Not all women experience all of these signs – again, this is very individual – but if you do feel like your baby has dropped lower, for example, or you have some mucousy discharge or more Braxton Hicks contractions than usual, you may be close to labor day!

Note: Before you get excited about labor starting, remember that many of these signs and symptoms can precede labor by weeks. Rather than predicting that labor is imminent, these can just be symptoms of being pregnant near your due date.

Still, here are some of the early signs that labor may be near:

Lightening

If this is your first pregnancy, you may feel what's known as lightening a few weeks before labor starts. Lightening means your baby has "dropped" and now rests lower in your pelvis.

When your baby drops, you might feel less pressure just below your ribcage, making it easier to catch your breath. If you experienced heartburn during pregnancy, it might now improve. (On the downside, you may need to pee more often because your baby's pressing on your bladder.)

If this isn't your first baby, however, lightening may not happen until labor begins.

Loss of the mucus plug

If your cervix begins to efface or dilate significantly as you get close to labor, you may pass your mucus plug – the small amount of thickened mucus that has collected within your cervical canal during your pregnancy. If you see mucus, it's likely a sign that you're dilating – but it can still be some time before labor begins.

The mucus plug may come out in a lump all at once or as an increased amount of clear, pink, or slightly bloody vaginal discharge over the course of several days – or even weeks. Without the other signs of labor noted below, you don't need to call your doctor or midwife if you pass your mucus plug.

Bloody show

You may have noticed more vaginal discharge during pregnancy, thanks to your body's increased estrogen. Normal, healthy discharge is usually creamy white or clear, but it may also be tinged brown, pink, or red. Other colors – such as yellow, green, or gray – may signal an infection or other problem.

When your cervix starts to soften, you may notice pink discharge or bright red blood. This is called "bloody show." Sometimes this happens as you lose your mucus plug (the mucus may be tinged with blood) but it can also happen independently. You may notice it a few days – or even weeks – before you go into labor, or you may notice it at the beginning of labor.

Having sex or a vaginal exam can also disturb the mucus in your cervix and result in some blood-tinged discharge or bleeding, even when labor isn't necessarily starting any time soon.

Call your provider if you have vaginal bleeding heavier than a period, consistent red bleeding that's not slowing, or bleeding in combination with abdominal pain.

Cervical dilation and effacement

In the days and weeks before delivery, changes in the connective tissue of your cervix make it soften and lead to dilation and effacement.

If you've given birth before, your cervix is more likely to dilate a centimeter or more before labor starts. Still, that's no guarantee that labor is imminent.

When you're at or near your due date, your doctor or midwife may do a vaginal exam during a prenatal visit to see whether your cervix has started the process of effacement and dilation. Whether you have this exam is up to you. Cervical exams can be uncomfortable, and they can't predict future labor timing. But exams can be helpful for planning an upcoming induction or for estimating how much time you'll have to get to the hospital if you have a history of fast labors.

Braxton Hicks contractions

You may have experienced Braxton Hicks contractions throughout your pregnancy. If you're having a Braxton Hicks contraction, you'll feel a tightening or squeezing of your uterus, lower abdominal area, or groin. Then it will relax. Unlike true labor contractions, Braxton Hicks contractions are irregular and usually not painful.

More frequent and intense Braxton Hicks contractions can signal that real contractions are coming soon – but not always.

Nesting

Many women report an urge to organize and clean things around the house in preparation for their baby's arrival. Whether this behavior is driven by hormones or cultural expectations is up for debate, but some studies have found that pregnant women engage in more nesting than non-pregnant women, and the amount of nesting they do increases as their pregnancy advances.

Not all women have this nesting instinct, but if you do, take advantage – just don't overdo it, because you want to be well rested for the big day.

Diarrhea

Is a bout of diarrhea your body's way of clearing the way for labor and delivery? Some people think so. But – while assertions abound that diarrhea means your labor will start in 24 to 48 hours – we have no good evidence that there's a link.

Throughout pregnancy, you may be more prone to diarrhea as hormones relax your muscles – including your uterus and rectum. On the other hand, for many women pregnancy results in constipation as these same hormones relax the gastrointestinal tract and slow the movement of food through it.

As labor begins, your body releases hormones called prostaglandins that tell your uterus to contract. Prostaglandins may also cause stool to move more quickly through your system.

If you have diarrhea, drink plenty of fluids to stay hydrated. If you have diarrhea and a fever or any other signs of illness, or if the diarrhea lasts more than a couple of days, call your doctor or midwife.

