Even moms who've been through it before can't always tell when labor is starting. That's because many of the early signs of labor are vague and easily misinterpreted: Are those cramps real contractions, or are they a result of the grande burrito you ate last night? Is that little trickle of fluid your water breaking, or is it just urine leaking because a seven-pound baby is resting on your full bladder?
Labor – like parenting itself – is never completely clear-cut. To help you figure out when you're really ready to head to the hospital, check out these cues.
Just when you think you can't possibly get any bigger and you'll never get off the couch without a crane, you may experience the following symptoms that let you know labor is near. Note that these symptoms don't occur in any particular order, and several may occur within the same day or a few days of each other.
An increase in vaginal discharge, possibly brownish or pinkish in color.
"Engagement," or the sensation of the baby dropping lower into your pelvic cavity. The weight of your baby is no longer pressing on your diaphragm, and you may be able to breathe more freely as a result.
Braxton Hicks contractions or "practice" contractions that feel like a tightening or hardening of the uterus with possible mild cramps.
Slight weight loss.
Dull pain low in your back that comes and goes.
Loose and frequent bowel movements with cramping. "That's the body's way of emptying the bowels so the uterus will contract well," surmises Rochel Lieberman, a Brooklyn, New York, nurse-midwife. "Indigestion and vomiting prior to labor are also possible."
Sensation of building pressure or cramping in your pelvic/rectal area.
A feeling of restlessness/increased energy, or marked sense of fatigue. The sense is that you don't want to leave any unfinished business at home. If you do feel a spike in the nesting instinct, "don't knock yourself out," says Barbara Moran, a nurse-midwife in Dunn Loring, Virginia. "You'll need your energy for labor."
Softening, thinning, or dilation of cervix (as shown by doctor's internal exam).
You've probably had nightmares about this sign of going into labor suddenly happening in the office elevator or at the movies. But only a small minority of women – in one study, as few as 8 percent – report that their sac of amniotic fluid broke before they started having regular contractions. Even if your water does break, you're likely to feel a small leak, not a big gush, because your baby's head often prevents too much fluid from leaking out.
Once the sac has ruptured, it usually means that labor is just around the corner, says Carol J. Grabowski, M.D., chief of staff of the women's division at Long Beach Memorial Medical Center, in California. Eighty percent of women spontaneously go into labor within 12 hours after their water breaks. And those who don't are likely to be induced because the risk of infection increases once the amniotic sac has ruptured.
During pregnancy, the cervix stays closed and plugged up with mucus. It's nature's way of protecting your baby from infection. But as you progress toward labor, the cervix begins to dilate and soften in preparation for delivery, causing what's accumulated there to dislodge. The mucus, which can measure up to a teaspoonful, is dispelled as either a blob (called the "mucus plug") or a runny smear. This mucous discharge may look brown – from old blood – or pink as the cervix continues to thin and open, causing tiny blood vessels to break along the surface of the cervix and tinge the mucus. After you notice the "bloody show," labor could be hours, days, or even weeks away, Dr. Grabowski says.
When true labor begins, the contractions start as mild, irregular cramps that become regular and more painful over time. You usually can't feel your baby move during the cramp or contraction. The contractions push the baby's head down, slowly thinning and opening the cervix; this is called effacement and dilation. "Most of the time, you'll feel contractions as a tight band that starts in your back and radiates across the front of your belly," says Kay Johnson, a certified nurse-midwife in Atlanta.
If you're like a lot of pregnant women, your back may have been aching for months. But when the pain becomes extremely harsh, this can be a sign that you're experiencing "back labor," which happens to nearly one-third of women. "Normally, a baby descends the birth canal with its face pressed against the mom's spine," Johnson notes. "But in some cases, the baby descends with its skull hitting the mom's spine." The result? "Constant pain that may radiate to the abdomen but is mostly concentrated in the back." Whether you experience true back labor or not, excruciating back pain is a sure signal that you're ready to deliver.
Braxton Hicks contractions – also called “false labor” – are different from the contractions you'll feel in labor:
They're irregular and will subside after a time.
They won't increase in strength or frequency.
They'll subside if you move around.
You'll feel pain in your lower abdomen, not your lower back.
Any lower back pain you do feel is not persistent.
“Braxton Hicks contractions rarely get strong or regular, and then they usually go away," says Patricia Devine, M.D., assistant clinical professor of Ob-Gyn at New York-Presbyterian/Columbia Medical Center, in New York City. This may be because practice contractions can be triggered by hunger or dehydration. So eating or drinking something can sometimes quell them.
You can also time true contractions. "When contractions are five to seven minutes apart for at least an hour, with each one just as intense as the last, you're in labor," says Myron Bethel, MD, chief of staff at Good Samaritan Hospital in Los Angeles.
First labors are usually a long process. The earliest pains are known as prodromal, latent, or early labor. This phase can last a day or two, or it can start and then stop. Time your contractions from the beginning of one contraction to the beginning of the next contraction (not to the end). When your contractions are regular and strong, and coming every four to five minutes for one to two hours, you should call your midwife or doctor. (A contraction is considered strong if you can't talk through it.) She will ask you several questions that will determine if it's time to go to the hospital to be examined. Only a vaginal exam can indicate whether your cervix has effaced and dilated. If your cervix is open approximately 4 centimeters (and hopefully effaced), you are in active labor and will be admitted.
If this isn't your first labor, call your doctor when your contractions are 10 to 15 minutes apart. In general, "a second labor tends to be half as long as the first," says Ted Peck, MD, a specialist in high-risk obstetrics at Gundersen Lutheran Medical Center, in La Crosse, Wisconsin, so you have less time to hang out at home. Also consider how quickly your contractions intensified last time. How long did it take you to go from contractions that were 5 minutes apart to the transition phase of labor or to contractions that were only 1-2 minutes apart?
In addition to timing your contractions, consider how far away you are from your birth center or hospital and how dilated your cervix was at your last prenatal visit. You'll also need to consider getting to the hospital sooner if your membranes have ruptured or if you're extremely anxious or in more pain than you think is normal for early labor.
If you are preterm, pregnant with twins or multiples, or have other high-risk conditions, contact your doctor or midwife immediately if you think you might be going into labor. Any pregnant woman who experiences any of the following conditions should also contact her doctor or midwife without delay:
Rupture of membranes (water breaking)
Heavy vaginal bleeding
No movement from baby
Swelling of the face and hands
Intense stomach/abdominal pain
Sudden weight gain (more than four pounds in a week)
Sources: University of Iowa Hospitals and Clinics, Department of Obstetrics and Gynecology; Jane Forester, MD