Being pregnant—especially if it’s your first pregnancy—is like wandering into a whole new frontier with your phone’s map app open only to find out you’ve got spotty service. You’ll get all the information eventually, but it feels like it comes at you in bits and pieces. Case in point: the signs of labor. Maybe your best friend told you she knew she was in labor the second she spotted some blood in her undies. But what about that woman in your prenatal yoga class who said she always knows she’s ready to deliver when she starts vomiting? And aren’t pregnant women in the movies always going into labor with dramatic gushes of amniotic fluid? If all those stories (and over-the-top dramatic scenes) have you confused about what really happens when you go into labor, you’re not alone. The truth is, everyone experiences labor differently, says Mary Fleming, MD, an OB-GYN and attending physician at Einstein Medical Center Montgomery in East Norriton, Pennsylvania. “For some it is a gradual process that occurs over weeks; others may not perceive any discomfort until active labor ensues,” Fleming says. So how will you know when you’re in labor? And what signs of labor mean it’s time to call the doctor? Here’s what the experts have to say.
Signs Your Body Is Getting Ready for Labor
The goal of every pregnancy is to reach labor, that time when your body is readying for delivery, or the actual arrival of baby. For most folks, that happens sometime after the 37th week of pregnancy, which is what doctors call term labor or sometimes full-term labor. That said, labor can happen any time after 20 weeks of pregnancy, says Jimmy Belotte, MD, PhD, interim medical director in the division of general OB-GYN at Montefiore Health System in New York. “When it occurs between 20 weeks and 36 weeks + 6 days, it is referred to as preterm labor.” Just when it will happen is hard to say, Belotte explains, as every pregnancy is as different as the parent and baby involved. But there are signs that your body is getting ready to go into labor.
Signs of Labor: When Baby Drops
With most pregnancies, especially those considered full-term, a baby will “drop” in the uterus. Typically this will happen near the end of the third trimester, Fleming says, as the fetus prepares for the labor process. “The head will begin descending into the pelvis,” Fleming says. “Women will usually feel more fullness and pressure in the pelvis and sometimes in the vaginal area. This process helps to apply pressure to the cervix and is part of the early stages of the labor process.” As a baby drops, the height of the fundus, which is a term a doctor uses to refer to the top of the uterus, will also shift downward, away from the chest. Depending on your body, that “drop” may be visibly apparent to friends and family.
Signs of Labor: Mucus Plug
Another sign your body is readying for labor? You might pass the mucus plug, which is literally a thick chunk (or plug) of mucus that dislodges from the cervix shortly before labor. The plug may be accompanied by pinkish vaginal discharge or spotting, akin to the breakthrough bleeding that can happen when you’re ovulating. Just how long it will take from the time a baby drops or the mucus plug drops into the toilet is hard for doctors to say because these processes can vary widely. But they’re both things to mention to your OB-GYN or midwife, as they’re signs that something is beginning to happen!
Signs of Labor: Cervix Dilation
Your medical practitioner will likely check to see if your cervix has dilated or started to open up, which is yet another sign that the body is preparing for labor, Fleming says. [pullquote align=”center”]You can walk around with a cervix that’s dilated an inch or two for days or even weeks without feeling it or going into full blown labor.[/pullquote] This is not something that can typically be felt—in fact, you can walk around with a cervix that’s dilated an inch or two for days or even weeks without feeling it or going into full blown labor—but a cervical exam will allow your doctor or midwife to get a gauge of whether the cervix is readying for labor and just how much. After 39 weeks, some providers may suggest stripping the membranes of the cervix. The optional process is considered a safe and simple way to induce the body to kickstart labor, if not always effective. “If possible, the provider will use her/his finger to sweep along the inside of the cervix where the cervix and the bag of water/membranes meet,” Fleming says of membrane stripping. “The process may be uncomfortable but usually lasts for 20 seconds or less.” It’s an optional procedure, Fleming says, and it’s one that should only be performed late in the third trimester by a medical professional.
