As the due date approaches, almost every twinge raises the same question: is this it? Labour rarely starts the way it does in films. For most women, especially in a first pregnancy, it builds slowly over hours, with signs that come and go before settling into a clear pattern. Knowing what to look for helps you stay calm at home during early labour, arrive at the hospital at the right time, and recognise the situations where you should not wait at all.
A full-term pregnancy is anywhere between 37 and 42 weeks, and only a small proportion of babies arrive on the exact due date. Labour starting a week or two either side of it is normal.
Early signs that labour is getting closer
In the days or weeks before labour, the body prepares. These signs are encouraging but do not mean you need to go to the hospital yet.
- The baby “drops” lower into the pelvis - breathing becomes easier, but you may pass urine more often
- A “show”: a plug of thick mucus, sometimes streaked with pink or brown blood, passed from the cervix
- More frequent Braxton Hicks (practice) contractions, especially in the evening
- Low backache or a period-like heaviness
- Loose stools or an upset stomach
- A burst of energy and an urge to prepare the house, often called nesting
True labour or false labour?
Braxton Hicks contractions tighten the uterus but do not open the cervix. They can be uncomfortable and confusing. The differences are usually clear once you watch the pattern for an hour or two.
- False labour: irregular contractions that do not become closer together; they ease with rest, a warm bath, a change of position or drinking water; usually felt only in the front of the abdomen
- True labour: contractions that come at regular intervals and become longer, stronger and closer together over time; they continue whatever you do; often start in the back and wrap around to the front
- In true labour, you usually cannot talk or walk comfortably through a contraction as it builds
Timing contractions: the 5-1-1 rule
Time each contraction from the start of one to the start of the next, and note how long each one lasts. A phone app or a simple notebook works well. For a first baby, a commonly used guide for when to come in is the 5-1-1 pattern:
- Contractions every 5 minutes
- Each lasting about 1 minute
- For at least 1 hour
If you have had a baby before, labour is often quicker, so come in earlier - when contractions are regular and about every 10 minutes, or as advised by your doctor. Also come in earlier if you live far from the hospital, travel in heavy traffic, or had a fast labour last time.
In early labour at home, rest when you can, eat light meals such as khichdi, curd rice or toast, drink water and fresh juices, walk around between contractions, take a warm shower, and empty your bladder regularly. Breathing slowly through contractions helps.
Waters breaking
The bag of fluid around the baby can break before or during labour. It may be a sudden gush, or a slow trickle that is easy to confuse with urine or discharge. Amniotic fluid is usually clear or pale straw-coloured and keeps leaking, particularly when you stand up.
- Put on a pad (not a tampon) and note the time, the colour and the amount
- Do not have a bath or intercourse once the waters have broken
- Call the hospital - you will usually be asked to come in for a check, even if you have no contractions
- Green, brown or bloodstained fluid, or a foul smell, means come in immediately
If the waters break at term without contractions, most women go into labour on their own within 24 hours. Because the chance of infection rises the longer the membranes are open, you will be offered either induction of labour or a short period of waiting with monitoring. Green or brown fluid may mean the baby has passed meconium, which can be a sign of stress and needs continuous monitoring.
Go to hospital immediately if you have
Do not wait for a contraction pattern if you have any of these: vaginal bleeding more than a light show; green or brown fluid; reduced or no baby movements; constant severe abdominal pain; a severe headache, blurred vision or swelling of the face and hands; fever or shivering; contractions or leaking fluid before 37 weeks; or if you feel the umbilical cord in the vagina. Come to the hospital straight away.
Women who have had a previous caesarean, women planning a VBAC, women with twins, high blood pressure or diabetes, and women whose baby is breech should come in as soon as contractions start or the waters break, rather than waiting for the 5-1-1 pattern.
Prepare in advance
- Pack your hospital bag by 36 weeks: antenatal file and all scan reports, ID, loose clothes, sanitary pads, baby clothes, a cap, socks and a soft cloth or towel
- Save the hospital phone numbers in your phone and on paper for family members
- Plan transport and the route, including a back-up if your partner is not at home
- Discuss your preferences for pain relief and a birth companion at a visit before labour
- Keep your blood group report handy
When you arrive, the team will check your blood pressure, pulse and temperature, listen to the baby’s heartbeat or start a CTG, feel your abdomen, and usually do an internal examination to see how far the cervix has opened. If you are in early labour and everything is normal, you may be advised to walk around, or occasionally to go home and return later. Active labour usually begins once the cervix is about 4 to 6 cm open.
When to see a doctor
If you are not sure whether you are in labour, call - it is always better to be checked and sent home than to stay at home with a problem. Come in immediately with any of the warning signs above. Divine Women’s Hospital, Gota provides labour and emergency obstetric care 24 × 7, with Dr. Devang Patel and the team, an operation theatre and newborn care available for planned and unplanned births.
Related care: Pregnancy care and delivery
More patient guides
- The NT scan at 11–14 weeks: what it checks and how to prepare
- High blood pressure in pregnancy: the warning signs you should not wait on
- Expecting twins? Why “do they share a placenta?” is the first question
- NIPT or NT scan: which test do you need, and can one replace the other?
- Pregnancy after 35: fertility, risks and how to plan a healthy pregnancy
This guide is general information for patients and does not replace a consultation with your own doctor.