It's time! Antenatal expert discusses the signs of labour

The long awaited moment is finally here. Midwife and antenatal expert, Grace Strange talks us through the signs of labour. 

We’ve all seen the movies where the pregnant woman’s waters break on the side of the road and suddenly everyone is panicking – getting her in the taxi to race her to the hospital where she arrives, sweaty and panting and all hell has broken loose in a matter of minutes – but is it really like that? I can tell you now, for most people going into labour is really not this dramatic! You will probably have a few subtle early signs of labour, probably noted in hindsight, and a slow increase in intensity of contractions over many hours. It's really not as chaotic and overwhelming as the movies make it out to be, I promise!

The end of your pregnancy will be filled with a wonderful sense of anticipation and excitement but it can also be long, uncomfortable and tiring. You’ve been waiting nine months for your baby to finally arrive and their ‘birthday’ is in sight. So what are some signs that you could go into labour soon and how will you know you are actually in labour?

Let's start by exploring some of the more subtle early signs.

SIGNS THAT YOU MIGHT GO INTO LABOUR

Some early signs could include the baby ‘dropping’, your cervix beginning to dilate,  you becoming increasingly more uncomfortable, loose bowels and that fatigue and nesting instinct really kicking in.

The baby engaging is the more technical term used to describe what we would commonly know as ‘dropping’ but basically means that the present part of the baby (eg head, or bottom if breech) has moved down into the pelvis in preparation for birth. This usually happens around 34-38 weeks with first babies, but in subsequent pregnancies can be much later or not happen until you are in labour.

Some signs that your baby has engaged could be that you no longer feel as breathless due to the pressure being taken off your diaphragm as the baby has moved down.

You feel more pressure in your pelvis and lower back, which means you need to pee more, you get that glamourous pregnancy waddle and your belly bump might look much lower, which friends and family will no doubt comment on. Engagement is not necessarily a sign of labour, particularly with your first baby as your baby could engage at say, 34 weeks, and then nothing happens for weeks!

For some women their cervix will start to dilate (open) and efface (thin out) in the days or weeks before labour starts. This won’t be painful and you probably won't even know it's happening. You will only know if your Lead Maternity Carer (LMC) does an internal exam or a ‘stretch and sweep’ for example. It is not necessarily a sign that you are about to go into labour but it is a sign that your body is starting to get ready.

As previously mentioned, those last few weeks of pregnancy can be incredibly uncomfortable. You may notice some cramping and pain in your lower back and groin as labour nears. A sign labour could be quite close is your pelvis and joints all over your body may surprisingly feel a little less tight and more relaxed. This is thanks to the pregnancy hormone relaxin that is responsible for loosening up your ligaments to allow your baby to grow and now as your body is preparing for labour and birth your muscles and joints are stretching and shifting to allow space for your baby to be born.

Just as your ligaments, muscles and joints are relaxing and loosening up in preparation for birth, so too are other parts of your body, including your bowels, which could lead to some pre-labour diarrhea. There is some suggestion that the emptying of your bowels, either prior to or during labour, is nature's way of making more room for your baby to emerge. As unpleasant as it is, it is normal and very common. If you are worried, call your LMC.

With your beautiful, generous-sized belly, uncomfortable joints, reflux and compressed bladder, getting a good night’s sleep at the end of pregnancy is but a faraway dream.

Even if you are lucky enough to be getting some good sleep, the fatigue as you near your baby’s birth day can be extreme and a sign that labour is near. Listen to your body, rest as much as possible, take naps during the day and get your LMC to check your bloods to make sure your iron levels are good before you head into labour.

In contrast, you might feel a sudden burst of energy to clean and organise everything in sight, this is known as ‘nesting’. Mothers of many species, including birds (hence the term ‘nesting’), go through a period of intense activity in preparation for the birth of their offspring. This is completely normal and will help ease your stress while providing you with some light exercise. But don't overdo it, listen to your body and rest as needed.

Remember that these are early signs that you might go into labour soon. Some people will have them, others won't, so don't read too much into them.

THE 'BLOODY SHOW’

Otherwise known as the mucous plug, sits inside the cervix to seal it shut for the duration of pregnancy. It is a mixture of clear mucous that’s often blood-stained, stringy and snot-like in texture. A bloody show is a sign that the cervix is starting to move and maybe open as your body prepares for labour, but is not definitely a sign of imminent labour. For some women it comes away weeks before labour, while others never even notice it, as it comes away during labour. Check with your LMC if they want to be notified if your mucous plug comes away.

