Signs of labor (labour): how to tell it’s starting and when to call
It can be hard to tell at first whether labour (labor in the US) has started. If you think you’re in labour or aren’t sure, call your midwife, maternity unit or doctor.
The main signs of labor
- Contractions or tightenings, which can feel like extreme period pains
- A “show”, when a plug of mucus comes away
- Backache
- An urge to go to the toilet
- Your water breaking (“waters” in the UK)
True labor or false labor? Contractions vs Braxton Hicks
Practice contractions are called Braxton Hicks, or false labor. The NHS says they’re usually painless, while ACOG says they can be very painful, so pain alone won’t tell you. Time yours, and see whether they continue when you rest and drink water.
| True labor contractions | False labor (practice contractions) | |
|---|---|---|
| Pattern | Regular, and get closer together | No pattern |
| With movement or rest | Continue | May stop when you walk, rest or change position |
| Strength | Steadily get stronger | Weak |
| Where you feel it | From the back round to the front | Only in the front |
From ACOG. Sometimes only an internal examination can tell.
When to call
Call your midwife, maternity unit or doctor if you think you’re in labour, or if contractions are regular and coming every 5 minutes or more often. In early labour you’ll usually stay at home for now. This stage can take hours or days.
Call straight away, even in the middle of the night
The NHS says to call urgently if:
- Your waters break
- You have vaginal bleeding
- Your baby is moving less than usual
- You’re less than 37 weeks pregnant and think you might be in labour
- A contraction lasts longer than 2 minutes
- You have 6 or more contractions in 10 minutes
When to call an ambulance or go in
In the UK, call 999 if you think the baby is coming now and you have a strong urge to push. ACOG says to go to the hospital if your water broke and you have no contractions, you have heavy bleeding, you have constant severe pain with no relief, or your baby is moving less.
If your water breaks
Call your maternity team and follow their advice. Use a pad, not a tampon. Labour usually starts within 24 hours. If it doesn’t, the NHS says you’ll be offered induction because of a small risk of infection. Until then, check your temperature every 4 hours. Tell your midwife if the fluid is smelly or coloured, or if you’re losing blood.
Signs of preterm (early) labor
The NHS says about 8 in 100 babies are born before 37 weeks. Call your midwife, maternity unit or ob-gyn straight away if you’re under 37 weeks and have any of these:
- Regular contractions or tightenings. ACOG’s guide is four in 20 minutes, or eight in an hour
- Period-type pains or mild cramps
- A gush or trickle of fluid from your vagina
- A dull backache, or one that isn’t usual for you
- Pressure in your pelvis
- A change in your discharge
How long does labor last?
Established labour starts when your cervix has opened to about 4 cm. The NHS says it then usually takes 8 to 18 hours in a first pregnancy, and 5 to 12 hours in a second or third. Pushing should take no longer than 3 hours with a first baby, or 2 hours if you’ve given birth before.
Questions people ask
How do I know if I’m in labor?
Contractions that are regular, get closer together, get stronger and continue when you move or rest are the usual sign. A show, backache or your water breaking can also be signs. If you’re unsure, call your midwife, maternity unit or doctor.
How do I know when to go to the hospital?
Call first. The NHS suggests calling if contractions are regular and every 5 minutes or more often, and urgently if your waters break, you bleed, your baby moves less, or you’re under 37 weeks. ACOG lists water breaking without contractions, heavy bleeding, constant severe pain and reduced movement as reasons to go in.
Can labor start without contractions?
Contractions aren’t the only sign. A show, backache or your waters breaking can come first. If your waters break, call your maternity team straight away.
When will I go into labor?
There’s no way to know exactly. ACOG says most women give birth between 38 and 41 weeks.
References
- NHS: Signs that labour has begun
- NHS: The stages of labour and birth
- NHS: Premature labour and birth
- ACOG: How to tell when labor begins
- ACOG: Preterm labor and birth
Advice differs between countries, so follow your own care team’s plan. How we check this.
Third trimester, week by week
Third trimester Weeks 28–40
Weight gain, brain and lung maturation, and getting into position for birth.