Nausea

Some women report feeling nauseated during labor and others say they were nauseated a day or two before going into labor. When labor begins, digestion slows or stops, and you may feel sick to your stomach. More often, nausea happens during active labor.

Nausea isn't uncommon, but let your doctor or midwife know if it persists or is new, with vomiting. Sometimes new nausea and vomiting at the end of pregnancy can be a sign of preeclampsia, a dangerous blood pressure disorder.

Signs of labor

These are reliable signs that you're in real labor:

Regular contractions

Once you're having regular, persistent contractions, you're considered to be in labor.

When your uterus contracts, your abdomen feels tight or hard, and you have a sensation of cramping. When the uterus relaxes between contractions, the sensation dissipates. Labor contractions will grow stronger, longer, and more frequent as they cause your cervix to dilate. True labor contractions are too painful to talk through, and they may bring tears to your eyes.

Find out more about what contractions feel like according to moms.

You'll want to start timing your contractions – how far apart they are and how long they last. (Time contractions starting from the beginning of one until the beginning of the next.) Your doctor or midwife probably gave you directions about when to head to the hospital based on the timing of the contractions. If not, give them a call and ask.

Back pain or pelvic pressure

You may feel increased pressure in your pelvis as your baby continues to move down. Contractions can also cause a feeling of pressure, along with abdominal pain.

If you're having lower back pain along with contractions, it may signal that you're having back labor. The pain from back labor continues between contractions, though it may get stronger during contractions.

Back pain usually means that your baby's head is pressing against your lower back, though one theory suggests that the pain may be "referred" from your uterus to your lower back.

Water breaking

When the fluid-filled amniotic sac surrounding your baby ruptures, fluid leaks from your vagina. This is called rupture of membranes. It may come out in a large gush or a small trickle, or anything in between.

Labor usually follows soon after your water breaks – regular contractions often start before this, but in some cases, the water breaks first.

If your water breaks when you're full term but you're not in labor (not having contractions), it's called premature rupture of membranes (PROM).

If you don't start having contractions on your own within six to 24 hours of your water breaking, your provider will most likely recommend that labor be induced. That's because your baby is more likely to get an infection without the amniotic sac's protection against germs. Most providers will offer you an immediate induction but give you the option to postpone if you want to give labor a chance to start on its own.

If you're leaking amniotic fluid before 37 weeks, it's called preterm premature rupture of membranes (PPROM), and it may mean your baby will need to be delivered prematurely due to the increased risk of infection.

Regardless of contractions, if you're group B strep positive you'll need to start on antibiotics as soon as your water breaks to prevent an infection in your baby.

Whenever your water breaks, call your doctor or midwife. (Call them even if you think your water broke but aren't sure.)

Signs of preterm labor

If you start having regular contractions that cause your cervix to begin to open before you reach 37 weeks of pregnancy, you're in preterm labor. (It's also known as premature labor.)

It can be difficult to tell whether you're having preterm labor or not, because some of the symptoms (like Braxton Hicks and low back pain) may be things you've experienced throughout your pregnancy.

Still, call your doctor or midwife right away if you're having any of the following symptoms before 37 weeks:

• More vaginal discharge than usual
• A change in the type of discharge – if you're leaking watery fluid or your discharge becomes watery, mucus-like, or bloody (even if it's pink or just tinged with blood)
• Any vaginal bleeding or spotting
• Abdominal pain, menstrual-like cramping, or six or more contractions in one hour (even if they don't hurt)
• More pressure in the pelvic area (a feeling that your baby is pushing down)
• Low back pain, especially if it's dull or rhythmic, or you didn't previously have back pain
• Your water breaks, either in a gush or a trickle

If you are – or might be – in preterm labor, your doctor or midwife may give you steroids to help your baby's lungs mature and to protect their brain. You may also receive medicine to stop or slow early contractions. Getting these medications early can improve outcomes for your baby, so be sure to call if you think you may be in preterm labor.

Braxton Hicks vs contractions

It can be hard to tell the difference between Braxton Hicks and "real" contractions at first. Use this chart to help figure out whether you're in true labor or false labor (in other words, just having Braxton Hicks contractions).

No matter how well informed you are about the signs of labor, it's normal to have a false alarm. Don't be embarrassed about calling your doctor or midwife – or showing up at the hospital – because you think you're in labor when you're not.

If you're assessed at the hospital and sent home because you're not in labor yet, your care team will give you specific instructions about changes to look for in the next few days or weeks and when to call or come back.

Learn more:

• Pregnancy symptoms you should never ignore
• Labor positions
• Video: How your cervix dilates during labor