Signs labour is starting

The first signs of labour are not always dramatic or easy to recognise. You may notice contractions or tightenings, a mucus “show”, backache, pressure or an urge to go to the toilet, or your waters breaking. Some people experience several of these signs, while others notice only one or two.

Early labour can also take time. The NHS explains that the latent phase, when the cervix begins to soften, thin and open, can last for hours or sometimes days. If you think labour may be starting, your midwife or maternity unit can help you decide what to do next.

1. Contractions become longer, stronger and more frequent

Contractions are one of the clearest signs that labour may be beginning.

During a contraction, the muscles of the womb tighten and then relax. The NHS notes that some people describe labour contractions as feeling like very strong period pains.

You may already have experienced Braxton Hicks contractions during pregnancy. These practice tightenings generally do not last very long, happen very frequently or steadily build in intensity.

Labour contractions tend to become longer, stronger and more frequent as labour progresses. Early contractions can still be irregular, particularly during the latent phase.

If you are unsure whether the tightenings you are experiencing are labour contractions, contact your midwife or maternity unit for advice.

2. You have a “show”

During pregnancy, a plug of mucus sits in the cervix. As the cervix begins to change in preparation for birth, this mucus can come away. This is known as a show.

The NHS describes a show as sticky, jelly-like pink mucus. It can come away as one piece or in several smaller pieces.

A show can mean that the cervix is beginning to open, but it does not tell you exactly when your baby will be born. Labour may follow fairly soon or it may still be a few days away. Some people do not notice a show at all.

A small amount of blood can be present in a show. More significant vaginal bleeding is different and needs urgent assessment by your maternity team.

3. Your waters break

Your baby develops inside an amniotic sac filled with fluid. When the sac breaks, the fluid drains through the vagina. This is commonly described as your waters breaking.

It does not always happen as a large gush. According to the NHS and Tommy’s, you might experience a sudden gush, a slow trickle or simply notice unexpected wetness.

Amniotic fluid is usually clear and pale. If you think your waters have broken, contact your midwife or maternity unit, even if contractions have not started.

The NHS recommends using a period pad rather than a tampon if fluid is leaking. This can also make it easier for your maternity team to assess the fluid if needed.

Tell your maternity team immediately if the fluid is smelly or coloured, or if you are losing blood.

4. You develop backache or a heavy aching feeling

Backache can happen for many reasons during pregnancy, but it can also occur as labour begins.

The NHS lists backache or a heavy, aching feeling as one possible sign of labour. Tommy’s also notes that lower back pain can occur alongside other early labour symptoms.

Back pain by itself cannot confirm that labour has started. Pay attention to whether it is accompanied by contractions, pelvic pressure, a show, leaking fluid or other changes.

If you have unusual backache before 37 weeks, contact your midwife or maternity unit urgently because it can be a sign of premature labour.

5. You feel more pressure or need the toilet

You may notice increased pressure low in your pelvis or feel that you need to use the toilet more often.

The NHS explains that an urge to go to the toilet can happen because the baby’s head is pressing on the bowel. Tommy’s also lists pelvic pressure and feeling as though you need to wee or poo among possible signs that labour may be starting.

This symptom alone does not necessarily mean you are in labour, but it can form part of the overall picture.

What does early labour feel like?

Early labour is known as the latent phase.

During this stage, the cervix becomes softer and thinner and starts to open. Contractions may begin but can be irregular. They may settle for a while and then return.

This stage varies considerably between people and pregnancies. The NHS says it can take hours or sometimes days.

If you have been advised to remain at home during the latent phase, your maternity team can tell you when to contact them again or come to your planned place of birth.

Braxton Hicks or labour contractions?

Braxton Hicks can make it difficult to tell whether labour has actually begun.

NICE recommends that antenatal information should explain the difference between Braxton Hicks and active labour contractions. The NHS describes Braxton Hicks as contractions that generally do not last very long, happen frequently or progressively build up.

Labour contractions tend to develop a clearer pattern and become longer, stronger and more frequent.

You do not need to work this out perfectly by yourself. If contractions are painful, regular, changing or simply making you wonder whether labour has started, contact your midwife or maternity unit.

Does losing your mucus plug mean labour is close?

Not necessarily.

A show is a recognised sign that the cervix is beginning to change, but the timing between losing the mucus plug and established labour varies. According to the NHS, labour may follow quickly or may take a few days.

You may also go into labour without noticing a show.

If you think you have had a show before 37 weeks, contact your maternity unit or midwife for assessment.

Do your waters always break before contractions start?

No. Waters can break before labour starts, but they often break during labour.

If your waters break before contractions begin, contact your maternity unit rather than waiting for contractions before seeking advice. Your team will tell you what happens next based on your pregnancy and circumstances.

If you are unsure whether the fluid is amniotic fluid or urine, it is still reasonable to call your maternity team and explain what you have noticed.

When should you start timing contractions?

If contractions are becoming regular, timing them can help you describe what is happening when you speak to your maternity team.

You can note how long each contraction lasts and the time from the beginning of one contraction to the beginning of the next.

The NHS advises contacting your midwife or maternity unit if you think you are in labour or if you are having regular contractions every five minutes or more often. Your own maternity service may give you specific instructions based on your pregnancy, so follow the advice they have provided.

What if you are not sure labour has started?

Uncertainty is very common in early labour, particularly when contractions are irregular or symptoms are subtle.

You do not have to wait until you are certain. Both the NHS and Tommy’s advise contacting your midwife or maternity unit if you think you may be in labour or are unsure about what you are experiencing.

They can ask about your contractions, waters, baby’s movements and other symptoms and advise you about the next step.

When to get professional advice

Call your midwife or maternity unit for guidance if you think you are in labour, if your contractions are regular and coming every five minutes or more often, or if you are simply unsure or worried.

The NHS advises contacting your midwife or maternity unit urgently if your waters break, you have vaginal bleeding, your baby is moving less than usual, you are less than 37 weeks pregnant and think you may be in labour, any contraction lasts longer than two minutes, or you are having six or more contractions in ten minutes.

Do not wait until the following day if one of these urgent signs occurs.

If your waters break and the fluid is smelly or coloured, or you are losing blood, tell your maternity team immediately.

Call NHS 111 if you cannot contact your midwife or maternity unit and need urgent advice.

Call 999 and ask for an ambulance if you think your baby is coming now and you have a strong urge to push.

Your maternity team may have given you personalised instructions about when to call or attend. Follow those instructions if they differ from general guidance.