7 Signs of Labour, and When to Go to the Hospital

Quick answer

Labour usually announces itself through regular contractions that get stronger and closer together, a show, or your waters breaking. Some signs, like the baby dropping or a burst of energy, can come days or weeks earlier. Go to hospital immediately if your waters break, if you have any bleeding, if contractions start before 37 weeks, or if your baby's movements change.

Key takeaways

• Regularity is what separates labour from practice contractions. Braxton Hicks are irregular and settle. Labour contractions come in a rhythm and get stronger.

• Before 37 weeks, any regular tightening is an emergency until proven otherwise. Call your hospital rather than waiting to see if it settles.

• If your waters break, call your hospital straight away, even if you have no contractions. Note the time, colour and smell.

• A change in your baby's movements at any stage needs same-day assessment. Do not wait for labour to start, and do not try to wake the baby first.

• Ask your hospital for their own rule on when to come in, because distance, traffic, a previous caesarean or a previous fast labour all change the answer.

The 7 signs of labour

1. Lightening: the baby drops

Your baby's head settles lower into the pelvis. You may notice easier breathing, less heartburn, more pelvic pressure, and needing to urinate more often.

Timing: in a first pregnancy this often happens two to four weeks before labour. In later pregnancies it may not happen until labour begins. It is not a reliable countdown.

2. A show: the mucus plug comes away

The plug of mucus sealing the cervix comes away, either in one piece or gradually, often tinged pink or brown with a little blood.

Timing: anywhere from a few days to a few hours before labour. Some women never notice it.

🚩 A blood-streaked mucus show is normal. Fresh red bleeding, or anything soaking a pad, is not. Bleeding needs immediate assessment, not a wait-and-see.

3. Contractions that build

The defining sign. Regularity and progression are what matter, not how strong the first ones feel.

Real labour contractions:

• Come at regular intervals, and the gaps get shorter

• Get longer and stronger over time

• Do not settle with rest, a change of position or a warm bath

• Often start in the back and wrap around to the front

• Make it hard to talk through them as they build

Time them: note when each one starts and how long it lasts. Apps help, but a pen and paper works.

4. Persistent low back pain in waves

Some babies face your spine, which puts the hardest pressure on your lower back. This is often called back labour, and the pain comes in waves rather than staying constant.

🚩 Back pain that comes and goes in a rhythm before 37 weeks is one of the most commonly missed signs of preterm labour, because it gets dismissed as an ordinary bad back. Call your hospital.

5. Your waters break

Either a sudden gush or a slow, persistent trickle you cannot control. It differs from urine because it keeps coming and does not smell like urine.

What to do immediately:

• Note the time

• Note the colour. Clear or slightly pink is usual

• Note the smell. It should not smell unpleasant

• Put on a pad, not a tampon

• Call your hospital straight away, even with no contractions

🚩 Go in urgently if the fluid is green, brown or foul-smelling, if there is bleeding, if it happens before 37 weeks, or if you feel anything in the vagina after your waters break. That last one is rare but is an emergency, so call an ambulance and, if you can, get onto your hands and knees with your chest down while you wait.

6. Looser joints and increased pelvic pressure

Your pelvic joints soften and your ligaments relax in preparation for birth. You may feel more pressure low down, or a heavier, more mobile sensation in the pelvis.

Some women also notice mild diarrhoea or loose stools in the day or two before labour, which is normal.

7. A burst of energy, or the opposite

Many women describe a sudden urge to clean, organise and prepare, often called nesting. Others feel unusually tired and heavy instead. Both are normal, and neither reliably predicts timing.

Do not exhaust yourself on a cleaning spree at 39 weeks. If the energy arrives, use some of it to check your hospital bag and rest with the remainder.

Is it real labour or false labour?

The simplest test: change what you are doing. Walk if you were resting, or rest if you were active. Braxton Hicks usually stop. Labour does not.

When should you go to the hospital?

Ask your hospital for their own rule at your next appointment, and write it down. The general guidance below varies considerably depending on your situation.

A common general guide for a first labour: contractions about 5 minutes apart, each lasting about 1 minute, continuing for 1 hour.

Go in sooner than that if:

• Your waters have broken, at any stage

• This is not your first baby, since later labours are often faster

• Your previous labour was fast

• You have had a caesarean before

• You live far from the hospital, or traffic is unpredictable. In Indian cities a 20-minute route can become an hour without warning, so build in a margin

• You have been told your pregnancy is high risk, or you are expecting twins

• You have tested positive for group B streptococcus

• You are frightened or unsure. That is a valid reason on its own

🚩 Go immediately, whatever your contraction pattern, for:

• Any bleeding

• Waters that are green, brown or foul-smelling

• Contractions before 37 weeks

• Reduced or changed baby movements

• Severe headache with visual changes, pain under the ribs, or sudden swelling of the face and hands

• Constant, severe abdominal pain that does not come and go

• Fever

• Fainting, or heavy dizziness

• A fall or blow to the abdomen

Baby's movements still matter during labour

This is the sign most often forgotten once women start focusing on contractions.

