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Time to give birth or a false alarm? Learn the early signs of labor, how to tell if it's true labor or false labor, and what happens when labor starts for real.
What are the signs that my body is preparing for labor?
You may notice the following signs or symptoms in the final days, weeks, or month before your due date:
Your baby "drops." If this is your first pregnancy, you may feel what's known as "lightening" a few weeks before labor starts. Lightening means the baby now rests lower in your pelvis.
You might feel less pressure just below your ribcage, so it will be easier to catch your breath, and if you experienced heartburn during pregnancy, it might now improve. If this isn't your first baby, however, lightening may not happen until labor begins.
- You have more Braxton Hicks contractions. More frequent and intense Braxton Hicks contractions can signal pre-labor, which is when your cervix starts to thin and widen, setting the stage for true labor. (See "What are the signs that labor is about to begin?" below.) Some women experience menstrual-like cramps during this time.
Your cervix starts to change. In the days and weeks before delivery, changes in the connective tissue of your cervix make it soften and eventually thin and open. The thinning of the cervix is called effacement. The opening is called dilation.
If you've given birth before, your cervix is more likely to dilate a centimeter or two before labor starts, but keep in mind that even being 40 weeks pregnant with your first baby and 1 centimeter dilated is no guarantee that labor is imminent.
When you're at or near your due date, your doctor or midwife may do a vaginal exam during your prenatal visit to see whether your cervix has started the process of effacement and dilation.
- You pass your mucus plug. If your cervix begins to efface or dilate significantly as you get close to labor, you may pass your mucus plug – the small amount of thickened mucus that has sealed off your cervical canal during your pregnancy. The mucus plug may come out in a lump all at once or as an increased amount of vaginal discharge over the course of several days.
- You have some "bloody show." When your cervix starts to soften or dilate, you may notice a pink discharge or bright-red blood. If this happens at the same time you lose your mucus plug, the mucus may be tinged with blood, but it can also happen independently. (Having sex or a vaginal exam can also disturb your mucus plug and result in some blood-tinged discharge, even when labor isn't necessarily starting any time soon.)
If you have significant bleeding (like a heavy period), call your doctor or midwife right away.
What are the signs that labor is about to begin?
Labor could be imminent if:
- Your baby "drops." Lightening can happen right before labor, especially if this isn't your first baby.
- You pass your mucus plug. Sometimes this happens in the days or weeks before labor, depending on when your cervix begins opening (see "What are the signs that my body is preparing for labor?" above). It can also happen right at the start of labor – or you might not notice it at all.
- You have some "bloody show." This can also happen well before or right before labor, depending on when your cervix is changing (see "What are the signs that my body is preparing for labor?" above).
If you have significant bleeding (like a heavy period), call your doctor or midwife right away.
Your water breaks. When the fluid-filled amniotic sac surrounding your baby ruptures, fluid leaks from your vagina. And whether it comes out in a large gush or a small trickle, this is a sign it's time to call your doctor or midwife.
Most women start having regular contractions before their water breaks, but in some cases, the water breaks first. When this happens, labor usually follows soon after.
What are the signs that labor has begun?
- Your contractions have become increasingly intense. When your uterus contracts, your abdomen feels tight or hard, and you have a sensation of cramping. When the uterus relaxes between contractions, the sensation dissipates. Labor contractions will grow stronger, longer, and more frequent as they cause your cervix to dilate.
- Lower back pain or rhythmic cramping. Some women experience intense pain in their lower back during or between contractions while they're in labor. (Back pain usually means that your baby's head is pressuring against your lower back, but some theories propose that the pain may be "referred" from your uterus to your lower back.)
What week does labor usually start?
Labor usually starts between week 37 and week 42 of pregnancy.
If you're having signs of labor before 37 weeks, you may be going into preterm labor. Call your doctor or midwife right away.
Is nesting a sign that I'm going into labor?
Probably not. There's no good evidence that nesting means you're about to give birth. Many expectant moms feel the urge to clean and organize things at home to get ready for their new baby. But this can happen weeks or even months before labor starts.
