How can you tell labor has started?

In the last weeks, it's natural to wonder with every twinge, “Is this it?” Knowing the signs that labor has started, and when to go to the hospital without waiting, helps you stay calm when the time comes.

Signs that labor has started

• Contractions: your uterus tightens and relaxes. The pain can feel like period cramps and may be felt in your back or lower belly.
• Bloody show: the mucus plug in your cervix comes out as a pink or slightly bloody, jelly-like discharge. Labor may start soon after, or it may take a few days.
• Water breaking: this can be a sudden gush or a steady trickle.
• Backache or a heavy feeling in your lower back
• An urge to go to the bathroom, caused by your baby's head pressing on your bowel

Some women notice the baby dropping lower and breathing becoming easier a few weeks or a few hours before labor. Not every woman has all of these signs. Most women give birth between weeks 38 and 41, but there is no way to know in advance exactly when labor will start.

True or false contractions?

False (Braxton Hicks) contractions, which are common in the last weeks, are usually irregular and don't get closer together or stronger; they may stop when you rest, walk or change position. True labor contractions come at regular intervals and get closer together, longer and stronger; they continue even when you rest. The pain often starts in the back and moves to the front. You can use the contraction timer to note how often contractions come and how long they last. Sometimes an exam is the only way to tell the difference; if you're not sure, call your doctor or the hospital where you plan to give birth.

When should you go to the hospital?

Call your doctor or the hospital when your contractions have become regular, are getting closer together and stronger, and have reached the interval your doctor gave you. The first stage of labor can last hours, sometimes days; your doctor may suggest you spend part of it at home. So before the final weeks, agree with your doctor on when to call, who to contact after hours, and whether to call first or go straight to the hospital. Plan your route to the hospital and how long it takes in advance.

If your water breaks, use a pad, not a tampon, so the color of the fluid can be seen. After your water breaks, labor usually starts on its own within 24 hours. If it doesn't, your doctor may suggest starting labor (induction), because the risk of infection for the baby goes up slightly. In the meantime, take your temperature; if it rises or the color or smell of the fluid changes, tell your doctor right away. If your baby moves less, go to the hospital without waiting.

“No one can know exactly when labor will start, but you can know in advance when you'll set off.”

Go to the hospital without waiting

In any of the following situations, go to the hospital without waiting for your contractions to become regular:

• Your water has broken (even if contractions haven't started), especially if the fluid is green, brown, foul-smelling or bloody
• You have vaginal bleeding (more than the light pink spotting of the bloody show)
• Your baby is moving less than usual or their pattern of movements has changed
• Regular contractions have started before 37 weeks
• You have a fever
• You have constant, severe pain that doesn't ease between contractions
• A contraction lasts longer than 2 minutes, or you have 6 or more contractions in 10 minutes
• You have a severe headache, vision problems or severe shortness of breath

If the baby seems to be coming and you feel a strong urge to push, call your local emergency number.