The Sign That Labor Has Started: Contractions
While your body can start prepping for labor weeks (or sometimes months) in advance of the real thing, you won’t be in actual labor until you’ve started contractions, Fleming says. “The definition of labor is consistent contractions that cause cervical change,” she explains. “We instruct women to contact their provider when they start having contractions that they can time, every 5 to 10 minutes over a two-hour time span.” During that phone call, your healthcare provider can assess if it’s time to make a trip to their office or a hospital or whether it’s time for them to come to your home if you’re having a home birth. [pullquote align=”center”]“The contractions have to be strong enough and consistent enough to cause the cervix to open before the diagnosis of labor can be given.” —Mary Fleming, MD[/pullquote] If it’s “go time,” a cervical exam will come next to determine whether the contractions are actually causing cervical dilation, meaning you’re in true labor, or if you’re having Braxton Hicks, a term for false contractions that don’t have any effect on the cervix. “We know it is often frustrating for first-time mothers who have contractions to be told they are not in labor,” Fleming says, “but the contractions have to be strong enough and consistent enough to cause the cervix to open before the diagnosis of labor can be given.”
Wait, what’s a contraction?
Hey, if you’ve never given birth before, you’ve probably never felt a contraction either, so it’s no surprise most people don’t know the difference between a Braxton Hicks contraction and a “real” one. Braxton Hicks contractions can start as early as the first trimester but may only be felt late in the second trimester, according to Belotte. “They are different from the labor contractions because they are sporadic, last longer than regular labor contractions, and tend to not be so painful,” he adds. As for the “real” contractions, there is no one right way to experience contractions. They vary depending on the person feeling them. “Some women will describe contractions as back pain and others as pelvic pressure,” Fleming explains. “Most will feel a tightening across their abdomen that intensifies for 30 seconds and up to one minute and then relaxes.” Mild contractions are typically uncomfortable enough to be noticeable but don’t necessarily interrupt normal activities, while intense contractions can make it difficult to walk or carry on a conversation. “Again, because all women experience pain in a different way, it is normal for some women to experience intense contractions in early labor and for others not to feel much intensity until closer to delivery,” Fleming says.
Isn’t water breaking a sign of labor?
Forget what you’ve seen on TV. Most women do not experience a giant gush of water flowing out between their knees, signaling that they’re suddenly in labor and need to get to the hospital stat. It’s not typical for your water to break at the beginning of labor. In fact, “for most women, their water breaks during labor,” Fleming says. Water can break spontaneously (on its own) or because your healthcare provider breaks it for you with a procedure called artificial rupture of membranes (AROM). If your water does break before labor begins, it may be a big gush. Then again you may simply notice your clothes are wet or wake up to find a clear puddle of fluid in the bed. Water may “break” and leak out slowly over time as well, Fleming says, as the membranes of the amniotic sac do not reseal. “For this reason, liquid will continue to drain from the vagina in small amounts until delivery,” she says.
Early Labor vs. Active Labor
Once your body is revved up and “in labor,” your provider still may say you’re not quite ready to be rolled into the delivery room. Sigh. That’s because labor is broken down into two parts: early labor and active labor. “Early labor starts when regularly recurring, painful labor contractions are felt by the mother, leading to cervical changes including progressive shortening, thinning, and opening (dilatation) of the cervix up to a point of rapid acceleration of the rate of cervical dilatation,” Belotte says. Typically, early labor is the longest phase. It can be just a few hours for some folks. Then again it can go on for days (literally) for others. A mom-to-be is monitored during early labor to determine whether dilation is progressing; the baby’s heartbeat is monitored also to ensure that the baby is healthy and handling the pressure of getting ready for delivery well. It’s during early labor that practitioners typically decide whether a delivery may be done vaginally or require surgical intervention. If the answer is the former, at around 6 centimeters of dilation, active labor typically begins. It’s shorter and faster than early labor, Belotte says, and is associated with the fetus moving lower and lower, while the cervix continues to dilate to 10 centimeters, which is the size needed for vaginal delivery. Active labor is what turns into delivery!