Early signs of Labour – and why you should not rush to the hospital immediately

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One of the top concerns that first-time pregnant couples have is how to know that one is in labour – what are the real early signs of labour? And the truth is that it is not always that clear cut. The end of pregnancy brings Braxton Hicks contractions, as well as all the other usual aches and pains. Many women have a few false starts before labour actually kicks in.

The fact that second-time moms are less worried should queue you in already – if you are still wondering if you’re in labour, its probably not labour yet!  Once you know what a real contraction feels like, you will be able to distinguish better. But if this is your first time, and you’ve never felt it before, then you truly have nothing to measure it by and no clue what to expect. In this article, we discuss early signs of labour and when you should go to the hospital.

There are three early signs of labour:

  • A show
  • Uterine contractions (or labour pains)
  • Your membranes rupturing (or water breaking)

A Show

A show is a mucous plug that comes from the cervix, due to hormonal changes as your body is getting ready for labour. It is literally a blob of mucous with some blood in it.

A heavier vaginal discharge in the last weeks is normal, due to increased progesterone levels. This is sometimes mistaken for a show.

You can have a show from a few days before going into labour until labour is well established already.

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Uterine contractions are probably the most difficult to sign to interpret. The uterus is a round muscle, and contracts from the top, effectively pushing baby down into the birth canal. Although your entire abdomen will feel hard during a contraction, you will experience pain in your lower abdomen and lower back. A contraction is basically just a very strong menstrual cramp.

Women can have Braxton Hicks contractions (or practice pains) from as early as around 20 weeks of pregnancy. Not all women feel these on the same level. They are typically worse with second and third babies, and after a previous Caesarean section. The books say they should not be sore, but many moms will tell you that it got pretty uncomfortable.

Braxton hicks contractions tend to be irregular in both severity and frequency, with some longer and stronger than others. They also tend to go away if you take a warm bath, or lie down with a warm water bottle against your lower abdomen.

Here are a few pointers of real contractions:

  • They are regular from the very onset – if they are ten minutes apart, then you WILL have a contraction every 10 minutes.
  • They become stronger and longer as labour progresses. During active labour, you can expect around 3-4 contractions in 10 minutes, lasting 60-90 seconds each.
  • They won’t go away if you take a warm bath or shower, or lie down a bit.

Contractions tend to be less uncomfortable if you are in an upright, forward position, like standing and leaning onto a surface, or kneeling next to a bed or couch.

Waters breaking

Your water will usually break with a gush, and you will know for sure that something has happened. It is also possible to have a small tear in the membranes (called a hind rupture), which will lead to fluid constantly drizzling/leaking out.

Your water can break any time from before labour starts, until you are fully dilated and pushing. If your water breaks before labour starts, your contractions will usually also start within a few hours. If nothing has happened after 24 hours your doctor will suggest induction of labour, to prevent infection of baby from the outside.

Amniotic fluid should be clear in colour; if it is brown/yellow/green it may mean that baby is in distress (or was in distress at some point), and you should contact your doctor immediately. It should also not have a bad smell which may indicate an infection of the placenta and the membranes (called chorioamnionitis).

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What happens on the inside when you go into early labour?

Your cervix will also show some signs of labour, which you won’t know about of course, but which your doctor or midwife will check during a vaginal examination:

  • Your cervix is about 5cm thick in the pregnancy, and will soften and thin out during the labour process
  • The opening (os) of the cervix will move to the front
  • It will start opening (dilating)

Cervical changes can happen within a very short time period. Many women are concerned as a doctor may tell them during a routine check that the cervix hasn’t started ripening yet. The truth is that a cervix will often only start changing when labour kicks in. A ripe cervix does not predict the path of your labour.

When should you go to the hospital?

This will obviously depend on a few things, like how far you live from the hospital. But if all is well with your pregnancy and baby, it is best to wait until labour is fully established before going in. Stress hormones work against labour hormones. If you go to the hospital too early the changing environment can lead to labour slowing down or even stopping.

Labour is usually well established by the time that you have 3-4 contractions in 10 minutes, lasting 60-90 seconds each. If your contractions are still short and further apart it would be good to still relax at home a bit and to give your body enough time to do its thing.

Contact your doctor or go to the hospital immediately if:

  • If you experience any signs of labour before 37 weeks of pregnancy, or if your baby is not lying in the right, head-down position.
  • If you experience signs of labour but you are actually booked for an elective Caesarean section.
  • If at any stage your baby is not moving well, or is moving far less or far more than usual
  • If you experience vaginal bleeding. A show will have some specks of blood, but if it contains a lot of blood, if blood is running down your legs (like a period) or if you have blood clots coming out you should have it looked at.
  • If you have any discharge with a funny sell or colour, or that are itchy or burning.
  • If your urine burns, or if it is painful to pass urine (as this may show a bladder infection)
  • If at any stage during contractions you feel the urge to push (which feels like when you need to pass stools).
  • Anything else that doesn’t feel right.

Christine Klynhans is a midwife and lactation consultant with a firm believe that gentle parenting can change the world. She has worked in midwifery since competing her B.Cur nursing degree in 2004, and has a special passion for education and for writing. She currently works in a well-baby clinic and give antenatal classes and breastfeeding support. She enjoys working with parents of babies and toddlers, aiming to help them find gentle solutions to their parenting problems and assisting them in incorporating healthy habits and natural health alternatives into their daily lives.

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