A comprehensive guide to recognizing the real onset of labor and knowing when to go to the hospital
The first physical step in preparing for labor
Weeks before actual labor (in first-time mothers) or hours before (in women who have delivered before), the baby's head descends into the pelvis. You'll feel more heaviness in the lower abdomen and pelvis. Shortness of breath improves as the uterus no longer presses on the lungs as forcefully. However, pressure on the bladder and bowels increases β frequent urination and constipation may occur. Walking may become more difficult. Some women experience pain in the inner thigh area.
Baby dropping doesn't mean labor will happen tomorrow β weeks may pass. But it's an important development signaling your body is preparing.
Signs from the reproductive tract that labor is approaching
The mucus plug is a thick clump of mucus that has sealed the cervix throughout pregnancy to protect the baby. As labor approaches, this plug is expelled. It may come out whole or gradually. It is white, light pink, or may contain traces of blood β called "bloody show." Its passage may occur hours, days, or even weeks before labor. Discharge may increase gradually as labor approaches. If you notice heavy actual bleeding (like a period), call your doctor.
Losing the mucus plug is not a definite sign that active labor has started β days may pass before you feel real contractions.
This is the primary sign of real labor
Braxton Hicks practice contractions occur throughout pregnancy β they're irregular and painless. Real contractions are completely different. They start as pain in the lower back, then move forward toward the abdomen. Real contractions are regular and increase in strength and frequency over time. Initially they may come every 10β15 minutes, then every 5 minutes, then every 2β3 minutes. Real contractions don't go away with walking or changing position β they actually get worse. Each contraction lasts about 30β60 seconds initially, then may last a full minute or more.
When contractions become regular, intense, and come every 5β10 minutes, it's time to call your doctor and go to the hospital if advised to do so.
A very clear sign that labor is beginning or imminent
The rupture of membranes (breaking of the amniotic sac) releases the fluid that has surrounded your baby throughout pregnancy. It may come as a dramatic gush or a slow, steady trickle. The fluid is usually clear or slightly yellowish and odorless (unlike urine). If your water breaks, contact your doctor immediately β even if you're not having contractions yet. Active labor usually begins within 24 hours of water breaking. If the fluid is green or brown (meconium), go to hospital immediately as this may indicate fetal distress.
Additional symptoms that may occur before or during labor
Diarrhea may occur β the bowels naturally clear in preparation for labor. Nausea and vomiting may happen. A slight weight loss (about 0.5β1.5 kg) may occur before labor. A sudden burst of energy β called the "nesting instinct" β where you feel an urge to clean and organize the home. Increased pelvic pressure and pressure in the inner thighs. Some women feel a strong urge to push β this can signal that the cervix is very dilated.
Every woman is different β you may experience some of these symptoms but not others. The important thing is to listen to your body and contact your doctor when in doubt.
Learn more about the labor experience
Comprehensive articles on contractions, real vs. false labor
What Contractions Feel Like βMedical notice: At any sign of true labor, contact your doctor or hospital immediately. When in doubt, it's better to come to hospital unnecessarily than to delay and risk harm.