The start of labor isn’t a single event, but rather a process that unfolds gradually. That’s why you often find yourself wondering what the signs of labor are and when it’s time to head to the maternity hospital, a birthing center, or when to call your midwife if you’ve chosen a home birth. And just as it’s impossible to plan exactly how labor will go, it’s also impossible to predict exactly when you will give birth.

Labor most commonly occurs between the 37th and 42nd week of pregnancy . At that point, we say the baby is full-term. There are known signs of labor that suggest it will start soon, but that is about all we can say for sure.

The factors that trigger the start of labor are still not fully understood. Signs of labor can appear all at once or individually. These signs can vary between different women, and even for the same woman, each subsequent birth can be different:

• the belly drops in the final weeks of pregnancy,
• the fetus becomes quieter before birth – barely perceptible movements,
• mood changes – some women become restless, nervous, sad, or discouraged,
• abdominal cramps at irregular intervals – pregnancy contractions,
• in first-time mothers, the vaginal part of the cervix disappears, and the external os is open by 1 finger; in women who have given birth before, the vaginal part of the cervix is shorter, and the external os is open by 1–2 fingers,
• one to two days before birth, mucus mixed with blood begins to discharge from the vagina.

For it to be considered active labor, the following must be present:

• contractions,
• effacement of the vaginal part of the cervix and dilation of the cervical canal,
• bloody mucus,
• spontaneous rupture of the membranes.

The best way to prepare for birth is through the online lecture BIRTH or by attending the PARENTS’ SCHOOL WITH A TWIST. Nevertheless, below is some content to help you recognize and understand potential signs of labor.

Bloody mucus plug

The plug, which sits in the cervix during pregnancy and protects the body from microorganisms entering the uterus through the vagina, can come away before labor begins. This often scares women because the cervix is very well-supplied with blood during pregnancy, so the mucus is mixed with blood. The plug can come away in one or several pieces. You will most often notice it on your underwear or on the paper when you go to the toilet and wipe. It’s perfectly fine if you don’t notice the plug at all.

A bloody mucus plug is a sign that your body has started preparing for labor. There is no need to rush to the maternity hospital when the bloody mucus plug appears, as it can come away several days before labor actually actively begins.

If heavier bleeding occurs (like a period), it is advised that you visit the maternity hospital immediately and consult with healthcare professionals.

Contractions

For most women, labor begins with labor contractions. At first, labor contractions are infrequent and occur rhythmically, but their intensity, duration, and frequency increase. Contractions involve the tightening of the uterus. If you were to place your hand on your belly, you would feel it harden. The midwife will also place her hand on your belly to feel the intensity and length of the contraction.

In the early stage of labor (latent phase), women most often feel contractions in the lower abdomen and lower back. Some describe them as strong menstrual cramps. When the contraction passes, the uterine muscles relax, so the belly becomes soft again and the pain subsides.

CHARACTERISTICS OF CONTRACTIONS:

• they are involuntary (you can neither start nor stop them),
• they last 0.5 to 1.5 min,
• there are shorter or longer breaks between contractions (lasting from 1 to 15 min),
• contractions are painful (the pain varies in intensity. It appears later than the contraction itself and fades before the contraction ends),
• contractions perform specific work (they open the cervix, push out the fetus and other parts of the egg, prevent bleeding and infection; they stimulate blood circulation in the uterus and act like a local heart – the fetus receives sufficient oxygen and nutrients and waste products are removed),
• the uterus is hard during a contraction (the midwife places her hand on the belly and records the duration of contractions, the breaks, and the intensity of the contractions).

THERE ARE 3 TYPES OF CONTRACTIONS:

• pregnancy (Braxton-Hicks contractions) – these are very rare, irregular, short-lived, and weak. Pregnant women usually don’t feel them, and they aren’t painful. In the last two months, they become more frequent, more regular, and slightly painful. They stimulate blood circulation in the uterus and prepare the stretchable part of the uterus for birth.
• labor contractions – these are regular and strong. They are divided into contractions of the first stage (to open the cervix), the second stage (to push out the fetus), and the third stage of labor (so the placenta detaches from the uterine wall and to compress the broken vessels that would otherwise cause bleeding). Within labor contractions, there are even more types, depending on the progress of labor or the baby’s position…
• postpartum contractions – these occur in the postpartum period and are irregular. They appear especially during breastfeeding. They are more painful for women who have given birth before. They protect the body from infection.

If you are giving birth for the first time, it is advised that you don’t need to head to the maternity hospital/birthing center until you feel regular contractions every 5 minutes that continue for at least 2 hours despite resting. Those of you giving birth at home should follow the instructions of your chosen midwife.