WATERS BREAKING

The waters breaking is most commonly assumed to be a sign of imminent labour, but that is not always the case. Contrary to the dramatic movie example, Te Whatu Ora (The NZ Ministry of Health) reports that the waters of only about 10% of women at full term (37 – 42 weeks pregnant) will break before they go into labour. Of those 10%, around 70-85% will then go into spontaneous labour within the following 24-48 hours.

Your waters breaking is the breaking of the amniotic sac that surrounds the baby, allowing the amniotic fluid to flow out. Depending on where the amniotic sac breaks will depend on the amount and flow of amniotic fluid. For example if the bulging waters in front of the baby’s head break (assuming baby is head down), these are known as the forewaters and you will likely have a sudden gush of fluid that wets through your pants. If the hind waters break, this is where the amniotic sac breaks somewhere around the baby’s body, the amniotic fluid will likely trickle out. You may be wondering if you are in fact peeing yourself! Either way if you think your waters have broken then pop a pad in your undies and call your LMC.

The amniotic sac has provided a safe cocoon for your baby to grow in over the previous 9 months, but once it has been broken, there is no longer a sterile environment around your baby and thus there are increased risks of infection. If you have risk factors, such as testing positive for GBS (Group B Strep) in pregnancy, or any signs of infection, such as fever or a high maternal heart rate, or if there is meconium present in the amniotic fluid, you may be advised by your LMC to go to hospital to be immediately induced and start IV antibiotics.

If you have no risk factors, you may be allowed to wait at home for 18-24 hours to go into spontaneous labour on your own, but once you hit that time limit you may be advised to go to hospital to start a medical induction.

So, are your waters breaking a sign of labour? Maybe! When they do break, you’ll either go into labour on your own or be induced within 24 hours.

CONTRACTIONS

Contractions are your only sure-fire sign that you are in fact in labour. They might feel like period pains that are across your pelvis, back and abdomen to begin with and then increase in length, strength and frequency until they reach a consistent pattern (for most people). Some people also describe them as uncomfortable waves or intense pressure.

Labour pains will usually start off like period pain, a dull cramping in your pelvis or lower back pain.

The pain will come and go in an irregular pattern and this is called ‘early labour’. You may, for example, have a contraction for 30 seconds then a 5 minute break then another contraction for 60 seconds and a 14 minute break. There is no pattern or regularity to them, they are all over the show! On average, this stage lasts around 12 hours but for some women it can last days as it stops and starts, while others skip this part of labour altogether as their body does it at the end of pregnancy without them noticing. What is happening in early labour is that your cervix, that is usually a few centimeters long, closed and thick, is shortening and thinning out, known as effacement, and then starting to dilate to about 2-3 cms.

Early labour will then become ‘active labour’ when, for most women, contractions settle into some sort of regular, consistent pattern and contractions increase in their intensity over time. For example you might have contractions that last for 60-90 seconds, that occur every 3-5 minutes. The key to knowing if you are in active labour is that the contractions are increasing in intensity over time. For example, initially you might be able to talk and hold a conversation through a contraction but as time goes on and your labour progresses, the intensity of the contractions will mean that you won't be able to do this, you will be concentrating on breathing and using all your coping techniques to get through the contraction.

Keep in mind that every woman is different and every labour is different; even subsequent labours for the same woman can vary hugely. For example your first labour might have 24 hours of early labour at home while the next labour might miss that stage altogether. One woman might have a long early labour with inconsistent contractions for 16 hours, while another might be 4 cm dilated and not even be in labour (true story!).

Let me just reassure you though, you WILL know when you’re in labour. Contractions can’t be ignored and your LMC will be happy to guide you. Make sure you discuss the signs of labour with them before it happens, and at what stage they’d want you to call them. Your LMC will be able to ascertain whether or not your baby is on the way.

Lastly, try to embrace the joy of this experience. The massive element of surprise is in the mystery of not knowing when the big day will arrive. Good luck!

Grace Strange is a midwife and creator of Antenatal Co. – independent antenatal classes that were born out of a desire to ensure parents have access to the very best antenatal education and head into labour, birth and beyond fully prepared. Find out more at antenatal.co.nz or on Instagram @antenatalco.

Photography: Catherine Smith