How can I tell the difference between true labor and false labor?
It can be hard to tell at first. The frequency, length, intensity, and location of your contractions can help you figure out whether you're in true labor or are having Braxton Hicks contractions. How changing positions, walking, and rest affect your contractions provides more clues. Additionally, if you notice any bloody show with your contractions, they're probably true labor contractions.
This chart outlines differences between true and false labor contractions.
|False labor contractions (Braxton Hicks)||True labor contractions|
|Timing||Are irregular and don't get closer together over time||Happen at regular intervals and get closer together over time|
|Length||Vary in length and don't get longer over time (fewer than 30 seconds or up to 2 minutes each)||Start to last longer with each contraction (about 30 to 70 seconds each)|
|Intensity||Are weak and don't get stronger with time (may be weak then strong, then weak again)||Grow stronger and more painful with each contraction|
|Location||Are felt at the front of the abdomen||May start in the back and move to the front, or radiate down into the thighs|
|Effect of moving or resting||Contractions stop when you change position, walk, or rest||Contractions continue even when you change position, walk, or rest|
What should I do if my water breaks?
Call your doctor or midwife to talk through what to do next. Labor will probably start soon if it hasn't already.
If you tested positive for group B streptococcus, your provider will probably want you to head to the hospital as soon as your water breaks so you can take antibiotics.
Your provider may ask you to go to the hospital right away if:
- You've been having pregnancy complications.
- Your water has broken.
- You notice meconium (it looks greenish or is streaked with green) in your amniotic fluid.
What happens if my water breaks and I don't have contractions?
If you don't start having contractions on your own within about 24 hours (your provider will discuss the timing with you), your doctor will most likely recommend that labor be induced because your baby is more likely to get an infection without the amniotic sac's protection against germs.
When should I tell my doctor or midwife that I'm in labor?
Toward the end of your pregnancy, your doctor or midwife will most likely give you clear guidelines about when to let her know that you're having contractions, and when you should go to the hospital or birth center.
Your instructions will depend on your individual situation – such as whether you have a high-risk pregnancy or other complications, if this is your first baby, and how far you live from the hospital or birth center.
If your pregnancy is uncomplicated, she'll probably have you wait to until you've been having contractions that last for about a minute each, and occur every five minutes for about an hour, before you come in. (Time contractions starting from the beginning of one until the beginning of the next.)
If you're unsure whether the time has come, go ahead and call. Doctors and midwives are used to getting calls from women for guidance about whether they're in labor.
When you call, your doctor or midwife will get some clues about your condition from the sound of your voice. She'll want to know:
- How close together your contractions are
- How long each one lasts
- How strong they are (like whether you can continue talking through a contraction)
- If you think your water has broken
- If you're feeling the baby move normally
What are pregnancy warning signs to look out for?
- Your water breaks or you have contractions before 37 weeks, because you could be going into preterm labor. Other signs of preterm labor include vaginal bleeding or spotting, unusual vaginal discharge, abdominal pain, pressure in your pelvic area, or low back pain.
- Your water breaks, or you suspect that you're leaking amniotic fluid that is yellow, brown, or greenish. This signals the presence of meconium, your baby's first stool, and is sometimes a sign of fetal stress. It's also important to let your provider know if the fluid looks bloody.
- You notice that your baby is less active.
- You have vaginal bleeding, constant and severe abdominal pain, or a fever.
- You have symptoms of preeclampsia, including abnormal swelling, severe or persistent headaches, vision changes, intense pain or tenderness in your upper abdomen, or difficulty breathing.
Some women assume that symptoms and discomfort are just part and parcel of being pregnant, while others worry that every physical change spells trouble. Knowing which pregnancy symptoms you should never ignore can help you decide whether to call your doctor or midwife.
That said, every pregnancy is different, and no list can cover all situations. If you're not sure whether a symptom is serious, or if you're uneasy and just don't feel like yourself, trust your instincts and call your healthcare provider. If there's a problem, you'll get help. If nothing's wrong, you'll be reassured.