The signs and stages of labour: how will I know I'm in labour?

As you head towards your due date, it's easy to assume every twinge, ache and pain means you're in labour. So what should you be looking out for? We look into the signs and stages of labour so when it happens, you'll know!

TV shows and movies may make it seem as if labour begins with a gush of water as your waters break, followed by a race against time to the labour ward – not to mention those immediate and agonising contractions kicking in.

'But in reality, things tend to happen a lot more subtly – and slowly,’ explains Netmums’ official midwife Leah Hazard who takes us through some of the key and most common symptoms of early labour.

Plus, find out how you'll know when you're actually in labour and when exactly you should make THAT call to your midwife ...

Early signs of labour

If you're wondering how you'll know whether or not you're in the early stages of labour, here are some of the most common symptoms:

• Backache¹
• Diarrhoea²
• Feeling or being sick¹
• Lack of appetite¹
• Increased vaginal discharge²
• Feeling the need to poo¹
• Contractions¹
• Waters breaking¹

Your lower back starts to ache

Backache is a common pregnancy complaint, caused by the weight and position of your growing baby and the relaxation of your ligaments in preparation for giving birth³.

But while your back may have felt uncomfortable throughout the third trimester, niggly backache that feels similar to period pain could be one of the first signs of labour¹.

Leah explains:

‘Just as many women feel period pains as a dull backache rather than an abdominal cramp, so each woman will experience the onset of labour differently.

'For some of us, that means backache rather than the belly tightenings you might have otherwise expected.

‘This ache is just your body’s way of feeling contractions, and can be exacerbated by a baby in the occipito-posterior position (known as 'back to back', when the baby’s spine is lying against yours).’

It can be deceptive if you were expecting to feel your contractions over your bump, but lower back pain is a common sign that labour has begun¹.

You have diarrhoea

No one ever said the last stages of pregnancy were glamorous, but did you know that you can add diarrhoea to the list of delightful symptoms you may experience in the final days?²

According to Leah:

‘Gastric upset is a common sign of early labour, and it’s not unusual for women to experience diarrhoea, nausea and vomiting as contractions begin.

'We don’t know exactly why this happens; it’s probably partly due to the increase in prostaglandins (hormones which can irritate the muscles in your gut as well as your uterus) at the onset of labour, and partly just the body’s natural way of clearing itself out to focus on the task at hand: having a baby.

'Nausea, vomiting and diarrhoea are troublesome but harmless as long as they don’t persist for an extended period of time.

'If you can’t stop being sick or running to the loo over a period of many hours, check in with your midwife to ensure you’re not becoming dehydrated.’

On the positive side, this pre-birth clear-out may mean you’re less likely to poo as you push!

Don’t worry if you don’t have much of an appetite, either, explains Leah:

‘Most women aren’t tremendously hungry during labour, but it’s a good idea to take in plenty of fluids (like water, diluting juice or sports drinks) to ensure you're hydrated, and it’s fine to have regular light snacks (like fruit, toast, biscuits, energy bars etc) while you’re labouring at home.

'Check with your hospital or birthing unit to see whether they encourage food and drink in the labour ward itself.'

Your discharge changes colour and consistency

During pregnancy, your uterus is sealed with a plug of mucus, and your body needs to get rid of it before your baby is born¹.

When it comes away, it’s called a show (or 'bloody show'), and it’s a sign that your body is making preparations for your baby to arrive¹.

Leah says:

‘Some women notice their mucus plug, or ‘show’, coming away in one large clump, others notice it appearing in dribs and drabs over a period of days or weeks, while others never notice a show at all until the advanced stages of labour.

‘Likewise, the appearance of the show can vary; it’s usually clumpy or stringy mucus that can be streaked with pink, red or brown blood.

'Any fresh, heavy, bright red bleeding (like the consistency and colour of a nosebleed) should be discussed immediately with your midwife.’

While a show is a sure sign that your baby is on the way, it doesn’t always mean that it’ll happen quickly¹.

Some mums-to-be don’t have a show, but for others, it can happen several days before their contractions start¹.

You feel the need to poo

Isn’t if funny how you never hear mums-to-be in the movies saying they need to do a great big number two?

‘As your baby descends onto your pelvic floor (the muscles supporting your vaginal and anal areas), its head puts pressure on your bowel and can squeeze it flat like a tube of toothpaste,’ says midwife Leah.

