Start of Labour

Labour begins when the uterus starts contracting regularly, and the contractions are getting stronger in intensity, and become increasingly closer tog

08:03 09 June 2009

After months of anticipation, now comes the moment of truth " labour. This article also appears on www.bbc.co.uk/parenting/having_a_baby

Is this what I think it is?

Labour begins when the uterus starts contracting regularly, and the contractions are getting stronger in intensity, and become increasingly closer together.

These contractions allow your uterus to push the baby downwards, and to pull the cervix upwards, allowing the exit point to get bigger and bigger, in preparation for your baby's head.

Most labours start off quite slowly and gently, and you may have several hours of wondering if this is actually 'it' or not.

Some women experience quite powerful Braxton-Hicks 'practice' contractions " these can really feel like labour, especially toward the end when you are waiting for the real thing to get underway. You can see your tummy harden, and then relax, and you may find it quite painful at times. It's not all that uncommon to be 'taken in' by a 'false labour' and to even end up in hospital and to then be sent home as 'nothing's happening'. Don't be embarrassed if this happens to you " maternity staff have seen it all before.

"...it's not uncommon to be 'taken in' by a 'false labour'..."

Bear in mind if you've had a normal pregnancy so far, you don't need to make a dash for the hospital, even if you know for sure you're in labour. You will probably cope better with the contractions when you are free to walk around, and to choose your distractions.

If you are in doubt, though, call the labour ward and speak to a midwife. She'll discuss what's happening to you, and give you advice on whether you can wait a little while or not.

How to tell if it's labour

• Time your contractions " it's probably true labour if your contractions are over 40 seconds long, and coming three in every 10 minutes.
• You've had a 'show' " a loss of pink mucus from the cervix, which you might notice on the loo paper after you have been to the toilet. This is the 'operculum' or the plug of mucus that keeps the cervix closed. Labour can start any time after the show, but it could be as long as a few days. It loosens because you have already started mild contractions. Some women never actually notice the show, so if you miss it, it doesn't mean you aren't in labour.
• Your waters have broken " this means the membranes holding the amniotic sac, (bag of waters) containing the amniotic fluid surrounding the baby, have started to leak. It can happen suddenly, but more usually, it's a gradual trickle. Usually, labour starts soon after this happens. Again, you may not notice your waters going at all. It is more likely to happen when you are already in established labour, and some women don't experience it until the end of the first stage (or even later). See our feature on Stages of labour.

There is a risk of infection if your waters break too soon before labour, and if your baby's head isn't engaged in the pelvis. The waters could bring the cord down as well (this is rare, but it could mean your baby's oxygen supply is compressed). Call the hospital if you are anxious about this.

Have a plan

Many pregnant women don't feel like going anywhere toward the end of their pregnancy. That's fine, but it also does you no harm to get out and about.

Don't be afraid to leave the confines of your home in case you go into labour. Just make sure you have a plan in case it all starts to happen while you're out.

This plan should include:

• making sure you have contact details of your partner/birthing partner to let them know the situation
• carrying a spare pair of knickers and a couple of sanitary towels. If you do go into labour and your waters break, you'll need to change your underwear for your own comfort, and the sanitary towels will help absorb the fluid
• keeping a spare bag with some of the essentials you will need for your hospital stay with you or in your car. See our feature on What to take to hospital for more information.

Passing the time

Have a warm, relaxing bath or find something enjoyable and undemanding to do " listen to music, watch TV, read a book. If you're in bed, try to sleep " if you can. Strong contractions won't allow you to do this, of course.

If you're in great pain, if you notice any loss of blood, if you feel sick or have a bad headache, or if you think there is any other thing happening that shouldn't be, call the labour ward and seek advice.

Home birth

You will probably have discussed the sequence of events with the midwife who is likely to be there when you give birth. Give her a call when you are fairly sure you are in labour and discuss your symptoms with her. This will allow her to plan when to come to you.

What is a contraction?

The uterus is made up of a complex network of muscle fibres. When labour starts, these fibres begin regular contractions and relaxings, and with each contraction, the fibres get shorter. This pulls up the cervix and, at the same time, increases the downward pressure at the top of the uterus.

At the height of the contraction, the muscle fibres are at their shortest and the pain you feel is the most intense at that moment. It's like a very strong period pain, or, some say, like a belt tightening across your abdomen. Then, the fibres relax and the contraction fades away... but when the contraction ends, the muscle fibres remain slightly shorter than they were before. The baby is pushed down a little further, and the cervix stays a little wider.