Signs of labour: contractions, waters breaking and when to call

Labour usually announces itself with a few changes rather than one clear moment. Early signs include a show (pink or bloodstained mucus), period-like cramps or a low backache, loose poo, your waters breaking, and contractions that slowly become regular, longer, stronger and closer together. Braxton Hicks "practice" tightenings, by contrast, tend to stay irregular and short and don't build.

When to call depends on where you'll give birth and what your midwife has told you. As a general guide, the NHS page on signs that labour has begun says to call your midwife or maternity unit when contractions are regular and coming every 5 minutes or more often. Australia's Pregnancy, Birth and Baby guide to contractions says to call at 2 or more painful contractions in 10 minutes. Some signs mean you call straight away, whatever the time: your waters breaking, bleeding, a baby who is moving less, or any sign of labour before 37 weeks.

What are the early signs of labour?

Pregnancy, Birth and Baby's page on early signs of labour says labour normally starts between 37 and 42 weeks, and early signs usually appear from around 37 weeks. ACOG in the US says most women give birth between 38 and 41 weeks. You may notice some, all or none of these before labour gets going:

• A show. The NHS describes sticky, jelly-like pink mucus that may come away in one blob or several pieces. It's the plug that sealed your cervix, and it can come before contractions start.
• Cramps or backache. Period-like pain low in your tummy, a low backache or a heavy, aching feeling.
• Loose poo or an urge to go to the toilet. The NHS says the toilet urge comes from your baby's head pressing on your bowel.
• Your waters breaking. A slow trickle or a sudden gush you can't control.
• Contractions. Your womb tightens and relaxes, and over time the tightenings get longer, stronger and more frequent.
• Other changes. Pregnancy, Birth and Baby lists your baby dropping lower into your pelvis, needing to wee more often, and a burst of energy to get ready (nesting).

A show or a few cramps can come days before labour. What tells you labour is under way is contractions that keep coming and build.

How can I tell Braxton Hicks from real labour?

Braxton Hicks contractions tighten the womb without opening the cervix. This comparison draws on Pregnancy, Birth and Baby and ACOG:

ACOG says that if rest and a drink of water make the contractions fade, they aren't true labour. It also notes that Braxton Hicks contractions can sometimes be very painful, and that occasionally only a vaginal examination can tell the difference. Pregnancy, Birth and Baby says that in active labour, contractions usually come every 2 to 3 minutes and last 50 to 60 seconds.

How do I time contractions?

1. Start when they seem to form a pattern. Pregnancy, Birth and Baby suggests timing once contractions feel more regular, get stronger or show a pattern.
2. Measure the gap from the start of one contraction to the start of the next. That's the number midwives mean by "how far apart".
3. Note how long each one lasts, from when the tightening starts to when it fades.
4. Keep going for a while. One short spell of regular tightenings can fade away; a pattern that holds and builds is more telling.
5. Have the numbers ready when you call. The midwife will usually ask how often, how long and how strong they are, and how you're coping.

A watch, a clock or a contraction-timer app all work.

When should I call the maternity unit or go in?

Different services give slightly different thresholds. Your own hospital or midwife may give you specific instructions, and those come first.

The Victorian advice is from Goulburn Valley Health's late-pregnancy leaflet, from a public health service in Australia. None of these sources gives a separate contraction rule for a first baby. They do agree that first labours tend to be longer: the leaflet says early labour with a first baby may last a few hours to a few days, and that more than one trip to hospital before labour is established isn't unusual. Once labour is established, the NHS says the first stage usually takes 8 to 18 hours for a first baby and about 5 to 12 hours for later babies.

Call sooner, whatever your contractions are doing, if:

• you need help to manage the pain, or you're frightened or unsure
• you have a planned caesarean and think labour has started
• you're planning a homebirth (Pregnancy, Birth and Baby says to let your midwife know once contractions start)
• you live a long way from your hospital and have agreed an earlier plan.

The NHS says to call urgently if any contraction lasts longer than 2 minutes, or you're having 6 or more contractions every 10 minutes.

What should I do when my waters break?

Your waters may break before or during labour. The fluid is usually clear, but can be yellow, straw-coloured or pink, and the NHS says it may be a little bloodstained at first. It can be hard to tell from wee.

1. Put on a pad, not a tampon, so the fluid can be checked.
2. Note the time, the colour, how much and the smell. Pregnancy, Birth and Baby suggests noting the time, colour and amount.
3. Call your midwife or maternity unit. The NHS, Pregnancy, Birth and Baby and ACOG all say to call when your waters break, even without contractions.
4. Watch your temperature if you're told to wait at home. The NHS suggests taking it every 4 hours while you're awake; a raised temperature is usually above 37.5°C.
5. Ask about the plan. The NHS says it's usual to go into labour within 24 hours, and you'll be offered an induction if not, because of a small increased risk of infection. Pregnancy, Birth and Baby's waters-breaking page says that from 37 weeks most people go into labour naturally within 24 to 96 hours, and your midwife or doctor will talk through waiting or induction. If you carry group B strep, it says antibiotics in labour are recommended.

