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Signs of Labor (Labour) and When to Go to the Hospital

How to tell early labour from practice contractions, and what to do next.

Before you use this guide: This is general educational information, not an individual medical assessment. We do not identify a clinician reviewer on this page, so please confirm personal health decisions with your doctor, midwife or paediatrician.

Knowing the signs of labour, and when to call your maternity unit or head in, can make the start of labour feel calmer. Labour rarely looks like it does in films. For most first-time mothers it builds slowly over many hours, and many babies arrive after their due date. The advice below is general, so follow the plan your own midwife or doctor has given you.

Signs that labour may be starting

• Regular contractions that get stronger, longer and closer together, and do not ease when you rest or change position
• A "show": a sticky pink, brown or blood-streaked plug of mucus from the vagina. It means your cervix is beginning to change, but labour may still be hours or days away.
• Your waters breaking, either as a gush or a steady trickle of fluid
• Lower back ache or period-like cramps that come and go
• Diarrhoea or a loose bowel, or a sudden burst of energy or nesting
• The baby dropping lower, with more pressure on the pelvis

What contractions feel like

Early contractions may feel like strong period pain, a tightening across your belly or pain in your back. They come in waves: they build, peak and ease off. The big difference from Braxton Hicks tightenings is that real contractions become regular, more intense and do not go away with rest or a drink of water. Our guide to Braxton Hicks versus real contractions explains how to tell them apart.

The usual timing guide

Most hospitals give a rule of thumb, but yours may be different, so ask at an antenatal appointment. A commonly used guide for a first baby is to call when contractions are about 5 minutes apart, lasting around a minute each, for an hour (the 5-1-1 rule). Some units say 3 contractions in 10 minutes. If you have had a baby before, call earlier, because labour is often faster.

Call sooner if you live far from the hospital, have had a very fast labour before, or are unsure.

When to call your maternity unit or midwife straight away

• Your waters break. Note the time, the amount and the colour. Clear or pale is usual. Green, brown, or bloodstained fluid needs urgent attention.
• You have vaginal bleeding that is more than a show, like a period or heavier
• Your baby is moving less than usual. Do not wait. Call at any time of day or night.
• You have constant severe pain that does not ease between contractions
• You think you might be in labour before 37 weeks
• You have a severe headache, vision changes, sudden swelling or pain under your ribs, which can be signs of pre-eclampsia
• Your pregnancy is higher risk, your baby is breech, you are expecting twins, you have had a previous caesarean or you have been told you carry group B strep
• You feel something is wrong, even without a specific sign

If you feel the cord

If you see or feel something in your vagina after your waters break, such as a loop of the cord, call an ambulance immediately: 911 in the US and Canada, 999 in the UK and Ireland, or 000 in Australia. Get on your hands and knees with your head down and your bottom up, and stay like that until help arrives. This is rare, but it needs emergency care.

If your waters break before contractions

Call your maternity unit. If the baby is at term, most women go into labour within 24 hours. Your team will advise whether to come in, usually to check you and your baby, and may talk to you about induction if labour does not start. If your waters break before 37 weeks, go in right away. Do not use tampons or have sex, because of the risk of infection.

Staying at home in early labour

• Rest, take a warm bath or shower and try to sleep if you can
• Eat light snacks and drink fluids to keep your energy up
• Move around, sway or rock on a ball
• Use a heat pack and ask your partner for back massage
• Time your contractions loosely. You do not need to do this constantly.
• Keep your hospital bag by the door. See our hospital bag checklist.

Getting to the hospital

• Have a plan for how you will travel, and a backup if the first is unavailable
• Keep your maternity notes, phone and charger handy
• Do not drive yourself if you are in strong pain, and call an ambulance if birth seems imminent.
• If you feel you need to push or the head is visible, call an ambulance, stay calm and keep breathing. Do not try to hold back.

If you are not in established labour

Sometimes you come in and are sent home because the cervix has not opened enough. This is common and not a waste of time. It means your body is warming up. Follow the advice you are given and return if things change.

Overdue pregnancy

Many first babies arrive after the due date. If you are past 41 weeks or so, your team will talk about monitoring and induction. See our guide to induction of labour.

Where to check current advice

Local advice differs, so ask your own midwife or maternity unit, and check the latest guidance from the NHS in the UK, the HSE in Ireland, ACOG in the US, the SOGC in Canada and RANZCOG in Australia.

This content is for general information only and is not medical advice. Every pregnancy and every baby is different. Always talk to your doctor, midwife or paediatrician about your own situation, and seek urgent care if you are worried.