This can make you feel like you need to go to the toilet¹ (and lots of women do actually poo as they push⁴ – cringeworthy, but the midwives have seen it all before, promise).

You feel stronger, more frequent contractions

Don’t expect to be doubled over in pain right from the start of labour; it’s far more common for your contractions to come on slowly¹ and, in the early stages, you might not know whether they’re proper contractions at all.

‘It’s impossible to describe exactly what contractions will feel like for each woman – we’re all different, with our own individual perceptions of pain,' explains Leah.

'For some women, early contractions will feel like strong period cramps; for others, it’s like a gradual tightening around the back and belly that builds to a peak then eases away; for others, contractions are felt down the hips and legs.'

If you’ve been having Braxton Hicks tightenings in your pregnancy, then early contractions might just feel like longer, stronger, more frequent versions of these.

‘When women ask me how they’ll know when they’re in labour, often the best thing I can say is, you’ll just know!' says Leah.

'It’s not really like anything you’ll have ever felt before.’

These early labour contractions can be uncomfortable and may go on for several days before things kick in properly².

‘It’s hard to define exactly when ‘early labour’ (the time when your cervix dilates up to 4cm) becomes ‘active labour’ (the time when your cervix opens from 4cm to full dilatation of 10cm) but, in general, the tightenings will become longer, stronger and closer together.

'I would generally expect a woman in active labour to be contracting every three to four minutes, with each contraction lasting around a minute.

'However, we’re all individuals, and some women can contract regularly with slow progress, while others will get to full dilatation with their tightenings still fairly irregular.

'If you’re struggling to cope at home, you’d like to be assessed, or you have concerns about yourself or your baby at this stage, you should always contact your own midwife for advice,’ says Leah.

Don't get too hung up about timings, though, she adds:

'Many women and their birth partners like to time contractions on a notepad or smartphone app.

‘This can be helpful in the early stages if you’re unsure of the frequency and duration of your tightenings, but I find that careful note-taking can be more of a hindrance as labour progresses.

'Trust your intuition and focus on your feelings as things become more intense.’

Your waters break

In the movies, waters always break with a huge splash (usually all over the supermarket or some other equally inconvenient place).

In reality, while some women experience the whole waterfall effect, it’s not always so obvious that your waters have broken¹. For most women, the waters don't break until they're already well into labour¹.

‘Some women do experience the classic ‘pop and gush’, when their clothes or bedsheets become suddenly soaked with fluid, but others will have a steady trickle, or just a constant feeling of wetness,’ says midwife Leah.

‘Occasionally, you might have a small gush and then nothing at all; this is when some fluid from the top of your uterus is released (the hindwaters), and then the baby’s head moves down in your pelvis, sealing the cervix much like a bathplug and leaving the rest of the amniotic fluid (forewaters) intact.'

If you’re unsure whether your waters have gone or whether it’s just discharge (or even a bit of wee), pop a maternity towel in your knickers or sit on a towel and phone the hospital¹.

They’ll ask about the colour, amount and consistency of any fluid, and they might suggest observing things for a while longer at home or tell you to come in if they think it’s time.

If the fluid coming away is greenish/brown (stained with meconium, or baby poo), very fresh red, or powerfully smelly, the midwife is likely to invite you in for immediate assessment¹.

However; clear, yellowish or even pink fluid is normal¹.

How will I know I'm in labour?

Lots of the early signs of labour can be easily mistaken for normal pregnancy symptoms, so you may wonder how you’ll know when you’re in labour.

The National Childbirth Trust's senior policy advisor, Elizabeth Duff, says it’s perfectly normal to be uncertain whether labour has begun:

‘It can be difficult to be sure, particularly for first-time mums who may well have all sorts of symptoms in the last weeks. But first-time labours are often particularly slow and the initial contractions can go on for some time.’

If you’re in any doubt or have any concerns about your pregnancy, call your midwife or your maternity unit¹. The numbers will be on your antenatal notes.

When to call your midwife

According to the NHS, if all else is well, it’s time to call your maternity ward when contractions are in a regular pattern and the following apply¹:

• last at least 60 seconds
• come every 5 minutes

However, you should also call your midwife or maternity unit immediately if:

• you think your waters have broken (or are unsure if they have)¹
• you have fresh vaginal bleeding (not mucusy like a show)¹
• your baby is moving less than usual, or not at all¹
• you’re less than 37 weeks pregnant and think you might be in labour¹
• you feel feverish or unwell²
• you have severe, constant abdominal pain (not like contractions, which will always allow your abdomen to relax for a few minutes in between)²
• you’re no longer coping at home, and you wish to be assessed or are keen for pain relief²
• you’re worried something isn’t right.