Your baby should keep moving as usual right up to and through early labour. A reduction or change in the pattern needs same-day assessment, whatever else is happening.

• Do not wait until morning

• Do not try to wake the baby first with cold drinks, sugar or lying down. These waste time

• Do not accept "the baby has run out of room." Reduced movement is not caused by lack of space

Preterm labour: signs before 37 weeks

Before 37 weeks, these need a call to your hospital straight away, not a wait-and-see:

• Regular tightening or cramping, even if mild

• Low backache that comes in waves

• Pelvic pressure, as though the baby is pushing down

• Period-like cramps

• A change or increase in vaginal discharge, or a watery leak

• Any bleeding

Preterm labour is often subtle and easily dismissed. Being checked and sent home is a good outcome, not a wasted trip.

What to do while you are in early labour at home

If your hospital has told you to stay home for now:

• Rest between contractions, especially at night. You will need the energy

• Eat light food and keep sipping fluids

• Move, change position, and try a warm shower for comfort

• Time your contractions, but not obsessively

• Have your bag, records and transport ready

• Keep someone with you

• Call back if anything changes, if you are worried, or if the pattern shifts

Be ready before it starts

• Save the numbers now: your hospital's labour ward, your doctor, and the ambulance services 102 and 108

• Keep your antenatal records with you at all times from 36 weeks

• Have your bag packed by 36 weeks

• Know the route and the travel time at different times of day, plus a backup plan

• Agree who is taking you, and a second option

• Tell one family member the warning signs, so someone else recognises them

• Do not drive yourself if you have bleeding, severe pain, visual changes or dizziness

Frequently asked questions

What are the first signs of labour?
Usually regular contractions that get stronger and closer together, a show, or your waters breaking. Lightening and nesting energy can come days or weeks earlier.

How do I know if my contractions are real?
Real contractions come in a rhythm, get longer and stronger, and do not settle when you change position or rest. Braxton Hicks are irregular and usually stop.

My waters broke but I have no contractions. What should I do?
Call your hospital straight away. Note the time, colour and smell of the fluid, use a pad rather than a tampon, and follow their instructions.

How long after a show does labour start?
Anywhere from a few hours to a few days. A show alone is not a reason to go in, but any actual bleeding is.

When exactly should I leave for the hospital?
Ask your own hospital for their rule. A common guide for a first labour is contractions five minutes apart, lasting a minute, for an hour. Go sooner if your waters have broken, this is not your first baby, you live far away, or you have any warning sign.

Is back pain a sign of labour?
It can be, especially if it comes in waves. Before 37 weeks, rhythmic back pain should be treated as possible preterm labour and reported immediately.

Can labour start without contractions?
It can begin with your waters breaking, or with a show, before contractions establish. Waters breaking always warrants a call to your hospital.

What if I go in and it is a false alarm?
That is a good outcome, not a wasted trip. Maternity units expect it, and being assessed and sent home is exactly what should happen.

Does the baby move less when labour is near?
No. Your baby should keep moving as usual. Any reduction or change needs same-day assessment, whatever stage you are at.

The bottom line

Labour usually announces itself through contractions that come in a rhythm and keep building, and the simplest test is that real labour does not settle when you rest or change position. Everything else on the list can arrive days or weeks ahead. What matters more than identifying the exact sign is knowing the four situations that mean going in immediately: waters breaking, any bleeding, contractions before 37 weeks, and any change in your baby's movements. Save your hospital's number today, and ask them for their own rule on when to come in.

Sources

• World Health Organization, recommendations on intrapartum care for a positive childbirth experience

• American College of Obstetricians and Gynecologists, how to tell when labour begins, and preterm labour and birth

• Royal College of Obstetricians and Gynaecologists, reduced fetal movements, and prelabour rupture of membranes

• National Institute for Health and Care Excellence, intrapartum care and preterm labour and birth

• NHS, signs that labour has begun

• Centers for Disease Control and Prevention, urgent maternal warning signs

• Federation of Obstetric and Gynaecological Societies of India, intrapartum care recommendations

This article is for general information and is not a substitute for medical advice. Go to hospital immediately if your waters break, you have any bleeding, contractions start before 37 weeks, or your baby's movements change.