For women who have given birth before, labor usually progresses faster, so it is advised to head to the maternity hospital/birthing center when contractions are regular and occur every 7–10 minutes.

Leaking of amniotic fluid

Labor can also begin with your amniotic fluid leaking (“water breaking”). This means that the fetal membranes (you will also hear terms like the amniotic sac or the baby’s bag of waters) have ruptured. Amniotic fluid can leak slowly in drops. In this case, it’s hard to tell if it’s urinary incontinence, which is common towards the end of pregnancy, or leaking amniotic fluid. They will be able to determine this at the maternity hospital or birthing center with a special test. However, it can also happen like in the movies, suddenly and in a large amount.

You can distinguish leaking amniotic fluid from leaking urine because with amniotic fluid, your underwear is constantly wet, regardless of whether you feel the urge to pee or not, as you cannot hold it back. You can also recognize amniotic fluid by its color, which is usually milky or pale yellow.

In case of (suspected) leaking amniotic fluid, use white sanitary pads so you can monitor what’s happening; this will also make the healthcare workers’ job easier. Professional guidelines in Slovenia dictate that you should head to the maternity hospital as soon as your water starts leaking. This is especially true if the amniotic fluid is brown or green, as this indicates fetal distress.

Especially when the rupture occurs before the 37th week (or the head is not yet engaged), or if the baby is small for gestational age (IUGR), if you have a lot of amniotic fluid (polyhydramnios), or when the baby is not head-down, it is advised to transport the mother in as flat a position as possible. When this isn’t feasible, it’s best to call an ambulance, as umbilical cord prolapse can occur. If you notice the umbilical cord between your legs, don’t consider any other form of transport than an ambulance and lie down as soon as possible with your buttocks propped up/elevated.

Advice

• In case of fresh vaginal bleeding (similar to a period) or sharp sudden abdominal pains, if you don’t feel the baby moving, or if you aren’t sure if your water is leaking, seek medical help immediately.

• On the day of birth or the day before, the body takes care of “cleansing” itself, so you might experience diarrhea.

• The start of labor (latent phase) is a time to gather energy. So get enough rest and eat food that suits you.

• If your maternity hospital/birthing center is close to home, you’ll be able to leave home later.

• Have your bag ready from the 37th week onwards, so you don’t have to worry about whether you have everything you need when it’s time to leave for the hospital. And you always have your maternity book and health card with you anyway (right? 🙂 ).

• If you’re giving birth in winter and it’s snowing outside, you must also take road conditions into account when planning the drive to the maternity hospital/birthing center.

• At the maternity hospital, they will ask you how far apart your contractions are. It will probably feel to you like they don’t stop at all, but still. This is the time from the start of one contraction to the start of the next.

• Sometimes a brown/bloody discharge can be scary, but it can be the result of, for example, a vaginal exam, sexual intercourse, or the mucus plug coming away, as the mucous membranes are very well-supplied with blood during pregnancy. When you come for medical help, you might state the reason for your arrival as “bleeding.” In this case, you must have a pad so the medical staff can assess the amount of bleeding.

• If your water is leaking in a large amount, women most often use cloth diapers or a towel instead of pads. Put a disposable waterproof pad in the car (turn the absorbent side up and sit on it).

• If it happens that you give birth to the baby in the car, (fathers) keep a cool head. Dry the baby with a towel or diaper, place them on your bare chest, and cover them so that the head is peeking out. Keep them warm this way until you arrive at the nearest maternity hospital/birthing center.

• Even if your water evidently leaks, you don’t need to worry about the baby running out. Amniotic fluid is produced constantly and continues to leak until the end of labor.

Sources:

Felc, Z. (2008). Neonatologija. Maribor: Faculty of Health Sciences.

Marshal, J.E. and Raynon, M.D. (2014). Myles Textbook for Midwives. 16^th ed. Edinburgh: Saunders.

Pajntar, M. (2004). Normalni porod. In: Pajntar M, Novak-Antolič Ž. Nosečnost in vodenje poroda. 2. rev. ed. Ljubljana: Cankarjeva založba, 136-73.

Petročnik, P. (2016). Porod za strokovnjake, Ljubljana: National Institute of Public Health. Retrieved from Source

Simkin P, Whalley J, Keppler A, Durham J, Bolding A (2010). When and How Labour Begins. In: Pregnancy Childbirth and the Newborn. 4th ed. New York: Meadowbrook Press, 162-75.