Your midwife is there to support you, and would rather hear 1,000 false alarms than miss one baby in danger. So always call if you're not sure about anything or need reassurance².

How to cope in the early stages of labour

Using a TENS machine may relieve pain in early labour AND it some can be used in the car en route to the hospital⁴. Some hospitals may provide this machine, but you can also get one at Amazon for £26.85.

A warm bath may help you to relax in early labour, relieving muscular pain (just make sure it's not too hot - if your skin goes bright pink, add some cool water). Epsom salts are ideal as they're natural and safe and you can easily get them at Amazon for less than £10.

If it’s your first pregnancy, your midwife will probably recommend that you don't rush to the hospital too soon².

‘Most women find that they labour more comfortably and effectively in their own home environment, surrounded by the people and things they love,' says Leah.

'If all is well with you and your baby, it’s absolutely fine to remain at home until the later stages of your labour.

'Attending your local triage unit just because you’d like to be examined is also fine, but do be aware that you may face an uncomfortable journey back home if you’re still found to be in the very early stages.

'Your midwife can give you extensive advice over the phone about when’s a good time to come in; don’t worry if it takes you a few phone calls back and forth to get the timing right.’

While things progress, Leah suggests these tips for helping to cope with any discomfort or anxiety:

• At night, try to sleep or just rest in between early tightenings, as you may have a long day ahead of you in the morning².
• If you’re feeling restless, walking around the house or even around your local neighbourhood can make the contractions more bearable and help your labour to establish².
• If you’re tired or would rather sit quietly, try to maintain an upright position²; either straddling the back of a chair, or bouncing gently on a birthing ball – upright, slightly forward-tilted postures will help nudge your baby into an optimal position for birth.
• Have regular light snacks to keep your energy up².
• Drink fluids little and often²; keep a bottle of water, juice or sports drink near you at all times.
• Try relaxation, visualisations or affirmations if these are things you’ve practised in pregnancy².
• Have a long soak in a warm bath²; run the water a bit deeper than usual (up to about cleavage height, if you’re sitting back), keep the water at a comfortable temperature, try different positions, and remember to keep your drink nearby to avoid becoming dehydrated.
• Take paracetamol according to the usual dosage if you’d like to try some light pain relief in the early stages⁴, or start using your TENS machine if you have one².

The different stages of labour

If you’re experiencing any or all of the above signs and symptoms, chances are you could be in early labour.

However, before you race over to the labour ward, it’s worth knowing that there might be a fair while to go before you’ll be meeting your baby¹.

Labour can be a slow and complex process, which is often said to be composed of three different stages².

Here's a look into what each stage involves so you’ll know exactly what to expect, as well as when to get yourself to that delivery suite.

The first stage of labour

‘The first stage of labour is when your cervix (the neck of your womb) dilates up to its full width (roughly 10 centimetres),' says Leah.

'During this stage, the uterus experiences long, strong, regular contractions, encouraging the baby’s head down into the pelvis until it’s ready to pass down through the vagina.'

'This stage can last anywhere from an hour to several days. However, first babies tend to take the better part of a day (or more), so don’t worry that you won’t have time to get to your planned place of birth. Second or subsequent babies tend to be quicker.'

The first stage can be broken up into three different phases⁴. These are:

1. Latent
2. Active
3. Transitional

The latent stage

‘The latent (or early) stage of labour can begin hours, days or even weeks before active labour establishes, and you may or may not even be aware it’s happening,’ says Leah.

‘You may feel Braxton Hicks contractions becoming gradually stronger in intensity, or things might start fairly suddenly. You might notice your show coming away or your waters breaking, or you might not experience either of those things.

'You might just have a sense of ‘feeling different’, or going into a quiet, withdrawn place in your mind, or you might feel restless and uncomfortable – there’s no way of knowing until it happens.’

'It's fine to phone the hospital for advice and support at this stage but if you do go to hospital and all is well with baby and yourself, you’re likely to be sent home until things progress.'