Call straight away if the fluid is green or brown. Pregnancy, Birth and Baby says this may mean your baby has passed meconium (their first poo) and may be distressed. Also call straight away if the fluid is blood-coloured or smells bad, you're bleeding, your temperature is 37.5°C or above, you feel unwell or flu-like, or your baby's movements change.

If you can see or feel the cord

Rarely, the umbilical cord slips down in front of the baby after the waters break. The RCOG's cord prolapse leaflet says this happens in between 1 in 200 and 1 in 1000 births, and is more likely if your baby isn't head-down or your waters break before 37 weeks. If you can see or feel the cord, call your local emergency number (000 in Australia, 999 in the UK, 911 in the US) and say you're pregnant. Get onto your knees with your elbows and hands on the floor and bend forward, or lie on your side with pillows under your hip, until help arrives. Don't try to push the cord back or touch it.

What helps in early labour at home?

The NHS guide to the stages of labour says the early (latent) stage can take many hours or even days, and is usually the longest stage. If you've had a straightforward pregnancy, Pregnancy, Birth and Baby says home is usually the best place for it, whether you plan a hospital, birth centre or home birth. The NHS notes that if you go in before labour is established, you may be asked to go home again for a while.

Things that help, from both sources:

• By day, stay upright and gently active: walk, sway or do gentle stretches.
• By night, try to relax and sleep between contractions if you can.
• Warm water. A warm bath or shower can ease the pain.
• Breathing and massage. Slow breathing, and massage or reassurance from your birth partner.
• Eat and drink. Sip water and eat light meals or snacks for energy.
• Empty your bladder regularly. It makes moving into different positions more comfortable.

Use the quieter hours to check your hospital bag and your birth plan, and line up who will drive you, so you aren't driving yourself while in labour. If you live in a rural or remote area, Pregnancy, Birth and Baby suggests agreeing ahead of time when to set off.

What are the signs of premature labour?

Labour before 37 weeks is premature. The NHS premature labour page lists these signs if you're less than 37 weeks pregnant:

• regular contractions or tightenings
• period-type pains
• a gush or trickle of fluid from your vagina
• backache that's not usual for you.

If you notice any of them, call your midwife or maternity unit straight away. Pregnancy, Birth and Baby says to call for advice and go to hospital, and the same applies if your waters break before 37 weeks. Don't wait to see whether the tightenings settle on their own.

When to get help

These tiers follow the sources above. If you're unsure which applies, choose the more urgent one.

The emergency list comes from Pregnancy, Birth and Baby's contractions page, which says to call an ambulance for heavy bleeding, a severe headache or blurred vision, or a labour moving so fast you may not make it in time. It also draws on the NHS, which says to call an ambulance if your baby is coming now, and ACOG, which lists constant, severe pain with no relief between contractions as a reason to go to hospital. The NHS pre-eclampsia page lists seizures (eclampsia) among the serious complications.

Call your maternity unit, birth suite or midwife now, day or night, if:

• your waters break, especially if the fluid is green, brown, blood-coloured or smells bad
• you have any vaginal bleeding beyond a streaky show
• your baby is moving less than usual, or their pattern of movement has changed (see baby movements in pregnancy)
• you have any signs of labour before 37 weeks
• a contraction lasts longer than 2 minutes, or you have 6 or more in 10 minutes
• your temperature is 37.5°C or above, or you feel unwell
• you have strong pressure in your vagina or bottom, or an urge to push
• you have signs of pre-eclampsia: a severe headache that doesn't go away with simple painkillers, vision problems such as blurring or flashing lights, pain below the ribs, being sick, or sudden swelling of your face, hands or feet.

The NHS is clear about a baby who is moving less: "Do not wait until the next day – call immediately, even if it's the middle of the night." Pregnancy, Birth and Baby's pre-eclampsia page says to see your midwife or doctor straight away with any of its symptoms. In the US, the CDC's urgent maternal warning signs include a baby's movement stopping or slowing, and vaginal bleeding or fluid leaking during pregnancy. If you can't get through to your unit, go to your hospital rather than waiting at home.

Talk to your midwife at your next visit about anything you'd like to plan ahead: when your hospital wants you to call, how long the drive takes at different times of day, and what happens if your waters break before labour.

What's useful to note down?

When labour starts, a few notes make the phone call easier: the time each contraction starts and how long it lasts, when your waters broke and what the fluid looked and smelled like, any bleeding, and whether your baby is moving as usual. A birth partner can keep the notes so you can focus on coping. Never wait to finish notes before calling about a warning sign.