'Home is a great place to try any relaxation techniques you might have had in mind – massage, relaxation and breathing techniques, baths, showers, hot water bottles, paracetamol and TENS machines are all safe to use, and you might not know what works for you until you try.'

'Some women feel intimate and comfortable enough to have intercourse in the early stages of labour, and orgasm can be a good way of intensifying your contractions; if, on the other hand, you want to be alone, that’s absolutely normal and fine too,' says Leah.

The active stage

‘Active labour is usually thought to be the phase when your cervix dilates from 4cm to 10cm, and is accompanied by long, strong, regular contractions,’ explains Leah.

‘You may want to head to the hospital or birth centre at this point – or call your midwife to your house if you’re planning to deliver at home.

‘If you arrive at the hospital or birth centre in advanced labour, do share your birth preferences with the midwife who assesses you; for example, if you’re keen for a birth pool or an epidural, your midwife can let you know if there’s time and availability to arrange those before baby arrives.’

Find out more about your pain relief options

The transitional stage

‘Not everyone is aware of ‘transition’, but this phase is often experienced when your cervix is fully dilated but you haven’t quite begun to push,' explains Leah.

'It’s normal for contractions to slow down or even stop temporarily, and you may feel shaky, nauseous, panicky, or discouraged at this point.

‘You might even feel elated, chatty or relieved if you get a break from your contractions! Midwives are trained to recognise this phase and support you through it, and it doesn’t usually last for long.’

The second stage of labour

The second stage of labour refers to the time between full dilatation of the cervix and birth of the baby⁴. In other words, your cervix has finally reached that ‘much talked about’ 10cm, so it’s wide enough and ready to start pushing your baby out.

‘You may feel rectal pressure (similar to the need to poo) that gradually changes into an unstoppable urge to bear down,’ says Leah.

‘If you’ve had an epidural, you may still be aware of pressure rather than pain as your baby descends onto your pelvic floor. Every contraction brings your baby slightly closer to being born, and your midwife will support and guide you during this intense but exciting time.

‘There’s no rush to push harder, faster or quicker as long as you and baby are fine. First babies can take up to a few hours, but second and subsequent babies usually arrive more quickly, sometimes in just a few minutes.’

If the second stage is prolonged or if there is a concern about baby’s heartbeat, there are several interventions that may be offered to help you deliver more quickly⁴.

If the baby is nearly born but needs some assistance to get past those final few inches, you may be offered an episiotomy (a cut to widen the vaginal opening) or a doctor may use a ventouse (suction cup)⁴.

If the baby is further up the vagina, or if there’s any doubt as to whether a caesarean section will be required, your medical team may suggest a forceps delivery (when large metal spoons are used to grip, sometimes rotate, and then pull the baby out of the vagina).

Find out more about what happens in labour.

‘Regardless of whether you have a spontaneous or ‘assisted’ vaginal birth, you will still need to push, and your midwife will guide you carefully through the final moments when the baby’s head is stretching the skin around your vagina and perineum,' says Leah.

'It’s not always possible to prevent tearing, but you and your midwife will work as a team to make the birth as gentle and safe as possible.

'After the head has been delivered, there tends to be a short rest before the shoulders and body come out with the next and final contraction, and you’ll meet your baby at last!’

The third stage of labour

Baby’s out so think you’re all done? Not quite! There’s a bit more to come, also known as the afterbirth⁴.

‘The third stage is the time between the birth of baby and the delivery of your placenta, the amazing organ that you’ve grown to nurture your baby throughout pregnancy,’ says Leah.

But don't worry, your midwife can give you a quick injection (with your consent) to get this out as quickly and easily as possible, if you want (managed third stage)⁴.

Besides, you'll be so overwhelmed, you may not even notice this happening.

Your midwife will check that the umbilical cord and placenta have come out fully⁴. She'll also check for bleeding and stitch up any tears or episiotomy (a cut a cut made by a midwife-doctor in the area between the vagina and anus to allow baby more room to come out) before you're moved up to the postnatal ward⁴.

Related stories

What is a membrane sweep?

CHAT: what were your early signs of labour?

What your midwife will do after the birth

Sources

• ¹ NHS. 2017. Signs that labour has begun. [^]
• ² NHS. 2018. Labour and birth - Information booklet for mums & families. [^]
• ³ NHS. 2018. Back pain in pregnancy. [^]
• ⁴ NHS. 2013. Labour: What happens and how it can be managed. [^]